OBJECTIVETo study technique and clinical therapeutic effects of internal fixation with three-column plates for the treatment of complex tibial plateau fractures through antero-midline and postero-medial approaches.

METHODSFrom January 2010 to December 2012, 28 patients with complex tibial plateau fractures were treated with internal fixation using three-column plates through antero-midline and postero-medial approaches. There were 17 males and 11 females, with an average age of 45.3 years old (ranged, 28 to 64 years old). Twelve patients had injuries in the left side and 16 patients had injuries in the right side. According to Schatzker classification, 12 patients were type V, 16 patients were type VI. According to three-column classification, all the patients had injuries of lateral, medial and posterior columns. The mean interval from injury to operation was 9.4 days (ranged, 6 to 15 days). The main clinical symptoms were knee joint swelling, deformity and limitation of motion before operation. The X-ray and CT showed all patients had complex tibial plateau fractures, which involved in the lateral, medial and posterior columns. The therapeutic effects were evaluated by fracture healing time, hospital for special surgery knee score (HSS) at one year after operation. The indexes such as tibial plateau-tibial shaft angle (TPA), posterior slope angle (PA) and femoral-tibial angle (FfA) were compared between immediate postoperation and one year after operation.

RESULTSAll incisions primarily healed without postoperative complications such as infection and cutaneous necrosis. All the patients were followed up, and the duration ranged from 12 to 24 months, with a mean of 18.1 months. The bone union time ranged from 5 to 10 months (mean, 7.8 months) after operation. Knee joint swelling and pain disappeared after bony union, and joint function completely recovered. The results of hospital for special surgery knee score (HSS) was 27.81 ± 2.17 in pain, 19.52 ± 2.05 in function,15.82 ± 1.73 in passive range of motion, 8.51 ± 1.32 in muscle strength, 8.33 ± 1.08 in flexion deformity, 9.36 ± 0.52 in joint stability, and the total mean score was 89.35 ± 3.19. According to results of HSS, 20 patients got an excellent result, 5 good,2 fair and 1 poor. There were no significant differences in tibial plateau-tibial shaft angle (TPA), posterior slope angle (PA) and femoral-tibial angle (FTA) between immediate postoperation and one year after operation.

CONCLUSIONThree-column plate internal fixation for the treatment of complex tibial plateau fractures through antero-midline and posteromedial approaches is effective to achieve anatomic reduction,rigid internal fixation and early functional exercise.

Adult ; Bone Plates ; Female ; Follow-Up Studies ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Middle Aged ; Tibial Fractures ; physiopathology ; surgery

A 10-year-old boy presented with a 3-year history of erythematous flat keratotic papules and brown-yellow, nail-like prominent keratotic plaques all over the body surface. Dermatological examination showed verrucous or nail-like prominence over multiple erythematous keratotic plaques on the head, face,trunk and limbs. The lesions, most of which confluenced, were covered with brown-yellow and greasy crusts,and gave a porcupine-like appearance. Skin biopsy of lesions from the back revealed epidermal hyperkeratosis,focal columnar parakeratosis, acanthosis, few acantholytic and dyskeratotic cells in stratum corneum, irregular upward proliferation of dermal papilla cells, and a superficial perivascular lymphocytic infiltration. A diagnosis of ichthyosis hystrix was established based on the histopathological findings. The boy was treated with oral acitretin and topical 0.1% acitretin cream for 8 years. The initial and maximum dose of oral acitretin was 0.5 mg·kg-1·d-1 and 1 mg·kg-1·d-1, respectively. Liver and kidney function, body height and weight were examined during the treatment, and no side effect was observed except for skin xerosis.

Objective To evaluate the effectiveness of endovascular deployment of metallic Z-type self- expandable stents in treating the patients with inferior vena eava(IVC)obstruction caused by hepatic malignant tumour.Methods One hundred and fifty six patients with IVC obstruction due to malignant compression were enrolled.Venography was performed via femoral vein before and after metallic Z-type self-expandable stent deployment across the stenotic segment of IVC.The diameter of stenotic segment,collateral vessels,venous pressures and the scores of patients IVC syndrome were compared before and after stent placement.Results One hundred and seventy nine stents were implanted in 156 patients successfully.The average obstructive length of IVC was(6.1?2.2)cm.The pressure gradient of stenotie segments of IVC declined from(2.1?0.5)kPa to (0.5?0.11)kPa.The diameters of stenotic segment of IVC increased from(0.33?0.11 )cm to(1.6?0.4) cm.After operations,the main clinical symptoms and physical signs relieved quickly.During 2～24 month follow-up,the pateney of IVC stents reached 86.7%.Conclusion Endovascular deployment of metallic Z-type self-expandable stent is an effective palliative treatment for patients with malignant obstruction of IVC.

Objective To analyze the key factors on long-term effect for comprehensive interventional therapy of primary liver cancer.Methods The clinical data,therapeutic protocols and follow-up of 56 patients with primary liver cancer survived for more than 5 years after comprehensive interventional therapy were analyzed retrospectively.Results Before TACE,20 patients were in clinical stageⅠ,35 were in stageⅡand one was in stageⅢ,including hepatic function of grade A(36 cases),grade B(20 cases),and grade C (0 case).The tumor patterns were consisted of mononodular type(32 cases),multinodular type(24 cases),and diffuse type(0 cases).The diameter of tumor demonstrated less than 3 cm(10 cases),3-5 cm(20 cases), 5-10 cm(19 cases)and more than 10 cm(7 cases).Thirty-three cases(58.9%)were treated by only TACE for the original lesions,while 23 cases(41.1%)were treated by TACE combined other treatment including TACE combined PEt(11 cases),TACE combined RFA(4 eases),TACE combined radiotherapy(one case),and TACE combinedⅡ-staged resection(7 cases).During follow-up,24 patients with hepatic recurrence and 17 cases of distal metastasis were treated by TACE and other anti-tumor treatment.Complications after interventional therapy in 20 cases were also treated.All cases survived for more than 5 years after interventional therapy including 3 more than 10 years.Conclusions Tumor factors,liver function, standardized TACE,combination of TACE with other anti-tumor therapy,treatment of hepatic recurrence and distal metastasis and complications are the key points to improve the long-term survival rate for primary liver cancer treated by comprehensive interventional therapy.

Objective To explore the effect of web problem-based learning in electrocardiography (ECG) teaching.Methods 100 clinical medical students from Grade 2014 were randomly selected and divided into two groups,with 50 in each.The control group received traditional methods in ECG teaching,while the WPBL teaching method was conducted in experimental group.The effect of ECG teaching in two groups were evaluated and analyzed by test scores and questionnaire survey.Continuous variables were expressed as mean ± standard deviation and were compared by t-test.Categorical variables were expressed as counts and percentages.Counting data were test by Chi-square.Results Comparing with control group,students in the experimental group performed better on independent learning capability,interesting of learning ECG,ability to analyze and solve problems,team cooperation,self-presentation and presentation skills (P＜0.05).The average experimental score in experimental group was higher than that in control group [(32.91 ± 3.56) vs.(27.38 ± 4.63),P＜0.05].There were no significant differences of theoretical scores between the two groups [(54.16 ± 3.87) vs.(52.84 ± 4.56),P＞0.05].Conclusion WPBL teaching could improve medical students' interest in electrocardiogram learning and cultivates their ability of active learning and problem solving,which is worthy of promotion.

OBJECTIVETo study the expressions of cystathionine-beta-synthase (CBS) and cystathionine-gamma-lyase (CSE) in the corpus cavernosum smooth muscle of castrated rats and their roles in erectile dysfunction after castration.

METHODSWe randomly assigned 40 eight-week-old male SD rats to groups A (2-week sham-operation), B (4-week sham-operation), C (2-week castration) and D (4-week castration). We determined the level of serum testosterone (T) and the expressions of CBS and CSE in the corpus cavernosum smooth muscle of the rats after operation using immunohistochemistry and RT-PCR.

RESULTSThe T level was significantly decreased in groups C ([11.85 +/- 6.73] nmol/L) and D ([1.96 +/- 1.23] nmol/L) as compared with A ([89.65 +/- 17.13] nmol/L) and B ([106.75 +/- 19.68] nmol/L) (P < 0.05). CBS and CSE were expressed in all groups of rats, but the relative expressions of CBS and CSE mRNA were significantly lower in groups C (0.93 +/- 0.14 and 0.87 +/- 0.20) and D (0.79 +/- 0.17 and 0.71 +/- 0.12) than in A (2.13 +/- 0.65 and 1.93 +/- 0.15) and B (2.07 +/- 0.53 and 1.89 +/- 0.45) (P < 0. 05), so were the optical density values (IA) of the CBS and CSE proteins, 130.35 +/- 23.56 and 93.56 +/- 36.64 in group C and 80.29 +/- 29.65 and 58.56 +/- 19.95 in group D, as compared with 310.57 +/- 130.56 and 269.56 +/- 116.76 in group A and 349.68 +/-112.35 and 298.35 +/- 100.76 in group B (P < 0.05). The androgen level was positively correlated with the expressions of CBS and CSE in the corpus cavernosum smooth muscle of the rats.

CONCLUSIONAndrogen regulates erectile function via the expressions of CBS and CSE.

Animals ; Cystathionine beta-Synthase ; metabolism ; Cystathionine gamma-Lyase ; metabolism ; Male ; Muscle, Smooth ; enzymology ; Orchiectomy ; Penis ; enzymology ; Rats ; Rats, Sprague-Dawley ; Testosterone ; blood

OBJECTIVETo investigate the value of serum estradiol increment and serum estradiol/follicles on the day of hCG administration in predicting the clinical outcomes of in vitro fertilization-embryo transfer (IVF-ET).

METHODSA retrospective analysis of the IVF-ET data was conducted involving 121 patients who received a long gonadotrophin-releasing hormone agonist (GnRHa) protocol. According to the increment of serum estradiol on the day of hCG administration (relative to the level on the day before hCG administration), the patients were divided into 3 groups (A1, A2 and A3) with a increment ratio below 30%, between 30% and 50%, and over 50%, respectively. In addition, according to the ratio of serum estradiol level on hCG day to mature follicle (diameter ≥ 14 mm) number, these patients were divided into three groups (B1, B2 and B3) with the ratio below 250 pg/ml, between 250 and 350 gp/ml, and over 350 pg/ml, respectively. The hormonal characteristics and clinical outcomes of the IVF-ET cycles were analyzed comparatively.

RESULTSBoth the clinical pregnancy rate (71.05%) and embryo implantation rate (52.63%) were significantly higher in group A3 than in groups A1 and A2 (P<0.05). The best clinical pregnancy rate (67.86%) and embryo implantation rate (49.14%) were significantly higher in group B2 than in groups B1 and B3 (P<0.05).

CONCLUSIONThe variation of serum estradiol shows an important impact on the clinical outcomes of IVF-ET in patients receiving long GnRH-a protocol. Favorable outcomes can be expected with a hCG day serum estradiol increment ratio above 50% and E(2)/follicle ratio between 250 and 350 pg/ml.

Embryo Transfer ; Estradiol ; blood ; Female ; Fertility Agents, Female ; administration & dosage ; Fertilization in Vitro ; Gonadotropin-Releasing Hormone ; administration & dosage ; agonists ; Humans ; Pregnancy ; Pregnancy Rate ; Retrospective Studies ; Treatment Outcome

Carcinoma, Hepatocellular ; complications ; drug therapy ; pathology ; Chemoembolization, Therapeutic ; methods ; Female ; Humans ; Liver Neoplasms ; complications ; drug therapy ; pathology ; Male ; Neoplastic Cells, Circulating ; Portal Vein ; pathology ; Stents ; Venous Thrombosis ; complications ; pathology

OBJECTIVETo investigate the molecular characteristics of noroviruses detected in Beijing.

METHODSFrom January to March 2007, cases from both outbreaks and sporadic episodes of acute nonbacterial gastroenteritis were investigated in Beijing, and the fecal specimens of the patients were collected. Noroviruses were detected by a reverse transcription polymerase chain reaction (RT-PCR), and then the PCR products were cloned and sequenced.

RESULTSA total of 27 positive cases were identified as caused by noroviruses among the 38 patients with acute viral gastroenteritis, and four PCR products were randomly selected for further studies on sequencing. When comparing to the nucleotide sequences of norovirus reference strains from GenBank, the highest homology was found between the four isolates and the norovirus GII/4 strains. The four strains isolated from Beijing were almost identical to the GII/4 variants that causing epidemics in the Netherlands and in Japan with the homology of 97.8%-98.5% and 95.2%-95.9%, respectively. Phylogenetic analysis revealed that the four isolates were located at the same branch as the norovirus GII/4 variants in Netherlands and Japan.

CONCLUSIONNew norovirus GII/4 variants were found in Beijing, and data from sequence analysis showed that the four isolates and the epidemic strains isolated from both the Netherlands and Japan in 2006 belonged to the same group of norovirus GII/4.

Amino Acid Sequence ; Caliciviridae Infections ; epidemiology ; virology ; China ; epidemiology ; Gastroenteritis ; virology ; Humans ; Molecular Sequence Data ; Norovirus ; enzymology ; Phylogeny ; RNA-Directed DNA Polymerase ; chemistry ; classification ; genetics ; Reverse Transcriptase Polymerase Chain Reaction ; Sequence Homology, Amino Acid ; Viral Proteins ; chemistry ; classification ; genetics

OBJECTIVETo study the features of blood supply and results of transarterial infusion and embolization in spinal metastases.

METHODSForty-one patients with spinal metastasis received transarterial infusion and embolization between March 2001 and June 2008. The inclusion criteria were: The metastatic lesion caused back pain; The metastatic lesion involved vertebra at or below T3 level. There were 29 males and 12 females with a mean age of 56.0 (33 - 71) years. Epirubicin was used as the chemotherapeutic agent. Lipoid Ultra-Fluid, Contour SE or gelfoam particles were used as embolitic material.

RESULTSThe technical success of therapy was achieved in 52 vertebrae (100%) including 14 thoracic, 35 lumbar and 3 sacral vertebrae. 105 arteries were used for infusion and embolization (16 intercostal arteries, 78 lumbar arteries, 4 iliolumbar arteries, 4 branches of iliac arteries, and 3 median sacral arteries). Lipoid Ultra-Fluid (2 - 8 ml) was used in 15, Contour SE (300 approximately 500 microm, 20 - 100 mg) in 20, and gelfoam particles in 33 arteries. Three days after treatment, complete pain relief (CR) was achieved in 17 patients, partial pain relief (PR) in 20, and moderate pain relief (MR) in 4, with an effective rate of 90.2%. Two weeks after treatment, CR was achieved in 17 patients, PR in 21, and MR in 3, with an effective rate of 92.7%. No adverse nervous system effect occurred. 16 patients developed swelling and pain of normal tissues which were alleviated after symptomatic treatment.

CONCLUSIONTransarterial infusion and embolization is an effective therapy in relieving pain resulting from spinal metastases.

Adult ; Aged ; Antibiotics, Antineoplastic ; administration & dosage ; Back Pain ; etiology ; therapy ; Breast Neoplasms ; pathology ; Chemoembolization, Therapeutic ; Combined Modality Therapy ; Embolization, Therapeutic ; methods ; Epirubicin ; administration & dosage ; Female ; Gelatin Sponge, Absorbable ; therapeutic use ; Humans ; Iodized Oil ; therapeutic use ; Liver Neoplasms ; pathology ; Lung Neoplasms ; pathology ; Male ; Middle Aged ; Remission Induction ; Spinal Neoplasms ; blood supply ; secondary ; therapy