OBJECTIVETo explore effective approaches of treating elderly patients with distal tibiofibular fractures.

METHODSFrom August 2008 to October 2012,175 elderly patients with distal tibiofibular fractures were treated with locking compression plate (LCP) through anterior tibial. There were 112 males and 63 females with an average of 71.3 (ranged 60 to 83) years old. Of them,89 cases were treated by anterior tibial tension reduced incision with LCP,including 62 males and 27 females with a mean age of (71.8 +/- 6.4) years old. Eighty-six patients were treated by distal tibial incision with LCP,including 58 males and 28 females with a mean age of (70.3 +/- 6.7) years old. Swelling time, operation time, intraoperative blood loss, hospital stay, healing time, complications and AOFAS scores were compared between two groups after operation.

RESULTSSwelling time in anterior tension reduced incision with LCP and distal tibial incision with LCP was (5.6 +/- 1.3) and (9.7 +/- 2.1) days, healing time was (4.2 +/- 1.4) and (5.4 +/- 1.9) months,and complications were found 3 in tension reduced incision and 10 in distak tibial incision respectively;and all data shown statistically significant differences between two groups (P < 0.05). At 12 months after operation,AOFAS score was 89.0 +/- 9.7, 87.9 +/- 9.4; and there was no statistically significant difference between two groups (P > 0.05).

CONCLUSIONTension reduced incision through anterior tibial combined with locking compression plate fixation in treating elderly patients with distal tibiofibular fractures can provide good clinical effects with quick fracture healing and low complications.

Adult ; Aged ; Aged, 80 and over ; Bone Plates ; Female ; Fibula ; injuries ; surgery ; Fracture Fixation, Internal ; instrumentation ; methods ; Humans ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; Tibia ; injuries ; surgery ; Tibial Fractures ; surgery ; Treatment Outcome

Objective To evaluate the efficacy of the treatment of hilar biliary malignant obstruc tion with multiple stent drainage.Methods One hundred and twenty-seven patients with malignant biliary hilar obstruction were enrolled.The obstructions at the common hepatic duct within less than 1 cm to the junction of the left and the right hepatic duct were found in 66 cases,at the proximal common hepatic duct and the left and the right hepatic ducts in 45 cases,at the right hepatic duct in 5 cases and at the both left and right hepatic duets in 11 cases.Sixty-six patients received stent placement through the right biliary ducts and the common bile duct by puncturing the right mid-axillary line.The other 37 patients received 2 stents placement (disposed"Y"style) through the left and the right hepatic duct punc turing routway.Seven patients received 2 stents placement (disposed"┌"style) through the right hepatic duct and the common bile duct with a stent placed between the left and the right hepatic duct.Three patients had right hepatic duct stent placed first,followed by right hepatic duct and common hepatic duct stent. Twelve patients had stents placed in the right hepatic duct with external drainage from the left hepatic duct. Two patients had multiple strictures at the right hepatic duct,who got multiple external drainages.The total serum bilirubin levels were measured pre-and post-operatively.Results One hundred and twenty-seven patients with bi[iary obstraction had internal stents placed for drainage.The average total bilirubin levels among 121 patients were (283.4?175.4 )?mol/L pre-operation and (63.2?11.8)?mol/L post-operation (P

BACKGROUND: This study aimed to observe the effect of recruitment maneuver (RM) and post-RM ventilation at different tidal volume on lung vascular diastole endothelial function in rats with acute lung injury (ALI). METHODS: A ALI rat model was produced by intravenous infusion of lipopolysaccharide (6 mg/kg). Twenty-five rats were randomly divided into five groups: control group (n=5), ALI group (n=5), low tidal volume group (LV group, VT 6 mL/kg, n=5), sustained inflation (SI) with low tidal volume group (SI+LV group, VT 6 mL/kg, n=5), and SI with moderate tidal volume group (SI+MV group, VT 12 mL/kg, n=5). RM was performed with SI, airway pressure 30 cmH2O for 30 seconds, and positive end-expiratory pressure (PEEP) was set to 5 cmH2O. Lung tissue was taken after 5 hours of mechanical ventilation. Mean arterial blood pressure (MAP) was monitored during the experiment. Endothelin-1 (ET-1), endothelial nitricoxide synthase (eNOS), Ach-induced endothelium-dependent relaxation response of isolated pulmonary artery rings were determined at 5 hours. RESULTS: LPS increased ET-1 level, decreased the expression of eNOS in lung tissue, impaired the Ach-induced endothelium-dependent relaxation response in the pulmonary artery, without obvious effect on systemic hemodynamics. SI+LV significantly reduced LPS-induced elevation of ET-1 level, increased the expression of eNOS, significantly improved endothelial dysfunction, and improved the dysfunction of endothelium-dependent relaxation in the pulmonary artery. CONCLUSIONS: RM with a high or low tidal volume ventilation could improve the lung vascular endothelial function of rats with acute lung injury, and RM with low tidal volume ventilation could lower significantly the injury of lung vascular endothelial diastole function in rats with acute lung injury.

OBJECTIVETo investigate the early diagnosis and treatment for trauma around the knee with popliteal vascular injury.

METHODSA retrospective analysis was employed to analyze the clinical data from 15 patients (9 males and 6 females were with a mean age of 39.2 years old,ranging from 26 to 62 years old) with fracture or dislocation around the knee with popliteal vascular injury from January 2007 to January 2013. Combined with clinical symptoms and signs, oxygen saturation monitors, color ultrasound, DSA angiography and interventional surgery were used to determine the vascular injury. The knee fracture and dislocation were fixed with hybrid external fixation and plate-screw fixation, respectively. Then, the blood circulation was reconstructed by thrombectomy, repair and autologous vein graft for individual injured vascular. The average total operation time, average hospitalization days, predictive salvage index (PSI), average blood transfusion amount, average medical expenses and infection cases were recorded to determine the effect of early diagnosis and treatment.

RESULTSThere was one patient with death, 8 patients with amputation, and 6 patients with successful repair surgery for popliteal artery, anterior tibial and posterior tibial arteries. These six patients with surviving limbs were followed up for an average of 28.3 months (ranged, 12 to 60 months). Among the 6 successful patients, the joint function of 4 patients was good and excellent.

CONCLUSIONThe trauma around the knee with popliteal vascular injury is characterized by complex and serious injury, easy misdiagnosis and loss diagnosis, poor prognosis and high risk of amputation. The early diagnosis of trauma around the knee with popliteal vascular injury should depend on the mechanism of trauma, local anatomical characteristics of injury site, clinical presentations and appropriate auxiliary examinations. The appropriate indications for limb salvage and amputation should be used to achieve more effective clinical results.

Adult ; Early Diagnosis ; Female ; Humans ; Knee Injuries ; diagnosis ; surgery ; Male ; Middle Aged ; Popliteal Artery ; injuries ; surgery ; Retrospective Studies

OBJECTIVETo investigate the differentiation of bone marrow stem cells in transplanted livers and its impact on the long-term survival of rats with orthotopic liver transplantation.

METHODSTwenty-four female recipient rats with orthotopic liver transplantation were randomized into blank-control group, D-hanks solution group, bone marrow stem cells group with postoperative infusion of stem cells, and the pathological changes of the liver grafts and survival time of the rats were observed. The differentiation of the bone marrow stem cells were assessed 60 days after transplantation using in situ hybridization histochemistry for Sry gene and alpha-fetoprotein (AFP) immunohistochemistry.

RESULTSIn rats with postoperative infusion of bone marrow stem cells through the portal vein, the median long-term graft survival time exceeded 180 days, significantly longer than that in the other two groups (P<0.05), and no obvious evidence of acute rejection was observed with positive Sry expression and AFP expression.

CONCLUSIONInfusion of bone marrow stem cells through the portal vein following liver transplantation may alleviate acute graft rejection and promote long-term liver graft survival and AFP expression.

Animals ; Cell Differentiation ; Female ; Graft Rejection ; prevention & control ; Graft Survival ; Hematopoietic Stem Cells ; cytology ; Liver ; pathology ; Liver Transplantation ; Portal Vein ; Rats ; Rats, Wistar

OBJECTIVETo investigate the autophagy in human bone marrow mesenchymal stem cells (hBMMSC) exposed to irradiation.

METHODSThe apoptosis and necrosis rate were assessed by Annexin V and propidium (PI) staining in hBMMSC at 4h after irradiated with X-ray at 0, 2, 4, 8 and 10 Gy. The autophagy was observed by transmission electron microscopy. The mRNA expression of Beclin1 and microtubule-associated protein 1 light chain 3 (MAPLC3 or LC3) was analyzed by RT-PCR in hBMMSC at 4h after X-ray irradiation at 0, 8 and 10 Gy.

RESULTSThe apoptosis rate of hBMMSC was markedly decreased while the necrosis and death rate were slowly increased with the increase of irradiation dose when under 8 Gy. The apoptosis rate was significantly increased and reached a peak while the necrosis and whole death rate were obviously increased when irradiated with 10 Gy X-rays. In addition, the change of apoptosis rate was more significant than that of necrosis rate. By electron microscopy, a mass of autophagic vacuoles (autophagosome and autolysosome) were observed in irradiation and positive control groups, but were only occasionally seen in normal control group. The proportion of hBMMSC with autophagic vacuoles in 8 Gy irradiation group was higher than that in 10 Gy one. The mRNA expression of Beclin1 and LC3 in irradiation groups and positive control group was significantly higher than in normal control group, and so did in 8 Gy irradiation group than that in 10 Gy group.

CONCLUSIONIrradiation may induce the autophagy in hBMMSC, and autophagy could protect hBMMSC from irradiation injury in a certain dose range.

Apoptosis ; radiation effects ; Autophagy ; radiation effects ; Bone Marrow Cells ; radiation effects ; Cell Line ; Humans ; Mesenchymal Stromal Cells ; radiation effects ; X-Rays

AIM:To investigate the effects of evodiamine on the growth and apoptosis of human hepatocellular carcinoma Huh7 cells,and to illustrate the molecular mechanism that evodiamine enhances antitumor activity of tumors nec -rosis factor-related apoptosis-inducing ligand(TRAIL)in Huh7 cells.METHODS: The cell viability was measured by MTT assay.The cell cycle distribution was analyzed by flow cytometry.The apoptosis rate was determined by TUNEL stai-ning.The protein levels of cell cycle-and apoptosis-related proteins were detected by Western blot analysis.RESULTS:Treatment of Huh7 cells with evodiamine reduced the cell viability(P<0.05).Evodiamine induced cell cycle arrest in G2/M phase by upregulation of p27,cyclin B1, cell division cycle protein 2(Cdc2)and p-Cdc2.Evodiamine triggered apoptosis accompanied by cleavage of caspase-3 and poly(ADP-ribose)polymerase(PARP).Combination of evodiamine with TRAIL significantly reduced the cell viability and increased cleavage of caspase -3 and PARP as compared with the use of each agent alone.Moreover,evodiamine increased the expression of death receptor 5(DR5)in the Huh7 cells.CON-CLUSION:Evodiamine inhibits the cell growth by reducing the cell viability and inducing cell cycle arrest.Evodiamine also triggers cell apoptosis and enhances the sensitivity of Huh 7 cells to TRAIL by upregulating the expression of DR5.

Objective:To explore effective approaches of treating elderly patients with distal tibiofibular fractures. Meth-ods:From August 2008 to October 2012,175 elderly patients with distal tibiofibular fractures were treated with locking com-pression plate (LCP) through anterior tibial. There were 112 males and 63 females with an average of 71.3 (ranged 60 to 83) years old. Of them,89 cases were treated by anterior tibial tension reduced incision with LCP,including 62 males and 27 fe-males with a mean age of (71.8±6.4) years old. Eighty six patients were treated by distal tibial incision with LCP,including 58 males and 28 females with a mean age of (70.3±6.7) years old. Swelling time,operation time,intraoperative blood loss,hospital stay,healing time,complications and AOFAS scores were compared between two groups after operation. Results:Swelling time in anterior tension reduced incision with LCP and distal tibial incision with LCP was (5.6±1.3) and (9.7±2.1) days,healing time was (4.2±1.4) and (5.4±1.9) months,and complications were found 3 in tension reduced incision and 10 in distak tibial incision respectively;and all data shown statistically significant differences between two groups (P<0.05). At 12 months after operation,AOFAS score was 89.0±9.7,87.9±9.4;and there was no statistically significant difference between two groups (P>0.05). Conclusion:Tension reduced incision through anterior tibial combined with locking compression plate fixation in treat-ing elderly patients with distal tibiofibular fractures can provide good clinical effects with quick fracture healing and low com-plications.

BACKGROUND & OBJECTIVE:Carcinoembryonic antigen(CEA) monitoring plays an important role in the management of malignancies,especially in colorectal cancer (CRC).The half-life (T1/2) of CEA has also been applied as a new predictor in the surveillance of some malignancies.This study was to examine the preoperative and early postoperative levels of CEA in CRC patients and calculate postoperative T1/2 of CEA to evaluate its potential role in prognosis prediction.METHODS:In this retrospective study, 98 CRC patients who had preoperatively elevated levels of CEA (≥5 μg/L)and serum CEA surveillance after radical operation were included.Postoperative T1,2 of CEA was calculated.Its correlation to prognosis was analyzed.RESULTS:Of the 98 patients,21 had local recurrence or distant metastasis (recurrence group),77 had no recurrence (non-recurrence group).The median value of preoperative CEA level was significantly higher in recurrence group than in non-recurrence group (23.9 μg/L vs.12.3 μg/L,P= 0.010);the median value of postoperative T1/2 of CEA was significantly longer in recurrence group than in non-recurrence group (6.2 days vs.4.7 days,P=0.042);the later the TNM stage was,the poorer the prognosis was (P<0.001).The 3-year disease-free survival (DFS) rate and overall survival (OS) rate were significantly higher in the patients with postoperative T1/2 of CEA of<4.8 days than in those with T1/2 of ≥4.8 days (87% vs.66%,P=0.017;90% vs.80%,P=0.032).The patients at earlier TNM stage had survival benefits both in DFS and OS:the 3-year DFS rates in stage Ⅰ,Ⅱ,and Ⅲ patients were 100%,93%,and 55%,respectively (P<0.001);the 3-year OS rates were 100%,98%,and 77%,respectively (P=0.192).In Cox regression analysis,both TNM stage and postoperative T1/2 of CEA were confirmed to be independent prognostic factors of CRC patients with preoperatively elevated CEA level.CONCLUSIONS:In addition to TNM stage,the T1/2 of CEA may be an independent prognostic factor in CRC patients with preoperatively elevated CEA level.The patients with longer T1/2 of CEA after radical operation have poorer prognosis.

OBJECTIVETo evaluate the risk factors of postoperative renal failure (RF) in the patients with type A dissection of aorta operated on with cerebral perfusion and deep hypothermia circulatory arrest (DHCA).

METHODSFrom January 2004 to October 2007, 157 patients with type A dissection of aorta underwent surgical procedures with cerebral perfusion and DHCA. There were 115 male patients and 42 female patients with the age from 17 to 76 years old. Antegrade selective cerebral perfusion through axillary artery was performed for 129 patients and retrograde cerebral perfusion from superior cava vein was performed for 28 patients. All the factors underwent univariate and multivariate analysis.

RESULTSMean cardiopulmonary bypass duration was (188.0 +/- 10.8) min and mean cerebral perfusion time was (36.0 +/- 3.1) min. Fifteen patients died in hospital and the hospital mortality was 9.6%. Permanent neurological dysfunction (PND) occurred in 8 patients (5.1%). Postoperative RF was observed in 20 patients (12.8%). Multivariate analysis showed the preoperative renal dysfunction (P = 0.042, OR = 4.41) and over seventy-year-old patients (P = 0.049, OR = 4.94) were found to be the risk factors of postoperative RF. There was a higher incidence of death (45%, P = 0.001) and PND (25%, P = 0.009) in the patients of postoperative RF when compared with the other patients.

CONCLUSIONThe preoperative renal dysfunction and elderly patients were found to be the risk factors of postoperative RF after type A dissection of aorta surgery.

Adolescent ; Adult ; Aged ; Aneurysm, Dissecting ; surgery ; Aortic Aneurysm, Thoracic ; surgery ; Female ; Heart Arrest, Induced ; Humans ; Hypothermia, Induced ; Male ; Middle Aged ; Perfusion ; Postoperative Complications ; etiology ; Renal Insufficiency ; etiology ; Risk Factors