Objective To explore the clinical outcome of self-designed bilateral external fixator combined with limited internal fixation for the treatment of open fracture of tibial plateau.Methods From February 2001 to September 2005,23 cases of open tibial plateau fractures were treated with bilateral external fixator combined with limited internal fixation.According to Schatzker classification,there were 35 patients with type Ⅴ fracture and 18 patients with type Ⅵ fracture.According to Gustilo classification,there were type Ⅰ in 15 eases,type Ⅱ in 22 cases, type Ⅲ in 16 cases.Results The follow-up period was 5 to 22 months(mean 10 months).All the fractures got unit- ed.According to Merchant grade,18 eases were evaluated as excellent,25 as good,9 as fair.The rate of excellent and good resuhs was 83 %.Conclusion Operation by using bilateral fixator combined with limited internal fixator can make fixation stable and reduce complication.It is an effective method to treat complex fractures of open tibial plateau.

Objective To evaluate the therapeutic effect and safety of forward-viewing,doublechannel endoscope in the process of ERCP in patients with bile duct diseases after Billroth-Ⅱ gastroenterostomy.Methods ERCP was applied to 46 patients with bile duct diseases using forward-viewing,doublechannel endoscope.All patients had the history of Billroth-Ⅱ gastroenterostomy.The success rate of selective cannulation,complication rate and the outcome of all the patients were recorded.Results The procedure succeeded in 38 patients with a success rate of 82.6％,and failed in 8.Of all the failing cases,the afferent loop couldn't be accessed in 6,failure in biliary cannulation in 2.Of 38 successful cases,bile duct stones were successfully removed in 31,metal stents placed for malignant bile duct obstruction in 4,and endoscopic balloon dilation for benign common bile duct stricture in 3.All patients recovered without complications of perforation,delayed bleeding or pancreatitis.Conclusion For patients with history of Billroth-Ⅱgastroenterostomy,ERCP with forward-viewing,double-channel endoscope yields to a higher success rate and lower complication rate.

Objective To investigate the characteristics of pathogenic bacteria/the drug resistance/the correlated risk fators/the prophylaxis control strategy of the severe craniocerebral injury patients combined with intracranial infection .Methods The clinical data of 35 craniocerebral injury patients with intracranial infection were retrospectively analyzed .Results 35 patients′cerebrospinal fluid were separated and 54 pathogenic bacterium had been cultured ,including G+ bacterium(61 .11% ) ,the G - bacteria(33 .33% ) , fungi(5 .56% ) .The pathogenic bacteria showed a higher resistance .The single factor analysis found that the wound itself exists in-fection factors ,the postoperative drainage of incision ,liquorrhoea ,with other basic diseases ,surgery lasted for a long time (>4 h) reoperative ,surgery is placed foreign body is severe craniocerebral trauma combined with intracranial infection were the main rele-vant factors .The total effective rate was 62 .86% ,and the mortality was 11 .43% by the positive therapy .Conclusion G+ bacteria were the main pathogenic bacterium in the severe craniocerebral injury patients combined with intracranial infection .The iatrogenic factors leaded to the increase of the proportion of intracranial infection and the resistance increased year after year .The clinical in-travenous antibiotics combined intrathecal injections were beneficial to control intracranial infection ,shorten the course of treatment and enhance the curative effect .

Objective:To study the effects of nitrous oxide(N2 O)sedation in the management of dental fear(DF)for dental treat-ments of children.Methods:66 cases of pediatric patients(aged 6 to 14 years)were given N2 O sedation for dental treatments.The heart rate(HR)and oxygen saturation(SpO2 )were measured before and after N2 O inhalation.N2 O effective concentration was eval-uated by Ramsay sedation score and Houpt behavior score.Results:The effective concentration of N2 O sedation was 25% -70%(49.6% ±12.1%),the maximum endurance concentration 35%-70% (56.4% ±10.1%).The Ramsy scores of N2 O sedation was (2.3 ±0.6).After N2 O inhalation,all patients could receive verbal demand during the treatments.The HR decreased(P <0. 05)and the Houpt behavior score increased(P <0.01).Before and after N2 O inhalation SpO2 had no significant difference(P >0.05).Conclusion:N2 O inhalation at 25% -70% is safe and effective in the management of DF for dental treatments of children.

Objective To study inflammatory cytokines changes in brain tissue of neonatal rats with periventricular leukomalacia (PVL).Method A total of 80 neonatal SD rats (P3) were randomly assigned into 2 equal groups,sham-operated group and PVL group.Rats in each group were further assigned into four subgroups (12,24,48,72 h),with 10 rats in each subgroup.The hypoxic-ischemic PVL modal were established following the procedure:first,isolation and ligation of left common carotid artery,and then exposed to 8％ O2 and 92％ N2 for 2.5 h.The sham-operated rats were processed with isolation of left common carotid artery only.Rats of the four subgroups were sacrificed at 12,24,48 h and 72 h respectively,then the brains were rapidly removed in corresponding time.Pathological changes of brain tissues were observed using HE stain.The mRNA expression levels of tumor necrosis factor α(TNF-α)and inter leukin-1β (IL-1β) were assessed using real-time quantitative PCR assays,the protein levels of TNF-α and IL-1β were detected using enzyme linked immunosorbent assay method.Result The brains tissues of rats in PVL group showed remarkably hyperemia and edema,with left ventricle enlargement.Periventricular white matter structure was disintegrated comparing with sham-operated group.The expression of TNF-α and IL-1 β mRNA in PVL group increased significantly,reaching peak by 24 h and then gradually decreased 72 h after the procedure.The mRNA levels of TNF-c and IL-1 β were significantly different between each two time points of 12,24 h and 48 h in PVL group (P ＜0.05).However,there was no differences between 72 h and 48 h within PVL and sham-operated group group(P ＞0.05).In PVL group,the protein expression trends of TNF-α and IL-1 β were similar to mRNA expression trends.Moreover,the protein levels were significantly different between each two time points of TNF-α and IL-1 β,respectively (P ＜ 0.01).The protein expression levels of TNF-α were different at each time point between PVL group and sham-operated group[(189.2 ± 20.4) pg/ml vs.(131.4 ±5.2) pg/ml at 12 h,(213.8 ± 16.7) pg/ml vs.(127.7 ±7.4) pg/ml at 24 h,(181.7 ± 15.0) pg/ml vs.(126.3 ± 6.0) pg/ml at 48 h,(159.6 ± 25.3) pg/ml vs.(131.4 ± 6.0) pg/ml at 72 h;P ＜0.01].The protein levels of IL-1β were different between the two groups only at 24 h and 48 h.[(121.8 ±30.0) pg/ml vs.(67.4 ± 13.7) pg/ml,(83.3 ± 15.7) pg/ml vs.(65.3 ± 14.9) pg/ml;P ＜0.05].In sham-operated group,no differences of TNF-α and IL-1 β protein levels were found between any different time points (P ＞ 0.05).Conclusion Inflammatory cytokines such as TNF-α and IL-1β are involved in ischemic-hypoxia induced PVL.Dynamic detection of inflammatory factors is expected to be an important method of early diagnosis,assessment of treatment efficacy and prognosis of PVL.

Objective To find the relationship between mutation of gamma 2 subunit of the gamma-aminobatyric acid type A receptor(GABRG2) and generalized epilepsy with febrile seizure plus(GEFS+).Methods Probands of 10 families with GEFS+ were selected,the GABRG2 gene were sequenced.Results We found a single nucleotide polymorphism site,and did not find the reported mutations.Conclusion GABRG2 mutation is not common in Hans of northern China.

Objective: To assess the activity of cathepsin D (CAT-D) and alpha-1 antitrypsin (AAT) in blood in patients with hip or knee osteoarthritis, and to explore whether these two enzymes could be served as serum biomarkers for cartilage degeneration. Methods: hTe activity of CAT-D and AAT in blood serum of 44 women and 26 men with hip or knee osteoarthritis was determined by the method of ELISA before total joint replacement and on the 10th day atfer the surgery. One hundred healthy volunteers were chosen as the control. All datawere analyzed by using SPSS19.0 sotfware. Results: Compared with the controls, the activity of CAT-D in patients with osteoarthritis was decreased by 25% (P<0.05) and 50% (P<0.05) before and atfer the surgery, respectively. hTe activity of AAT in the osteoarthritis patients before the surgery was not signiifcantly changed compared with the control group (P>0.05), but it was increased by 80% after the surgery than that in the control group (P<0.05). hTere was no signiifcant difference in the activities of 2 enzymes between hip and knee osteoarthritis (P>0.05). hTe gender, hypertension, diabetes and age did not affect the activities of the 2 enzymes (P>0.05). Conclusion: AAT might be a possible inflammatory indicator in the osteoarthritis. CAT-D and AAT enzymes are not affected by gender, age, hypertension and diabetes, etc, and they might be served as potential biomarkers for cartilage degradation.

Objective To investigate the characteristics of etiology,efficacy of endoscopic management for recurrent idiopathic pancreatitis (RIP).MethodsThe clinical data of 58 cases of RIP diagnosed in our hospital from April 2005 to April 2011 were retrospectively analyzed.All the patients underwent endoscopic retrograde cholangiopancreatography (ERCP),and patients with suspected sphincter of Oddi dysfunction received manometry.According to the clinical and ERCP manifestations,the etiologies of RIP were determined and individualized endoscopic treatment was applied.The patients were followed-up postoperatively about the improvement of abdominal pain and recurrence of RIP.ResuItsFifty-eight patients (29 males,29 females) were suffered from acute pancreatitis from 3 to more than 10 times.The etiologies were as follows:29 cases of biliary microlithiasis,19 case of sphincter of Oddi dysfunction ( 16 cases of pancreatic type,3 cases of mixed type),4 cases of anomalous arrangement of the pancreaticobiliary duct,and 6 cases of normal manifestations at ERCP.Biliary sphincterotomy alone was performed in 33 patients,while both biliary and pancreatic sphincterotomy was performed in 8 patients,and pancreatic sphincterotomy alone was performed in 17 patients,after sphincterotomy,pancreatic stent insertion was performed in 24 patients.The follow-up data was obtained from 41 out of 58 patients,the follow-up period ranged from 3 ～ 67 months ( average 33 months).During this period,9(22.0％ ) patients suffered from RIP,and the treatment efficiency was 78％.ConclusionsBiliary microlithiasis and sphincter of Oddi dysfunction are the main causes of RIP.Drink could induce RIP.ERCP has definite treatment efficacy for RIP.

The application and expanding of nasal endoscopic surgery,an epoch-making transform of rhinology,have a very close associations with medical imaging,which includes anatomy photograph,conceptual diagram,radiological imaging,nasal endoscopic image display system,operation photographic recording and computer assisted instruction courseware,etc.It is important to collect the medical imaging through various means and set up medical imaging resources library for nasal endoscopic surgery teaching.

To carry out bilingual education among seven-year-program students of clinical medicine is for further raising of professional English level of the students so as to cultivate highlevel medical personnel. We put emphasis on teaching material,the ability of teachers and courseware ,adopting the form and methods to make students comprehend and memorize easily, which has raised the students’interests and ability and helped them lay a solid foundation for the study of clinical knowledge.