Objective To discuss the clinical features in the diagnosis and treatment of Maisonneuve fracture.Methods Twenty-three patients(16 males and 7 females)with Maisonneuve fractures were surgically treated in our hospital from August 2005 to August 2009.Mean patient age was 35.3 years(range,25-43 years).The causes of injuries were fall down injury(10 patients),sports related injury(8 patients),traffic injury(4 patients),and high falling injury(1 patient).All of the fractures were closed.The surgical procedures include ORIF of the medial malleolus or repair of the medial deltoid ligament and percutaneous screw fixation of the disrupted distal tibiofibular syndesmosis.The ankle function was evaluated by Baird-Jackson criteria.Results In all the 23 patients,9(39.13%)were misdiagnosed at the time of admission or emergency.Twenty-two patients were followed up and the average follow up time was 16.8 months(range,12-25months).No patient complained of pain,tenderness and obvious swelling of the ankle,and range of motion of the injured ankle was similar to that of the contralateral side.At the latest follow up,19 patients had resumed their preinjury activity level.Radiographs of all 22 patients showed union of all the fractures and normal mortises.And there was no traumatic arthritis and breakage of the syndesmotic screws.Baird-Jackson ankle functional score was from 85 to 100.In all the 22 patients,11 were rated as excellent,8 as good,and 3 as fair.The excellent and good rate was 86.4%(19/22).Conclusion Maisonneuve fracture is easy to be misdiagnosed.The lack of knowledge of this fracture and only initially focus on the local condition are the main reasons for the misdiagnosis.Surgical treatments include ORIF of the medial malleolus or repair of the medial deltoid ligament and percutaneous screw fixation of the disrupted distal tibiofibular syndesmosis.

Objective To discuss the clinical features of Traumatic Spinopelvic Dissociation(TSD) and to evaluate the clinical results treated by lumbopelvic fixation by retrospective case study.Methods From July 2008 to December 2012,twelve patients of Traumatic Spinopelvic Dissociations were surgically treated at our department in Tianjin Hospital.There were 8 males and 4 females with a mean age of 34.6±9.2 years(range,18-50 years).The causes of injuries were fall or jump from height (11 patients) and traffic injury (1 patient).All the fractures were closed injuries and associated injuries in different degrees were noted in all the patients.The sacral fractures were classified according to fracture shape,with 4 cases of U shape,6 cases of H shape and 2 cases of Y shape.The transverse part of the sacral fractures were classified by Roy-Camille classification,and there were 6 cases of type Ⅱ and 6 cases of type Ⅲ.All the 12 patients were surgically treated by lumbopelvic fixation of a posterior approach,and 6 patients with significant neurological impairments were performed with sacral decompression via the same approach.The clinical results were evaluated by Majeed functional evaluation and the neurological impairments were evaluated by Gibbons score.Results All the patients were followed up on an average of 15.5±6.3 months (range,12-36 months).The diagnosis of the TSD were missed or delayed in 9 of the 12 patients.There were different neurological impairments in all the 12 patients.All the fractures healed in a mean time of 4.8±2.8 months(range,4-8 months).Clinical outcome was rated excellent in 4 patients,good in 4 patients,fair in 2 patients,and poor in 2 patients,according to the Majeed functional evaluation,and the excellent and good rate was 66.7％ (8/12).The neurological injuries were recovered completely or partially in sensation and motion in 11 of all 12 patients (91.7％).For the neural decompression patients,the neurological injuries were recovered completely or partially in sensation and motion in 5 of all 6 patients (83.3％).At last follow up,the average Gibbons score improved from 3.25 preoperatively to 1.67 postoperatively,with significant difference.Conclusion TSD is a rare high-energy injury pattern.It has a high rate of associated injuries and neurological impairments.The correct diagnosis of the injury pattern is easy to be missed or delayed.Surgical procedure of lumbopelvic fixation via post approach should be considered as the method of choice.Early neural decompression for the patients with obvious indications could be helpful in overall neurological and functional recoveries.

Objective:To summarize the ultrasound features of renal arteriovenous fistula(RAVF)under various ultrasound imaging modes,so as to avoid missed diagnosis of RAVF on initial ultrasound examination.Methods:The clinical data of 6 patients with RAVF,including the ultrasound evidence,the timing of ultrasound diagnosis,the modes of ultrasound diagnosis, and the agreement between ultrasound diagnosis and selective renal arterial angiography,were retrospectively analyzed.Results: 2D ultrasound had 1 case of correct diagnosis,1 case of misdiagnosis and 4 cases of missed diagnosis.Color Doppler and spectral Doppler both had all the 6 cases correctly diagnosed.Ultrasound angiography in 3 cases demonstrated that the contrast agent reached the renal veins earlier than reached the renal parenchyma;large fistula lumen was associated with ischemia of downstream areas.3D ultrasound vividly reflected the structure of fistula lumen volume,and provided us with the profiles of blood signal in fistula at different planes and angles,improving our knowledge of blood flow on the fistula.Conclusion: Ultrasound is the first line screening method for RAVF.Color Doppler plays a decisive role in the diagnosis of RAVF and pulsed spectral Doppler plays a synergetic role and contributes to differential diagnosis.Contrast-enhanced ultrasound may help to discover the abnormality of venous circulation and the ischemic parenehyma area due to shunting.2D ultrasound has a poor diagnostic value and is liable to lead to misdiagnosis and missed diagnosis.

Objective To study the effect of auricular-plaster and meridian-pressing instrument on the prevention of gallstones recurrence after stone removeol.Methods 120 cases which were after endoscopic minimally cholecystolithotomy were selected and randomly divided into the control group and treatment group.All cases were observed for 3 years.Results This research altogether fell off 6 cases,including 2 cases in the control group and 4 cases in the treatment group.The treatment group's gallbladder wall (2.13 ± 0.36)mm was more thinner than the control group's(3.21 ± 0.40)mm,the treatment contract function was more strenghen than the control group,and the gallstone recurrence after stone removeol of the treatment was more smaller.Conclusion Aricular-plaster and meridian-pressing instrument can reduce inflammation of the gallbladder wall,enhance the gallbladder contraction function,and prevent the recurrence of gallstone.

Objective To explore the recent clinical efficacy of closed reduction and cannulated screws internal fixation for the treatment of Ideberg Ⅲ type glenoid fractures.Methods From October 2005 to January 2012,9 cases of Ideberg Ⅲ type gleuoid fractures with closed reduction and cannulated screws internal fixation were studied retrospectively,including 6 males and 3 females,4 cases on the left and 5 on the right,with the average age of 42.2 years (range,28-56).There were three cases combined with clavicle fractures,take S-shaped incision reset for clavicle reconstruction and plate fixation.Three cases combined with acromioclavicular joint dislocation were used the hook plate fixation,and 3 cases with combined acromion fracture were used tension band wire fixation.Suspension structures in the reconstruction of the shoulder glenoid fracture underwent closed reduction and cannulated screw internal fixation.After giving adjustable shoulder abduction brace,rehabilitation exercises were performed under the guidance of doctors.After 1,6 weeks,and 3,6,12 months,X-ray examinations at anteroposterior shoulder view were conducted.By X-ray and clinical examination to determine the fracture healing time,to assess shoulder function with the American Shoulder and Elbow Society (ASES) scoring system,and recorded complications and corresponding outcome.Results Nine cases were obtained from 12 to 46 months,the average (30.8±9.1) months follow-up all fractures healed,with an average healing time of X-rays 12 to 24 weeks,mean (16.8±4.8) weeks.After 12 months surgery,row ASES scores was 82.3 (range,57-95),compared with the preoperative difference was statistically significant.ASES scores were excellent in 5 cases,good in 2,fair in 1 and poor in 1.One patient with traumatic arthritis obtained satisfactory clinical results through oral nonsteroidal drugs and intra-articular injection of sodium hyaluronate.No screw loosening,fracture fixation failure complications were observed.Conclusion Closed reduction and cannulated screws internal fixation of Ideberg Ⅲ type glenoid fractures recently obtained satisfactory results.

Objective To evaluate the application of 3D printing technology in the treatment of displaced acetabular fractures ( DAF ) complicated with unstable injury to the posterior pelvic ring. Meth-ods A retrospective study was conducted of all the 19 DAF patients complicated with unstable posterior pelvic ring who had been treated from August 2009 to June 2015 in our hospital. They were 12 men and 7 women, aged from 24 to 62 years ( average, 39. 8 years ) . Twelve DAFs were complicated with ipsilateral unstable injury to the posterior pelvic ring, 5 with contralateral unstable injury to the posterior pelvic ring, and 2 with bilateral unstable injury to the posterior pelvic ring. Preoperatively, 3D digital models of the pelvis were reconstructed for the 19 patients using their CT scanning data. Their pelvic models were printed using 3 D printing technology for visual evaluation of their fractures and design of individualized surgical proce-dures. Results With the help of their 3D printing models, the 19 patients obtained successful operations within a mean time of 3. 2 hours. Their intraoperative blood loss averaged 658. 5 mL. They were followed up for an average of 10. 7 months ( range, from 8 to 24 months ) . According to Matta′s criteria for pelvic reduc-tion, 14 cases achieved anatomical reduction, 2 satisfactory reduction and 3 unsatisfactory reduction. Ac-cording to Mears's criteria for reduction of the posterior pelvic ring, 13 cases achieved anatomical reduction, 4 satisfactory reduction and 2 unsatisfactory reduction. The 19 acetabular fractures healed after 9 to 18 weeks ( average, 14. 5 weeks ) . The pelvic fractures healed after 8 to 17 weeks ( average, 13. 5 weeks ) . According to the Merle d'Aubigne-Postel criteria at the last follow-ups, the hip functions were excellent in 7, good in 9, fair in one, and poor in 2 cases. According to the Majeed's functional evaluation, the pelvic functions were excellent in 10 cases, good in 7, fair in one, and poor in one. Complications were incision infection in one, heterotopic ossi-fication in 2, avascular necrosis of the femoral head in one and traumatic arthritis in one. Conclusion In thetreatment of DAF complicated with unstable injury to the posterior pelvic ring, application of 3D printing technology can provide direct visualization of the pelvic and acetabular fractures which facilitate preoperative evaluation and design of individualized surgical protocols, leading to fine outcomes.

Objective To investigate the effects of methylprednisolone(MP) on the expression of matrix metalloproteinase(MMP)-9 and airway inflammation in murine models of asthma. Methods Thirty female BALB/c mice were randomly divided into asthma group,MP group and control group(n=10).Murine models of acute asthma were established by ovalbumin(OVA) via peritoneal injection and intranasal instillation.The pathological changes of lung tissues were observed with HE staining,and cell quantitation was conducted in bronchalveolar lavage fluid(BALF).The expression of MMP-9 protein was determined by immunohistochemistry and gelatin zymogram,and the expression of MMP-9 mRNA was detected by RT-PCR. Results Compared with control group,there were more significant airway spasm and more infiltration of inflammatory cells in histologic examination,and there was higher eosinophil cell quantitation in BALF in asthma group(P

Humans ; Nanoparticles ; toxicity ; Skin ; drug effects ; Skin Absorption

OBJECTIVE:To study the effects of Xiaoruzeng capsule on the gastric acid and pepsin in rats. METHODS:Rats were randomized into a blank group (distilled water),a positive control group (3.6 mg/kg omeprazole ) and the groups of low, middle and high doses of Xiaoruzeng capsule [2.25,4.5,9.1 g(crude drug)/kg]. These groups were respectively marked as groups A,B,C,D and E,with 10 rats in each group. All the rats were given corresponding drugs,ig,for consecutive 10 d. Their suc-cus gastricus was collected 3 h after the last administration,and determined for pH value with precision pH test strip and for free acidity and total acidity by acid-base neutralization titration method. The content and activity of pepsin were determined and calculat-ed with the test kit and microplate reader. The pathological change of the stomach was observed under the electron microscope. RE-SULTS:Compared with group A,groups B,C and D had higher pH value of succus gastricus;groups C,D and E had lower free acidity;groups B,C and D had lower total acidity,group E had higher total acidity;groups B,D and E had lower activity of pep-sin;and group C had higher content of pepsin. Compared with group B,group D had lower pH value of succus gastricus;group C had lower total acidity;group E had higher acidity;and groups C,D and E had higher activity of pepsin. There was statistical sig-nificance(P<0.01 or P<0.05). Gastric mucosal erosive haemorrhage was noted in three rats in group E,and other groups demon-strated no obvious pathological change. CONCLUSIONS:Low dose of Xiaoruzeng capsule can slightly inhibit the gastric acid in rats,but will not effect the activity of pepsin.

Adult ; Bacteremia ; Hematopoietic Stem Cell Transplantation ; Humans ; Male ; Nontuberculous Mycobacteria ; Postoperative Complications