Elastic stable intramedullary nailing (ESIN) is a well-accepted fixation method of long bone fractures in children.The advantages of ESIN include primary bone union with avoidance of growth plate injury and minimum invasive surgery.The good results of ESIN are obtained when surgeons have a good knowledge of the principle of the correction of the fracture and its stability, especially in the understanding of the unique pathophysiology characteristics of pediatric fractures.This review discussed the biomechanical mechanisms of ESIN, and the principles,indications and contraindications of ESIN in the treatment of pediatric long bone fractures.The article also comprehensively introduced the application of ESIN in femur,tibia,fibula,humerus, ulna, radius,clavicle and metacarpal bone fractures.The technique details of nailing, preoperative planning, positioning of the patient, sizing of the nail, entry points for the nail, reduction maneuvers for safe passage of nails through the fracture site, and postoperative management were also introduced in this review.

ve To investigate the mechanism of myocardial ischemia-reperfusion injury during cardiac surgery and the protective effect of low dose nicardipine. Methods Sixteen patients undergoing valve replacement under cardiopulmonary bypass (CPB) were randomized to one of the two groups: control group (group C, n = 8) and nicardipine group (group N, n = 8) . In group N low dose nicardipine (O.5?g?kg-1 ?min-1) was infused after induction of anesthesia until beginning of CPB, a total dose of 0.05 mg?kg-1 was given. All patients were premedicated with intramuscular morphine 0.1-0.2 mg?kg-1 and scopolamine 0.3 mg 30 min before surgery. Anesthesia was induced with midazolam 0.05-0.1 mg?kg-1, fentanyl 15-20 ?g?kg-1 and pipecuronium 0.1 mg?kg-1 and maintained with intermittent boluses of midazolam 0.05 mg? kg-1, fentanyl 10-30?g?kg-1 and pipecuronium 2 mg. After induction of anesthesia Swan-Ganz catheter was placed for hemodynamic monitoring. Moderate hypothermia (26℃-28℃) was maintained and Hct was diluted to 20%-24% during CPB. Hyperkalemic cardioplegia was used for myocardial protection. Arterial blood (a) and coronary sinus (cs) blood were taken simultaneously for determination of tumor necrosis factor a (TNF-a), superoxide dismutase (SOD), lipid peroxide (LPO), creative kinase(CK-MB) before CPB and at 5 and 30 min after release of aortic cross-clamp (RACC), at the end of operation (EO) and at 6h and 18h after operation. Myocardial net release of TNF-a (TNF-anr) and LPO (LPOnr) and net consumption of SOD (SODnc) were calculated. The number of defibrillation after RACC, weaning index from CPB and dopamine requirement after CPB were recorded simultaneously. Results In group C LPOa and LPOcs increased significantly after RACC until the end of operation as compared with the baseline (P

Objective: To investigate the role of endogenous nitric oxide (NO) in the pulmonary edema caused by overinfusion of colloid. Method: Forty healthy rabbits were randomly allocated into (Ⅰ) control group, (Ⅱ) infusion control group: one fold total blood volume of Gelofusine was infused at 2ml?kg~(-1)?min~(-1)(Ⅲ)L-NNA group:LNNA 20 mg/kg was intravenously injected before infusion, (Ⅳ)L-Arg+L-NNA group:L-arginine 300mg/kg and LNNA 20 mg/kg was intravenously injected before infusion. MAP,HR and CVP were recorded during the experiment, arterial blood gas analysis was examined before and after infusion,serumal NO value and lung water content were measured at the end of the experiment. Result: Overinfusion of colloid,L-NNA,an inhibitor of NO synthesis increased the extravascular lung water (EVLW) content and decreased NO value,meanwhile CVP increased,HR,PaO_2 and SaO_2 decreased,excess dose of L-arginine completely reversed the effect of L-NNA. Serumal NO value was negatively correlated with EVLW content (r=-0.94). EVLW content was significantly correlated with total lung water (r=0.41). Conclusion:Endogenous NO can reduce the pulmonary edema caused by overinfusion of colloid.

Objective To evaluate the efficacies of different ventilatory pattern during one lung ventilation (OLV). Methods During OLV, all patients underwent two different ventilatory pattern, total volume (10ml/kg) without PEEP and half tidal volume (5ml/kg) with PEEP of 7cmH 2O. The arterial blood samples were collected for blood gases analysis immediately before one lung ventilation, 30min following two different OLV pattern and 30 min after resuming two lung ventilation. The airway pressure and hemodynamic parameters were monitored simutaneously. Results PaO 2 and PaCO 2 were higher during half tidal volume than during total tidal volume(P

Objective To determine perioperative changes of tumor necrosis factor alpha (TNF ?),superoxide dismutase(SOD),lipid peroxides(LPO) and creatine kinase MB (CK MB) in patients undergoing cardiopulmonary bypass (CPB) Methods Thirteen patients undergoing heart valves surgery were studied Blood samples were taken from artery and coronary sinus for measurement of plasma TNF ? and LPO concentrations, and plasma SOD and CK MB activities prior to CPB, 5min,30min after aorta declamping, at the end of operation, 6h and 18h after surgery respectively Blood gas analysis was done at various intervals and alveolar arterial oxygen gradient (P A a DO 2) was calculated The net myocardial release of TNF ? (coronary sinus plasma level minus arterial level) was recorded Results Arterial and coronary sinus TNF? levels increased significantly following aortic declamping as compared with those before CPB and were kept at the higher level till the end of operation (P

Objective To assess the influences of cardiopulmonary bypass (CPB) on energy matabolism and the effect of nicardipine pretreatment. Methods Sixteen patients with valvlar heart disease undergoing valve replacement were chosen and randomly allocated into control group (group C, n=8) and nicardipine pretreatment group (group N,n=8). In group N, nicardipine 0.5?g?kg -1?min -1 was continuously infused after induction of anesthesia and terminated before CPB. The total dose given was 0.5mg?kg -1. If the total dose was not reached before CPB, the rest dose was given immediately after the beginning of CPB. Arterial and coronary sinus blood samples were taken immediately before CPB,at 5,30min after the aortic declamping , the end of operation, 6 and 18h after operation.Blood lactate and glucose concentrations were measured. Blood gas was checked simultaneously. Then myocardial lactate extraction rate (LER) and myocardial glucose extraction rate(GER) and myocardial oxygen extraction index(MOEI) were calculated. Results In group C GER and LER decreased signficantly after aortic declamping as compared with those before CPB (P

With the development of imaging techniques, aphasia caused by subcortical impairment is increasingly found in recent years. This paper reviewed the literature about the subcortical aphasia and expolred the anatomical and clinical features and pathogenesis of subcortical aphasia.

Objective To investigate the effects of protein active composition of Scorpio on apoptosis of L1210 tumor cells for the purpose of establishing the quality evaluation method of biological effect of Scorpio. Methods L1210 cells were examined by trypan blue exclusion. The proliferation of cells was determined by improved MTT assay. Flow cytometry was performed to analyze cell apoptosis with propidium iodide (PI). Results When the concentration of protein active composition of Scorpio exceeded or equaled 37 mg/ml, the coefficient correlation of the growth inhibiting curve of L1210 cells was 0.9357, and IC50 was 175 mg/ml. The excellence time was 0 to 48 hours. When the concentration of protein active composition of Scorpio exceeded or equaled 9.25 mg/ml, the apoptosis ratio of L1210 cells was raised significantly.Conclusion The protein active composition of Scorpio might promote the apoptosis and restrain the proliferation of L1210 cells. The value of anti-tumor biological effect of the protein active composition of Scorpio was 9.25 ～ 175 mg/ml. This value may be one of the indexes for quality evaluation of biological effect of Scorpio.

Objective To investigate the mRNA level of glucocorticoid receptor α (GRα) and heat shock protein 90 (HSP90) in peripheral blood mononuclear cells (PBMCs) and the plasma protein level of macrophage migration inhibitory factor (MIF) in patients with systemic lupus erythematosus (SLE) and to analyze their association with glucocorticoid (GC) resistance.Methods One hundred and six patients with SLE and thirty-eight healthy controls were enrolled in this study.Transcription levels of GRα and HSP90 were determined by real-time polymerase chain reaction.Enzyme-linked immunosorbent assay was used to detect the protein level of plasma MIF.The association between these parameters and GC resistance was analyzed by Spearman correlation analysis.The multivariate logistic regression model was used to analyze the risk factors for GC resistance.Results The mRNA level of GRα and HSP90 in GC resistance group was significantly lower than that in GC sensitive group [10.18(3.12,17.20) vs 16.83(12.01,24.18), P =0.001;18.46(14.77,26.45) vs 25.84 (17.97,35.90), P =0.005].MIF protein level in GC resistance group was significantly higher than that in GC sensitive group [(23.21 ±7.98) μg/L vs (18.34 ±6.29)μg/L;P =0.013].The mRNA level of HSP90 in the high MIF group was significantly lower than that in the low MIF group [23.67 (13.84,28.32) vs 26.64 (23.61,47.16);P =0.001], as well as HSP90/GRαratio(P =0.008).Additionally, the plasma protein level of MIF was negatively correlated with HSP90 (r =-0.275, P =0.004) and HSP90/GRα ratio(r =-0.341, P ＜ 0.001).SLE activity index score in GC resistance group was significantly higher than that in GC sensitive group [(12.23 ±2.86) μg./L vs (9.63 ± 3.48) μg/L;P =0.003].Logistic regression model indicated that disease activity was an independent risk factor for GC resistance (OR =17.481, 95％ CI 1.747-174.903, P =0.015).Conclusions Our preliminary findings suggest that low mRNA level of GRα and HSP90 and high protein level of MIF are associated with GC resistance.Elevated MIF level in SLE patients may play an important role in the development of GC resistance through down-regulating HSP90 and destabilizing the balance of HSP90/ Grα.Disease activity is the risk factor for GC resistance, which might be the viable evidence of therapy response.

Objective:To determine the content of triptolide in different parts of Tripterygii radix by high performance liquid chromatography. Methods:Tripterygii radix was determined by high performance liquid chromatography with Agilent Technologies C18 column (4.6 mm × 250 mm, 5 μm), acetonitrile-water (33:67) as mobile phase, flow rate of 1 ml/min, the column temperature of 30 ℃, injection volume of 20 ml and wavelength of 218 nm. Results:The linear relationship of triptolide was good in the range of 0.204-2.040 μg ( r=0.999 9), and the average recovery rate was 93.35%; RSD was 1.56% ( n=6). The lignin content in different parts of root was higher than that of the skin. Conclusions:The method is simple, rapid and accurate, which could be used to determine the content of triptolide in Tripterygii radix.