Objective To evaluate clinical features, therapeutic regimen and prognosis of unexplained rhabdomyolysis. Method Clinical manifestations, therapeutic regimen and prognosis were recorded in 23 patients,who were admitted to The First Affiliated Hospital of Nanjing Medical University 13 to 27 August,2010.The 23 patients were diagnozed as unexplained rhabdomyolysis. Results The patients all presented myalgia of upper body,like neck,waist and back,maybe with asthenia, nausea,dyspnea,abdominal pain, red urine or changed color of urine. Laboratory examination: obviously step-up of creatine kinase [CK: (4655 ± 2556) U/L( normal: 25 ～ 190U/L) AST:(141 ±78) U/L(normal:10～45 U/L),LDH:(348± 127) U/L(normal: 110～ 250 U/L)]and myoglobin[( Mb ＞ 1000 μg/L (normal: 0 ～ 50 μg/L)]. Therapeutic regimen included treatment of the underlying diseases, volume repletion, alkalization and dealing with the complications. No patients developed acute renal failure.All the patients recovered. Conclusions Rhabdomyolysis is a syndrome with different clinical manifestations.However, early diagnosis, proper treatment could prevent serious complications,and prognosis is good.

Objective To discuss the clinical character and the therapeutic strategy of the super-proximal bicondylartibial plateau fracture.Methods A review of 8 patients with an average age of 40.8 years old (range,28-56 years; 6 males,2 females) surgically treated from June 2007 to October 2012 was conducted.Conventional pre-operative three-dimensional CT scans were used to clarify the types of fractures and the locations of major displaced bone fragments.All patients received open reduction and internal fixation 7-14 days after injury for recovery of soft tissue.Anterolateral incision combined anteromedial incision was made on those with limited posterior column shift.Otherwise anterolateral incision combined posteromedial might be better for those with obvious displacement.Six of the patients were implanted autograft bone or allograft bone.The collateral ligaments could be repaired in one stage,but a routine repair of cruciate ligaments was not concerned,and an immobilization for six weeks with a plaster or a brace should be followed.Results All cases were followed-up for 12 to 26 months (median follow-up period,18.6 months).All the fractures in the series achieved bone union at or before the last follow-up,and the healing time ranged from 18 to 26 weeks (median healing period,21.5 weeks).The X-rays showed the smooth surface and good alignment of knee joint at the last follow-up.The median hospital for special surgery knee score (HSS) was 78.12 (range,56-90),with 3 excellent cases,3 good cases,1 fair cases and 1 poor case; the excellent and good rate was 75％ (6 of 8).The median Lysholm score was 81.37 (range,58-91),with 4 good cases,3 fair cases and 1 poor case; the excellent and good rate was 50％ (4 of 8).Conclusion Super-proximal bicondylartibial plateau fracture is a special fracture type accompanied with posterior dislocation of knee,which is predominantly presented as an anterior plateau fracture.And injuries of blood vessels and nerve are common.Conventional pre-operative three-dimensional CT scans,paying attention to the stability of the knee,restoring the alignment and joint surface and early analgesic exercises with brace might be commended in management of such plateau fracture.

Objective This study is aimed to compare sinus tarsi approach and conventional extensile L shape approach in the management of Sanders type III calcaneal fractures. Methods A total of 36 cases of Sanders type III calcaneal fractures treated in our hospital between August 2011 to February 2014(35 patients, 27males, 8 females. Nineteen of them were performed a limited open reduction and internal fixation(ORIF) via the sinus tarsi approach(as minimal invasive group), while the other 17 cas?es were performed ORIF via conventional lateral extensile L shape approach(as conventional group). X?ray films were taken post?operatively to record the changes of B?hler angle and Gissane angle. The AOFAS ankle hind?foot scale, visual analogue scale and the MOS item short from health survey(SF?36) were adopted to assess the therapeutic effect. Results The average follow?up peri?od of minimal invasive group was 14.6 months. And conventional group were followed up for average period of 18.3 months. All the fractures in the series had a boney union at or before the final follow?up. The immediate correction and final correction of B?hler angle and Gissane angle were significantly increased in both minimal invasive group and conventional group, while there was sig?nificant difference between the two groups. The median AOFAS score ,VAS score and SF?36 score of the minimal invasive group were 84.74±8.14,1.68±0.95 and 89.36±4.69, while those in the conventional group were 82.06±10.95,1.94±1.43and 86.71±5.39. There was no significant statistically difference between the two groups. No wound problem happened in the minimal invasive group, 3 cases of subtalar joint stiffness were found, and 1 developed traumatic arthritis. Respectively, 2 cases in conventional group got hematoma and dehiscence for each, 8 cases of subtalar joint stiffness were found, and 2 cases developed traumatic arthri?tis finally. Conclusion Limited ORIF via a sinus tarsi incision have the familiar therapeutic effects to ORIF via a conventional extensile L shape incision in the management of type III calcaneal fractures. But the former has the advantage of lower incision complication rate and lower stiffness subtalar joint rate.

Objective To evaluate quantitatively the spasticity of elbow flexor biceps in stroke patients using integrated EMG (IEMG),and to correlate the IEMG with Ashworth scale.Methods The IEMG data was recorded from the biceps while passively stretch the elbow joint of a group of 90 subjects,and was correlated with the varying levels of Ashworth category(20 cases with grade 0,6 cases gradeⅠ,16 cases gradeⅠ~+,20 cases gradeⅡ,and 18 ca- ses gradeⅢ).Results The IEMG data were positively correlated with simultaneous Ashworth scale categories.The range of IEMG value corresponding to the Ashworth category is as follows:1.3～12.1 (6.7?5.4)?V?s vs Ash- worth grade 0;4.6～12.3 (8.5?3.9)?V?s vs Ashworth gradeⅠ.15.3～28.4(21.8?6.6)?V?s vs Ashworth gradeⅠ~+;37.2～68.9 (53.1?15.6)?V?s vs Ashworth gradeⅡ;82.3～144.1 (113.2?30.9)?V?s vs Ash- worth gradeⅢ.Conclusion The IEMG value can be used to quantify the spasticity of elbow flexor in stroke pa- tients.

ObjectiveTo probe into the clinical efficiency of reconstruction to person who had composite tissue defect of the floor of mouth and the lower part of face with the free forearm flap and free iliac bone in the same term.MethodsBefore the surgery, the surgeon should carefully evaluate the scope and shape of defects in 11 cases who had the composite tissue defects of the floor of mouth and the lower part of face, to design the individual forearm flap, so that it matches with the defect region. During surgery, the first resumption of defects using titanium plates forming the basic shape of mandible and the occlusal relationship,then used to re-sawing to take modeling of the iliac bone,transplanted free iliac bone and fixed after the inside of the titanium plate, thereby restoring the continuity of mandible missing.ResultsFree forearm flap and free iliac bone all survived in 11 cases, the success rate of 100％. The patients were followed up for 6 to 12 months, although the shape of restoration areas were different levels of fat, but eating, swallowing and other oral function had been well improved, 7/11 could enter normal diet, 4/11 to enter liquid diet, At the same time, the patients in social activities can communicate in a language daily, sensory function of skin flap and facial appearance has been satisfactory recovery.ConclusionConformal free forearm flap and free iliac bone is an ideal way to reconstruct the composite tissue defects of the floor of mouth and the lower part of face in the same period, not only safe, practical prognostic effect, and also can significantly improve the patients quality of life, which is worthy of reference and use.

The study focused on the therapeutic efficacy of Tibetan medicines on cerebral ischemia. The combined medication methods and administration habits in clinic for more than 10 years were simulated. Three typical Tibetan medicines, i.e., 25-Herb Shanhu pill, Wishful-Treasure pill and 20-Herb Chenxiang pill, were administered to the animal model of permanent middle cerebral artery occlusion in the morning, noon and evening, respectively. On the second day after the final administration, the activity of serum oxidative stress marker SOD and the content of MDA were evaluated. Infarct volumes were quantified through TTC staining. Inflammatory reaction maker NF-kappaB p65 gene and apoptosis. makers Bax and Cyct were selected to study the molecular mechanism of combined herbs with the immunohistochemistry technique. According to the result, the respective combination of 25-Herb Shanhu pill, Wishful-Treasure pill and 20-Herb Chenxiang pill in the morning, noon and evening showed unique advantages in reducing the damage of oxidative stress, infarct volumes, encephaledema caused by ischemia, inflammatory factor aggregation and inhibiting apoptosis, with consistent therapeutic efficacies in clinic.
Animals ; Brain Ischemia ; drug therapy ; metabolism ; Lipid Peroxidation ; Male ; Medicine, Tibetan Traditional ; Rats ; Superoxide Dismutase ; metabolism ; Time Factors ; Transcription Factor RelA ; physiology

Objective This study is to explore the expression of CIP2A mRNA in hepatocellular carcinoma (HCC), and its correlations with clinicopathologic features and prognosis of HCC patients.Methods CIP2A mRNA expression was analyzed in four liver cancer cell lines (Hep-G2, MHCC97,SMMC-7721 and BEI-7402), one immortalized liver cell line L-O2, neoplastic tissues and adjacent matched non-neoplastic liver tissues in 120 HCC patients and normal liver tissues of 20 cases using semi-quantitative reverse transcription-polymerase chain reaction (RT-PCR). The correlations between CIP2A mRNA and clinicopathologic features and prognosis of HCC were analyzed. Results CIP2A mRNA was detected in Hep-G2, MHCC-97H, SMMC-7721 and BEL-7402, but not in L-O2.The positive rate of CIP2A mRNA expression was significantly increased in HCC tissues (78.3%)than in adjacent matched non-neoplastic liver tissues (28.3%) and normal liver tissues (5.0%,P＜0. 01). CIP2A mRNA expression was correlated with tumor size, differentiation and TNM stage (P＜0.05). Patients with positive expression of CIP2A mRNA had lower overall survival and diseasefree survival rates. Conclusions CIP2A mRNA, which is highly expressed in liver cancer cell lines and HCC tissues, may be involved in hepatocarcinogenesis. CIP2A mRNA may be a valuable biomarker for assessing the prognosis of HCC.

Objective To evaluate the expressions of estrogen receptor (ER) α and β in human prostate cancer and adjacent non-cancerous tissues,and to evaluate the correlation between the expression and the clinicopathological features and prognosis.Methods Immunohistochemical staining was used to detect ERα and ERβ in 85 prostate adenocarcinoma tissues,adjacent non-cancerous tissues,and 29 benign prostatic hyperplasia (BPH) tissues.The correlation between the expression and the clinicopathological features was analyzed by Spearman's coefficient.Cox's proportional hazards regression model was used to identify the risk factors for biological recurrence.Results There were significant differences between the expression of ERα in prostate cancer,adjacent non-cancerous tissues,and BPH [epithelial cell 0 (0/85),11.8％ (10/85) and 24.1％ (7/29),P=0.000; and in stromal cell 52.9％ (45/85),67.1％ (57/85),31.0％ (9/29),P =0.003].There were significant differences between the expression of ERβ in these groups [epithelial cell 36.5％ (31/85),61.2％ (52/85),100.0％ (29/29),P =0.000; and in stromal cell 49.4％ (42/85),72.9％ (62/85),79.3％ (23/29),P =0.001].The ERα expression in cancerous stromal cells was positively correlated with the PSA level (r =0.296,P =0.006) and Gleason score (r =0.404,P =0.000).The ERβ expression was negatively correlated with Gleason score in cancerous epithelial cells (r =-0.254,P =0.019) and stromal cells (r =-0.315,P =0.003).Multivariate analysis revealed that negative expression was an independent poor prognostic factor for the biological recurrence free survival after radical prostatectomy (HR =0.107,95.0％ CI 0.019-0.592,P =0.010).Conclusions There were significant differences between the expression of ERα and ERβ in prostate cancer,adjacent non-cancerous tissues,and BPH.ERα in cancerous stromal cells,ERβ in cancerous epithelial and stromal cells were related to the differentiation of prostate adenocarcinoma.ERβ in cancerous epithelial cells can be used as an independent prognostic factor for biological recurrence after radical surgery.

Objective To establish a porcine model of penetrating-suture pancreaticojejunostomy.Methods Ten domestic pigs were selected,and after general anesthesia they underwent laparotomy and the pancreas was visualized.Then the pancreas was dissected at the level of superior mesenteric vascular,and the proximal pancreatic stump was sewed up.The anastomosis between the distal pancreatic stump and the intestinal wall adopted penetrating-suture pancreaticojejunostomy; the digestive tract was reconstructed by Roux-en-Y.Results The anastomosis with penetrating-suture pancreaticojejunostomy was successful in ten domestic pigs.The mean pancreatic stump diameter was 2.5 cm,and the mean pancreatic duct diameter was 1.5 mm,the mean time for operation was 1.0 ～ 2.5 h,and the average time of pancreaticojejunostomy was 8 minutes.The mean blood loss was 25 ml.After operation,diarrhea occurred in 2 pigs and wound infection occurred in 1 pig,and all were cured with appropriate management.No pig died intra-operatively,and no pancreatic fistula or death occurred after operation.Conclusions A porcine model of penetrating-suture pancreaticojejunostomy is successfully established.

0.05), but the level of albumin dropped significantly(P