OBJECTIVETo explore optimal choice of surgical treatment for subtrochanteric fractures in older children.

METHODSA retrospective study of 36 older children with subtrochanteric fractures was performed between January 2010 and January 2012. Among them, 18 patients (11 males and 7 females) aged from 7 to 13 years old with an average of 9.4 were treated with titanic elastic nail (TEN) fixation, 4 cases were Type II A, 3 cases were II B, 2 cases were II C, 4 cases were III A, 3 cases were III B according to Seinsheimer classification. Eighteen patients (10 males and 8 females) aged was from 8 to 13 years with an average of 9.6 were treated with locking compression pine (LCP) fixation, and 3 cases were Type II A, 4 cases were II B, 3 cases were II C, 4 cases were IIIA, 2 cases were III B. Fracture healing time, postoperative complications (including wound infection, failure and breakage of internal fixtion, deformities of angular on the sagittal view, deformities of coxa vara) and recovery of hip joint function were observed and recorded.

RESULTSAll children were followed up from 15 to 36 months with an average of 21. Fracture were all healed, the time ranged from 7 to 16 weeks (mean 9.5). Three cases in TEN group occurred mild deformities of angular on the sagittal view, 3 cases occurred deformities of coxa vara and 2 cases occurred limb shortening; while 1 case occurred mild deformities of angular on the sagittal view, and no deformities of coxa vara and limb shortening occurred in LCP group. No early close of epiphyseal injury, avascular necrosis of femoral head occurred. Clinical efficacy were evaluated by Sanders standard, 14 cases got excellent results, 3 cases were moderate in LCP group, while 9 cases in excellent, 4 in moderate in TEN group. There were no significant differences between two group in recovery of hip joint function and complications.

CONCLUSIONFor the treatment of subtrochanteric fractures in older children,the efficacy of LCP fixation is better than that of TFN fixation, which has advantages of reliable fixation, and less complications.

Adolescent ; Bone Nails ; Child ; Female ; Fracture Fixation, Intramedullary ; instrumentation ; methods ; Hip Fractures ; surgery ; Humans ; Male ; Retrospective Studies ; Treatment Outcome

Objective: To evaluate the effects of percutaneous balloon pulmonary valvuloplasty ( PBPV) for pulmonary valve stenosis (PS) by single-balloon, double-balloon and Inoue-balloon methods. Methods: PBPV was performed in 42 patients with PS. The systolic right ventricular pressure (SRVP) , systolic right ventricular outflow pressure and systolic pulmonary arterial pressure ( SPAP) were contrasted before and after the procedure. Systolic transpulmonary valve pressure gradient (TVPG) and total pressure gradient from right ventricular to pulmonary arterial after the procedure were compared among the three gropes. Results:SRVP, SRVOP were decreased from (14. 69?6. 01 )kPa, (12. 16?3. 48)kPa to (8.14?5.26)kPa, (5.39?2.21)kPa and PAP increased from (1.57?0.56)cm to (17. 16? 2.16)cm after PBPV, respectively. TVPGs were (2. 40?2. 05) kPa, (3. 29?2. 25 ) kPa, (2.52? 1.95)kPa and TPGs were (2. 40?2. 05)kPa, (4.98?4.26)kPa, (6.16?6.93)kPa, (5.65?4.75) kPa after PBPV by single balloon, double balloon and Inoue balloon methods, respectively. During the follow-up period (2. 5?1. 6) years, bloodflow velocity at pulmonary valve measured by supersonic Doppler decreased from (2. 38?1. 89) m/s immediately after PBPV to (2.22?1. 96) m/s, further TVPG decreasing was indicated. Conclusion: The short and long term results of PBPV for PS by each of the three methods were excellent. Inoue balloon may be the first choice for elder children and adults, while for younger children, single balloon method may be preferred. Double balloon method can be remained as the second choice when Inoue method failed.

Objective To construct a novel tissue?engineered bone matrix gelatin (BMG)/poly[butylene succinate?co?tere?phthalate] (PBST) biphasic scaffold for annulus fibrosus. Methods The PBST spinning fibers were prepared by electrospinning and the porosity and water absorption rate were tested. Rabbit annulus fibrosus cells were isolated, cultured and identified through SafraninOstaining, and collagenⅡimmunohistochemical staining in vitro. And then annulus fibrosus cells were implanted on the PBST fiber, whose growth situation was observed by scanning electron microscope (SEM). Then the BMG/PBST biphasic scaf?fold was constructed by BMG as the outer annular fibrosus and PBST fiber as the inner annular fibrosus. The annulus fibrosus cells were implanted on the biphasic scafflod and cultured for 3, 7 and 21 days in vitro. The biomechanical and biological property was observed at the predetermined time point. Results The porosity of the fiber was 61.83%±7.33%and its water absorption rate was 297.34%± 57.13%. The identified result of annulus fibrosus cells were positive, suggesting that the cells have still kept their annulus fibrosus cells characteristics. The cells growth could be observed through SEM at 3rd and 7th day after implanted on the fi?bers. After cultured on the BMG/PBST scaffold, HE staining proved that the cells could ingress into the inner of fiber with time. SafraninOstaining and collagenⅡimmunohistochemical staining proved that the cells can secreted abundant proteoglycan and collagenⅡ, the special annulus fibrosus cell extracellular matrix. Compared with the BMG/PBST scaffold without cells, the elastic modulus of biphasic scaffold was increased from 14.83±1.02 MPa to 17.56±1.47 MPa after cultured with cells for 21 days in vitro. Conclusion The novel tissue?engineered biphasic scaffold for annulus fibrosus constructed with BMG and PBST fiber spinning has good cytocompatibility and biomechanical characteristics, which provide a basis for the complete tissue engineered interverte?bral disc.

Objective To investigate the dynamic changes of adenosine receptors, A1 (A1R) and A2a (A2aR) in the brain from the acute to chronic phase after kindling and to explore the correlation between seizure and expression level of A1R and A2aR. MethodsRats were randomly selected into the testing model, reference and normal control groups.Testing rats were kindled by lithium choride-pilocarpine, reference rats were treated with saline, and no treatment was given in normal control group. The dynamic expression of A1R and A2aR were detected by RT-PCR, immunofluorescence staining and Western blot at time-points of 24 hours, 1 month and 6 months post-kindling. Results In the acute phase of 24 hours after kindling, the A1R expression level (mRNA level was (1. 1483 ±0. 1182); Western blot result was ( 0. 7872± 0. 0621 ) ; immunofluorescence staining count was ( 76. 17 ± 4. 62 )/HP) was increased and A2aR (mRNA level was (0. 8338±0. 0572) ; Western blot result was (0. 2098 ±0. 0257) ; immunofluorescence staining count was (43. 83 ± 5. 12 )/HP) was decreased.The results showed statistically difference compared with the reference and normal groups (P< 0. 05 ). In the later chronic phase of 1 month and 6 months after kindling, the expression level of A1R was decreased and A2aR was increased. These data revealed statistically significant difference (P <0. 01 ). Furthermore, the comparison of the results in 1 month and 6 months after kindling found that the expression of AIR was lower in 6 months (mRNA level was (0. 5682 ±0. 0443) ; Western blot result was (0. 7749 ±0. 0262) ; immunofluorescence staining count was (38. 50 ±4. 81 )/HP) than in 1 month and that of A2aR was higher in 6 months (mRNA level was (1. 2169±0. 0332) ; Western blot result was (0. 7080 ±0. 0371 ); immunofluorescence staining count was (114. 50 ± 4. 04)/HP). The differences were statistical significant (t = - 19. 02--13.28, P < 0. 05). ConclusionsThe expressions of A1R and A2AR during and after kindling presents a bidirectional change. In the acute phas the expression of AR is regulated to suppress seizures. While in the chronic phase, the repeated seizures result in the change of A1R and A2aR expression in the opposite direction. This mechanism plays an important role in refractory seizures.

Objective To clinically analyze the frequent stroke localizations of moyamoya disease in order to improve our cognition toward it and reduce missed diagnosis. Methods All 32 patients were prospectively analyzed over the past 10 years in our hospital. Results The ratio of female to male was 1.28 and their age of onset ranged from 7 to 47 years old. Mean age of 5 ischemic stroke patients (15.6%) was 24 and mean age of 21 haemorrhagic stroke patients (65.6%) was 33 while mean age of 6 mixed type stroke patients (18. 8% ) was 32. The frequent ischemic stroke localizations were frontoparietal lobe (60%),temporo-occipital lobe (20%), and periventricular zone (20%). The frequent haemorrhagic stroke iocalizations were periventricular zone (42.8%), ventricle (39.2%), temporo-occipital lobe (10. 8%) and subarachnoid space (7.2%). No cerebellum and brain stem stroke occurred. Conclusion Adult patients usually develop intracranial hemorrhage. Moyamoya disease should be considered severely when adult patients develop periventricular and ventricular intracranial hemorrhage, frontoparietal cerebral infarction or adolescent patients develop ischemic stroke, especially companied with epilepsy.

Objective To investigate the effects of testosterone (T) replacement therapy (TRT) on carotid artery intima-media thickness (IMT) in middle aged and elderly male patients.Methods A total of 80 middle-aged and elderly male patients with testosterone deficiency and increased carotid artery IMT were selected and randomly divided into two groups:the treatment group (n=38,treated with testosterone for 1 year) and the control group (n=42,without any treatment).The serum T level,IMT and prostate-specific antigen (PSA) before and after treatment were determined.The correlation between the testosterone level and carotid artery IMT was analyzed.Results There were no significant differences in the serum T level and IMT between the control group and the treatment group before treatment [(10.39 ± 1.44) nmol/L vs.(10.88 ± 1.87) nmol/L,(1.25 ±0.11) mm vs.(1.24±0.13) mm,t=1.32,-0.26,P=0.191,0.794].Compared with pretreatment,the serum T level was significantly increased and the IMT was significantly decreased in the treatment group afterTRT [(10.88±1.87) nmol/L vs.(22.83±1.56) nmol/L,(1.24±0.13) mmvs.(1.18±0.16) mm,t=-29.14,2.55,P=0.000,0.015],while no significant differences in the serum T level and IMT were found in the control group before and after treatment [(10.39± 1.44)nmol/L vs.(9.99±1.72) nmol/L,(1.25±0.11) mm vs.(1.27±0.11) mm,t=1.24,-1.00,P =0.219,0.323].Linear correlation analysis showed that the serum T level was negatively correlated with IMT (r-0.605,P=0.000) and multiple regression analysis showed that the T level was an independent factor for IMT.Conclusions Testosterone replacement therapy is an effective treatment to alleviate IMT in middle-aged and elderly male patients,which may play an important role in preventing cardiovascular diseases in middle-aged and elderly male patients.

Objective To fabricate a novel tissue-engineered cartilage with adipose-derived stem cells (ADSCs) seeded on the chitosan hydrogel scaffold to repair articular cartilage defect.Methods Adipose tissue and costal cartilage were harvested from New Zealand rabbits,and ADSCs in passage one and chondrocytes were obtained after the samples were digested and cultured in vitro.ADSCs were digested,suspended,seeded onto the sterile chitosan gel,and cultured in vitro for 1 week to fabricate the tissue-engineered cartilage.The defects were respectively filled with the tissue-engineered cartilage (composite group),chondrocyte suspension (cell group),chitosan gel (material group) and nothing at all (control group).At postoperative 12 weeks,cartilage repair was evaluated using the gross examination,histological staining,immunohistochemical staining and international cartilage repair society (ICRS) histological score.Results Effect of cartilage repair in composite group was significantly better compared to other groups.The regenerated tissue in composite group seemed tightly bound in normal tissue,with similar structure and extracellular matrix secretion.ICRS histological score in composite group was (13.89 ± 0.14) points,which differed significantly from (7.06 ± 0.19) points in control group,(7.14 ± 0.22) points in cell group and (7.46 ± 0.26) points in material group (P ＜0.01).Conclusion The tissue-engineered cartilage with ADSCs seeded onto the chitosan hydrogel is effective for repair of articular cartilage defect.

The purpose of this study was to evaluate the effect of adenosine A2A receptor antagonist ZM241385 on amygdala-kindled seizures and its roles in epileptogenesis. Electrodes were implanted into the right amygdala of male adult Wistar rats. Kindling was accomplished by using stimulus strength of 500 μA applied daily to the amygdala until 10 consecutive stage 5 seizues were induced. Then effect of ZM241385 was studied in fully kindled rats after intracerebroventricular administration of the drug. In addition, the effect on kindling progression was evaluated through ZM241385 injection before daily stimulation. In all experiments, behavioral changes in the rats in response to ZM241385 were monitored closely. The results showed that, in fully amygdala-kindled rats, ZM241385 (0.001-0.1 nmol/L) decreased afterdischage duration (ADD), motor seizure duration (MSD), stage 5 duration (S5D) and seizure duration (SD), but only the effect on ADD was dose-dependent. The doses of 0.001-0.1 nmol/L had no influence on stage 4 latency (S4L) and seizure stage (SS). The dosages of 0.0001 and 1 nmol/L of ZM241385 did not exert any effect on all seizure parameters. In contrast to the results in fully amygdala-kindled rats, ZM241385 (0.001-0.1 nmol/L) had minimal or no effects on the progression of amygdala-kindled seizures. We are led to the conclusion that although ZM241385 had no influence on the progression of amygdala-kindled seizures, it had potent anti-convulsant profile and little adverse effects at the dosage of 0.001-0.1 nmol/L, suggesting that the agent is effective against the amygdala-kindled seizures.

Objective To observe the effect of flexible laryngeal mask (FLMA) in transnaso-sphenoidal microsurgery for pituitary adenoma on airway management and variation of stress response.Methods One hundred patients (71 males, 29 females, aged 18-65 years, BMI 21-28 kg/m2, ASA physical status Ⅰ or Ⅱ) undergoing transnaso-sphenoidal microsurgery for pituitary adenoma were randomly divided into two groups: the FLMA group (group F) and the reinforced endotracheal tube group (group T) using a random number table, 50 cases in each group.The plasma concentration of epinephrine and norepinephrine were measured before anesthesia induction (T0), at the time of inserting the FLMA or reinforced endotracheal tube (T1), 1 min (T2) and 5 min (T3) after insertion.The Berry scores of the preoperative and postoperative airway exposure by branchofiberoscope in group F were assessed.The time of removal of FLMA (endotracheal tube) and the occurrence of choking, laryngeal spasm, sore throat, hoarseness and other adverse reactions were recorded.Results The levels of epinephrine and norepinephrine were were significantly lower at T2 and T3 in group F than those in group T (P<0.05).There was no significant difference in airway Berry scores.The time of extubation was shorter in group F than that in group T [(9±3) min vs (17±6) min] (P<0.05).The incidence of choking (2% vs 22%) and sore throat (4% vs 30%) were significantly lower in group F than those in group T (P<0.05).Conclusion Compared with the reinforced endotracheal tube, FLMA can be applied safely and effectively to transnaso-sphenoidal microsurgery for pituitary adenoma, reduces stress respond associated with anesthesia and post-extubation complications, improves the recovery of patients.

OBJECTIVETo report a Chinese Han family with two patients of Leigh syndrome (LS) and to scan the mutation in mitochondrial DNA(mtDNA).

METHODSThe clinical features and the laboratory findings were summarized. Mitochondrial DNA chip and direct sequencing were performed to detect the mutation in entire mtDNA.

RESULTSFailure of thrive, psychomotor retardation, hypotonia and weakness, cerebellar ataxia, and seizure were the main manifestations of the family. Brain magnetic resonance imaging (MRI) showed lesions at midbrain, periaqueductal gray matter, dentate nuclei of cerebellar and thalami. The levels of lactic acid and pyruvate were mildly abnormal. The mutation of ND5*13513 G to A was identified in the LS family.

CONCLUSIONPatients with ND5*13513 G to A mutation may have a characteristic clinical course and ND5 *13513 G to A might be a preferential candidate mutation of Leigh syndrome.

Base Sequence ; Child, Preschool ; DNA, Mitochondrial ; genetics ; Electron Transport Complex I ; genetics ; Female ; Humans ; Infant ; Leigh Disease ; diagnostic imaging ; genetics ; pathology ; physiopathology ; Magnetic Resonance Imaging ; Male ; Mitochondrial Proteins ; genetics ; Polymorphism, Single Nucleotide ; genetics ; Tomography, X-Ray Computed