OBJECTIVETo investigate clinical outcomes of Kirschner wire as blocking screws combined with interlocking intramedullary nail internal fixation in treating tibial metaphyseal fractures (AO 43A).

METHODSFrom March 2011 to June 2012, 9 patients with tibial metaphyseal fractures were treated with blocking screws Kirschner wire combined with interlocking intramedullary nail, including 7 males and 2 females aged from 23 to 54 years old with an average of 37.4. Postoperative complications, X-ray were observed, AOFAS scoring were used to evaluate function after operation at 12 weeks.

RESULTSAll patients were followed up from 6 to 40 weeks (mean 20.1), and healed at stage I. No serious swelling, infection and skin necrosis occurred. No fracture instability and displacement appeaered at 4 and 8 week after operation. AOFAS score was (95.2±4.6) at 12 weeks after operation and 7 patients gained excellent result and 2 patients good.

CONCLUSIONKirschner wire as blocking screws with interlocking intramedullary nail for treatment of tibial metaphyseal fractures can fix well and perform simply.

Adult ; Bone Screws ; Bone Wires ; Female ; Fracture Fixation, Intramedullary ; methods ; Humans ; Male ; Middle Aged ; Tibial Fractures ; surgery

Epitope vaccine is one of the emerging vaccine techniques developing in past decade years.Particularly the advantages of this vaccine on preventing and therapy illness,as cancer and virus,are espacially outstanding.The most importent elements about the vaccine,namely T/B-epitopes obtainment and identification,vehicles for epitope and vaccine construction,are reviewed.In addition,applications of the vaccine technique in some refractory diseases,such as cancer,virus and pathogen infection,are depicted.

Objective To investigate the scope of application of precise hepatectomy and its value.Methods The clinical data of 112 consecutive patients with liver neoplasm who received hepatectomy at Renji Hospital from November 2006 to March 2009 were retrospectively analyzed.Precise hepatectomy technique was applied to 88 patients(precise group),whereas pringle maneuver was applied to the rest 24 patients(prince group).Patients in precise group had undergone lobectomy,segmentectomy or local resection,while patients in pringle group received segmenteetomy or local resection.The perioperative conditions of patients in the 2 groups were compared via Fisher exact probability and l test.Results No perioperative mortality,hepatic failure,reoperation due to massive hemorrhage or bile leakage was observed.The blood transfusion rate,blood loss,postoperative total bilirubin(Tbil),prothrombin time(PT)were 7%(2/29),220 ml,20 μmol/L,13 seconds in patients who received segmentectomy and local resection in precise group,and were 4%(1/24),210 ml,19μmol/L and 13 seconds in patients who received segmentectomy and local resection in pringle group,with no significant difference(t=0.248,0.263,0.246,P>0.05).The operation time,postoperative white blood cell (WBC)count.alanine aminotransferase(ALT)value and fever incidence were 60 minutes,7.5×10~9/L,66 U/L,10%(3/29)in patients who received segmentectomy and local resection in precise group,and were 15 minutes,14.0×10~9/L,335 U/L and 42%(10/24)in patients who received segmentectomy and local resection in pringle group,with significant difference(t=4.962,4.961,4.959,P<0.05).In precise group,the blood transfusion rate,postoperative WBC count,ALT value.PT and fever incidence were 9%(4/45),8.3×10~9/L,153 U/L,17 seconds and 13%(6/45)in patients who received Iobectomy,and were 12%(5/43),8.2×10~9/L,133 U/L,14 seconds and 14%(6/43)in patients who received segmentectomy or lncal resection,with no significant difference (t=1.652,1.225,1.236,P>0.05);the blood loss,operation time and postoperative Tbil level were 350 ml,250 minutes and 32μmol/L in patients who received lobectomy.and were 240 ml,150 minutes and 21 μmol/L in patients who received segmentectomy or local resection(t=4.915,4.967,4.829,P＜0.05).Conclusions Precise hepatectomy can decrease damage to patients,but it should be applied in selected patients according to the tumor location and the excision range.Precise hepatectomy is recommended to be applied in lobeetomy.

The evaluation of the immunosuppression state in liver transplanted recipients is vital for a correct posttransplantation management and a major step towards the personalized treatment of the immunosuppression.To date,immunological monitoring after liver transplantation relies mainly on clinical judgment and pathological examination of the graft,without a proper assessment of the actual state.Previous studies have ever identified many markers for acute rejection(AR) and immune tolerance after liver transplantation.Many markers for AR are pro-inflammatory or immunoregulatory cytokines and other proteins related to inflammation.However,many markers have been proved to be also able to predict other diseases and only a few of the markers for AR have been validated.Standard liver tests cannot be used as markers for graft rejection due to the low sensitivity and specificity.This review summarized the potential markers for AR and immune tolerance after liver transplantation based on published literatures in recent years and to provide evidence for clinical application.

Objective To explore the association between glycated hemoglobin (HbA1c) level at admission and coronary plaque characteristics under intravenous ultrasound (IVUS) study in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS). Methods 118 patients with NSTE-ACS were divided into the low(HbA1c ≤ 5.6％), medium(HbA1c 5.7％-6.4％)and high(HbA1c ≥ 6.5％)level groups based on admission HbA1c. IVUS was performed in all target lesions. Results As compared with the other two groups, patients with high level HbA1c had higher mean body weight index, higher co-morbidities of diabetes mellitus, dyslipidemia and non-ST-elevation acute myocardial infarction.The high HbA1c level group had more diffuse coronary atherosclerosis ,increased plaque burden and higher rates of positive remodeling, soft plaque and plaque rupture. Conculsions The HbAlc level of admission is associated with plaque vulnerability in NSTE-ACS patients.

Objective To explore early diagnosis and treatment of congenital esophageal atresia and tracheoesophageal fistula.Methods Clinical data of 11 patients with congenital esophageal atresia and tracheoesophageal fistula were analyzed retrospectively.Definite diagnoses were made for all cases in 24 hours through making an esophagus opacification with acetrezoic acid or iodinated oil.And an esophagus anastomosis outside pleura was made.Some experience of diagnosis and therapy were summarized.Results All of the 11 cases underwent operation.Among them,9 cases were cured (81.8%),and 2 cases died(18.2%).Anastomosis stenosis of esophagus was found in 1 case after operation,which was cured through esophagus dilatation.Tracheoesophageal fistula was found in another case after operation and it was cured through combined treatment including anti-infection, nutritional support and sufficient draining.Conclusion Early diagnosis and surgical treatment, postoperative care,prevention and cure of complication are very important to improve the survival rate of the patients with congenital esophageal atresia and tracheoesophageal fistula.

Objective To compare the detection efficiency between multiplex RT-PCR method and liquichip technology for screening the viral etiological agents of diarrhea.Methods The development of the multiplex RT-PCR method.A total of 107 feces samples from patients who suffered from diarrhea and attended to Zhujiang Hospital of Southern University from September 2013 to February 2014 were collected and tested in parallel by both multiplex RT-PCR and xTAG Gastrointestinal Pathogen Panel ( xTAG GPP) for Adenovirus, Norovirus genogroupⅠandⅡ, as well as by both multiplex RT-PCR and monoplex RT-PCR for Astrovirus and Sapovirus.To evaluate the sensitivity and specificity of multiplex RT-PCR, xTAG GPP and monoplex RT-PCR were used as reference.Kappa coefficient test was used to evaluate the consistency among the methods.The detection limit and accuracy of multiplex RT-PCR were evaluated by detection of serial dilution of positive plasmids and products sequencing for the five viral agents.Results The multiplex RT-PCR showed high consistency with xTAG GPP and monoplex RT-PCR, in which Kappa value was 0.885 and 1.000 respectively( P=0.000 ).Compared to xTAG GPP, the sensitivity and specificity of the multiplex RT-PCR were at average of 80.8%( 21/26 ) and 100%( 295/295 ) respectively.The detection limit and accuracy of multiplex RT-PCR were 104 copies /μl-106 copies/μl.Conclusion The high consistency indicated that both the multiplex RT-PCR and xTAG GPP are useful as a special,sensitive, high throughput and rapid diagnostic tools for the detection of the major viral pathogens related to diarrhea in clinical laboratory.

Objective To compare the metabolic characteristics, dosages and blood concentrations of tacrolimus (Tac) in patients subject to cadaveric liver transplantation (CLT) vs living-donor partial liver transplantation (LDLT) in order to investigate the usage of Tac in patients undergoing LDLT. Methods The clinical data of 85 patients undergoing liver transplantation from April 2007 to September 2009 were analyzed retrospectively. Thirty-four underwent LDLT (group A)and the remaining 51 underwent CLT (group B). Results The time to reach therapeutic window was shorter in group A (3. 4 ± 1.0 days) than in group B (4. 5 ± 2. 0 days, P = 0. 002). The Tac dosage in group A was significantly less than in group B during the first 28 days post-transplantation. However,the Tac dosage approached gradually and tended to be consistent after 28 days. On the postoperative day7, 14, 21 and 28 days, the Tac dosage in group A was 72.74 ％, 82.26 ％, 83.92 ％ and 88. 87 ％ of that in group B respectively. Correlation analysis revealed that graft-recipient body weight ratio (GR/WR) was significantly correlated with the Tac dosage on the day 7 (mg·day-1 · kg-1) (r =0. 728, P＜0. 01) and Tac concentration/dosage ratio (ng/ml)/(mg/kg) (r = - 0. 644, P＜0. 01 ).Conclusion The early Tac dosages in patients subject to LDLT were correlated significantly with the volume of graft. The early Tac dosages in patients undergoing LDLT were about 70 ％ of those in patients undergoing cadaveric liver transplantation. Moreover, with the regeneration of the liver, they tended to be consistent after 28 days.

BACKGROUNDDepression related cognitive deficits are frequently considered as simple epiphenomena of the disorder. However, whether or not the depression might directly bring about cognitive deficits is still under investigation. This study was to investigate the distinct pattern of cognitive deficits in patients with depression by comparing the cognitive function before and after anti-depressive drug therapy.

METHODSSixty cases of patients, first-time diagnosed with depression, were assessed by 17-item Hamilton Rating Scale for Depression (HAMD17scale). The memory ability was tested by quantitatively clinical memory scale, while the attention ability by modified Ruff 2&7 Selective Attention Test. Forty-two healthy volunteers were recruited as controls. The depressive patients were treated with Venlafaxine (75 - 300 mg/d), Fluoxetine (20 - 40 mg/d), Paroxetine (20 - 40 mg/d), and Sertraline (50 - 150 mg/d). After 12 weeks treatment, patients were tested again by HAMD17scale, quantitatively clinical memory scale, and modified Ruff 2&7 selective attention test to assess the effect of anti-depressive drugs on cognitive deficits.

RESULTSThe memory quotient (MQ) was significantly lowered in depressive patients. The selection speed was also significantly decreased and the number of missing and error hits increased in the depression group as compared to control. However, there was no significant difference in clinical memory scale and Ruff 2&7 selective attention test between mild-to-moderate and severe depression group. Importantly, after anti-depressive drug therapy, the HAMD17 scale scores in depressive patients were significantly decreased, but the MQ, directional memory (DM), free recall (FR), associative learning (AL), and face recognition were comparable with those before the treatment. Furthermore, the selection speed and the number of missing and error hits were also not significantly different after anti-depressive drugs treatment.

CONCLUSIONSDepressive patients suffer from short-term memory deficits, and attention extent, stability and rearrangement deficiency. Even though anti-depressive drugs sufficiently relieve the cardinal presentation of depression, they could not successfully alleviate the accompanying cognitive deficits. This might indicate a distinct pattern of cognitive deficits in patients with depression.

Adolescent ; Adult ; Antidepressive Agents ; therapeutic use ; Cognition Disorders ; etiology ; physiopathology ; Depression ; complications ; drug therapy ; physiopathology ; Female ; Humans ; Male ; Memory ; drug effects ; physiology ; Middle Aged ; Neuropsychological Tests ; Young Adult

ObjectiveTo surnmarize the experience of tacrolimus or cyclosporine A-based immunosuppression after pediatric living-donor liver transplamation.Methods The clinical data of 30 children undergoing living-donor liver trarsplantation from October 2006 to January 2010 were analyzed retrospectively.In 30 patients,7 were given Tac-based immunosuppression (group A),10 given CsA-based immunosuppression (group B),and 13 switched from CsA to Tac for complications or adverse effects of drugs.Dosages and blood concentrations of immunosuppressants were recorded.Changes of liver and kidney functions were monitored.Incidence of rejection,infection and adverse effects of drugs were observed.ResultsIn the premise of the stable concentration and liver and kidney functions,the weight of children was increased by about 50％ and the per- kilogram dosage of CNIs was decreased significantly 1year postoperatively.There was no case of rejection in group A and 4 cases of rejection in group B(40％,4/10),and the original symptoms were gradually alleviated after the increased dosage in immunosuppressants.During the first 3 months,there was 1case of abdominal infection in group A (1/7) and 3 cases of lung infection in group B (3/10),and the original symptoms were gradually alleviated after anti-infective therapy.There was 1CMV lgM-positive case in group A (1/7) and 2 CMV IgM-positive cases in group B (2/10),and the original symptoms were gradually alleviated after using ganciclovir.The original symptoms of the 13 children switched from CsA to Tac were gradually alleviated.ConclusionThe two CNIs can be safely used in children undergoing pediatric livlng-donor liver transplantation.Both of them show the same effect in promoting the restoration of liver and kidney functions,but tacrolimus has more satisfactory effect in inhibiting the rejection and it has leas adverse effects.