Objective To seek an effective method for the treatment of grade ⅢB tibial fractures.Method From Oct. 1985 to Oct.1999, 26 cases of grade ⅢB tibial fractures were treated by early soft tissue coverage(including 12 cases of free muscle flaps and 14 cases of local muscle flaps), early fracture fixation(including 21 cases of external fixation and 5 cases of non-reamed intramedullary nail) and early bone grafting(15 cases).Results The follow up duration were from 10 to 32 months with an average of 15.5 months. The success rates of free and local muscle flaps were respectively 91.7 %(11/12) and 92.9 %(13/14)?Infection occurred in 5 cases (3 cases of local superficial infection and 2 cases of osteomyelitis). The time for bone union were from 17 to 66 weeks with an average of 42 weeks. Conclusion "San-Zao"therapy,especially early soft tissue coverage and early fracture fixation is on effective management for grade ⅢB tibial fractures with the advantages of promoting wound healing and bone union and decreasing the possibility of infection.

BACKGROUND: Pathological changes of form and structure are induced in some tissues during repairing albuginea penis trauma, while structure and component of collagen fiber will be correspondingly changed necessarily.OBJECTIVE: To find a convenient, shortcut, and sensitive method to observe the dynamic change of type and distribution of collagen fiber during albuginea penis healing. DESIGN, TIME AND SETTING: A contrast study was performed at the Laboratory of Tissue Engineering, Guiyang Medical College between June 2005 and October 2007. MATERIALS: Fifteen male New Zealand rabbits were used in this study. METHODS: All rabbits underwent an excision of albuginea sizing 5 mm×5 mm at dorsal penis to establish models of albuginea penis trauma, and then the excision was sutured in situ. Thereafter, albuginea penis was obtained from five rabbits once after 2, 6, and 12 weeks. The samples were treated with picric-sirius red staining and observed under polarizing microscope. MAIN OUTCOME MEASURES: Dynamic changes of area of collagen fiber during albuginea penis healing.RESULTS: There were significant differences in content of the same collagen fiber at different time points (P<0.05). At 2 weeks post-trauma, both type Ⅰ and type Ⅲ collagen fibers were observed, and the ratio was equal, but the arrangement was confused and disorder. At 6 weeks post-trauma, red and yellow type Ⅰ collagen fiber was apparently increased, but type Ⅲ collagen fiber was decreased, and the arrangement was still disorder. At 12 weeks post-trauma, thick, bright red and yellow type Ⅰ collagen fiber was rapidly increased, but thin and green type Ⅲ collagen fiber was rapidly decreased.CONCLUSION: Picric-sirius red polarized light method can not only differentiate types of collagen fiber, but also clearly display the distribution, form and proportion of type Ⅰ and type Ⅲ collagen fiber, characterizing by simple, convenient, specific, and highly sensitive.

Objective To explore the application of integrating 64-slice CT image with three-dimensional electroanatomic mapping(Carto-Merge) in guiding catheter ablation of atrial fibrillation(AF).Methods Fifteen patients with drug-refractory AF received catheter ablation of AF.64-slice CT scan was performee 1-3 days prior to the ablation procedures.Using a novel software package,the left atrium(LA)with PVs was segmented and extracted for image registration with a combination of landmark registration and surface registration.Results The integration of the CT image into the electroanatomic mapping system was performed successfully in all patients with an error of 2.11?0.82 mm.Thirty pairs of PVs were electrically isolated after circumferential rediogrequency pulmorary rein ablation.The mean procedure time was 170.51?38.47 minutes.Cardiac tamponade occurred in one patient.All the fifteen patients were free of AF recurrence after 3 months of follow up including the 2 cases of persistent AF who required antiarrhythmic drugs.No thromboembolic events or stenosis were observed.Conclusion Integration of 64-slice CT image into the CARTO system successfully performed in patients undergoing catheter ablation of AF and enhance the ablation success rate.

Objective: To explore influence of p38 mitogen-activated protein kinase (p38MAPK) inhibitor on myocardial cell apoptosis and expression of tumor necrosis factor (TNF)-α in rats with ischemia/reperfusion (I/R) injury. Methods: According to number table method, a total of 30 SD rats were randomly and equally divided into blank control group, I/R group and inhibitor group. p38MAPK mRNA expression, TNF-α level and myocardial cell apoptotic rate were measured, compared and analyzed among three groups. Results: Compared with blank control group, there were significant increase in TNF-α level [(3.68±0.16) μg/L vs. (5.02±0.09) μg/L], p38MAPK mRNA expression [(1.76±0.46) vs. (2.35±0.02)] and myocardial cell apoptotic rate [-(3.51±0.40) % vs. - (1.8±0.23) %] in I/R group, P=0.001 all. Compared with I/R group, there were significant decrease in p38MAPK mRNA expression (2.09±0.16), TNF-α level [(4.15±0.11) μg/L] and myocardial cell apoptotic rate [-(2.9±0.50) %] in inhibitor group, P=0.001 all. Conclusion: Inhibition of p38 mitogen-activated protein kinase expression in myocardium of rats can decrease production of tumor necrosis factor-α and myocardial cell apoptosis, then relieve ischemia/ reperfusion injury of myocardial cells.

AIDS has become a global disease,and a variety of drugs are used in the treatment of AIDS ,but the interindividual variabilities in efficacy and toxicity remain important limitations for the use of these drugs.Studies have shown genetic polymor-phism is the main reason for interindividual variabilities of drug reaction.In recent years,scholars focused on the pharmacog-enomics of anti-AIDS drugs and found that genetic polymor-phisms,in large part,determine the interindividual variabilities of the responese of these drugs.This paper reviews the research progress on pharmacogenomics of the four types of anti-AIDS drugs commonly used in China,including nucleoside reverse transcriptase inhibitors (NRTIs),non-nucleoside reverse tran-scriptase inhibitors (NNRTIs),protease inhibitors (PIs)and integrase inhibitors (raltegravir).

Objective:To obverse the therapeutic effect of superficial needling with different frequencies for intractable facial paralysis. Methods: A total of 120 patients with intractable peripheral facial paralysis were allocated into a superficial needling with high frequency group (150 times/min), a moderate frequency group (100 times/min) and a low frequency group (50 times/min) according to the random number table method. The Toronto facial grading system (TFGS) was used to evaluate facial nerve functions before treatment and after 2 weeks and 4 weeks of treatment respectively. The electromyography (EMG) test of the mandibular branch of facial nerve was used to compare the motor nerve conduction velocity (MCV), sensory nerve conduction velocity (SCV) and monophasic action potential (MAP) among different groups, and was done before treatment and after 4 weeks of treatment. The clinical efficacy was also compared. Results: After 2 weeks and 4 weeks of treatment, the changes of TFGS scores in the three groups all showed statistical significance (all P＜0.05), and the TFGS score in the low frequency group was substantially higher than that in the other two groups. After treatment, the changes of the MCV and SCV in the three groups all showed statistical significance (all P＜0.05), and the results in the low frequency group were higher than those in the other two groups; the change of MAP in the three groups showed no statistical significance (P＞0.05). The total effective rate was 65.0%, 80.0% and 95.0% in the high frequency group, moderate frequency group and low frequency group respectively, and the between-group differences showed statistical significance (P＜0.05). Conclusion: Compared with the superficial needling with high and moderate frequencies, superficial needling with low frequency can produce more significant clinical efficacy for intractable facial paralysis.

Objective:To analyze the clinical characteristics and treatment effect between bilateral(bi-)and unilateral(uni-) sudden sensorineural hearing loss(SSNHL).Method:Four hundred and eighty cases of SSNHL were retrospective study,which were divided into two groups of bi-SSNHL(n=40) and uni-SSNHL(n=440).Clinical characteristics and treatment effects were compared of the two groups.Result:The incidence rate of bi-SSNHL was 8.3 percent and uni-SSNHL was 91.7 percent of all patients with SSNHL. Bi-SSNHL occurs more commonly in patients of old age, diabetes mellitus, and lipid panes abnormalities compared to uni-SSNHL. Twenty-eight ears in the bi-SSNHL group showed hearing recovery (35%),compared with 56.4 percent of patients with uni-SSNHL.Conclusion:Bi-SSNHL and uni-SSNHL may have a completely different clinical characteristics and treatment effect,that implies a different pathophysiology and prognosis. Recognition their different clinical characteristics and treatment effect between bilateral and unilateral SSNHL can help in counseling and managing the patients and correctly evaluate the prognosis.

Objective To investigate the efficacy and safety of laparoscopic radiofrequency ablation (RFA) therapy for hepatocellular carcinoma.Methods Clinical data of 78 hepatocellular carcinoma patients undergoing laparoscopic radiofrequency in Beijing China-Japan Friendship Hospital from May.2008 to July.2010 were reviewed retrospectively.Age ranged from 31 to 87 years,41 were male and 37 were female.Intraoperative ultrasound-guided needle biopsy was performed and diagnosis of hepatocellular carcinoma was established in all cases before RFA was carried out.Data analysis was performed using software SPSS or OriginPro7.Necrosis,local recurrence of the tumor and the cumulative survival rate were analyzed by Kaplan-Meier test and x2 test.Results The median follow-up time was 16 months after RFA treatment.Tumor size,proximity to intrahepatic vessels and combination with TACE were factors that influence local recurrence.The complete ablation (CA) rate was remarkably higher in tumors ＜ 3 cm than in tumors ＞ 3 -5 cm (90.5％ vs 71.4％,x2 =4.291,P =0.038 ).Tumors adjacent to major vessels had a significantly lower CA rate as compared with those not adjacent to them (63.6％ vs 91.9％,x2 =6.351,P =0.012).The CA rate were 88.9％ in the TACE ± RFA group and 75.0％ in the RFA group ( x2 =1.567,P =0.211 ).The mean overall survival were 48.7 ± 2.4 months,the cumulative survival rate was 86.1％ at 1 year、76.9％ at 2 years、60.3％ at 3 years、51.8％ at4 years and 33.1％ at 5 years.Conclusions Laparoscopic RFA is safe,mini-invasive and effective for unresectable hepatic carcinoma with a favorable long term survival.

Objective To investigate the impact of thyrotropic hormone (TSH) on recurrence rate of common bile duct stone (CBDS).Methods The clinical data of 268 cases of primary or recurrent CBDS undergoing surgery was analyzed.According to whether screening preoperative TSH level routinely,we assigned the patients into two groups,unchecked group with 171 cases and screened group with 97 cases.The postoperative recurrence rates in 36 months between two groups were compared.Results The recurrence rates of unchecked group and screened group were 3.5％,12.9％,16.9％ and 0.0％,5.2％,8.2％ respectively in 12-,24-,36-months,there was statistically significant difference between two groups (x2 =4.029,P ＜ 0.05).In unchecked group,patients ≥ 60 years had a significant higher recurrence rate than ＜ 60 years patients (x2 =6.485,P ＜ 0.05).In screened group,there was no statistically significant difference between ≥60 and ＜ 60 patients (x2 =0.142,P ＞ 0.05).In those 34 patients with a high TSH level in the screened group,normalizing the level from (6.23 ± 1.44) μIU/ml to (2.91 ±0.74) μIU/ml by oral intake of thyroid hormone postoperatively,led to the recurrence rates of 0％,5.9％,8.8％ in 12-,24-,36-months,which was not significantly different from those with normal TSH (x2 =0.022,P ＞ 0.05).And that,there was not statistically different between the young and elder patients in those 34 cases for the 12-,24-,36-month recurrence rates (x2 =0.086,P ＞ 0.05).Conclusions Some CBDS patients may be with high level of TSH.Normalizing TSH level may be conducive to a reduced postoperative recurrence rate of CBDS.

Adult ; Female ; Humans ; Paraquat ; poisoning