Objective To introduce the experience of treating high energy P il on fractures with an articulated external fixator. Methods From March to June 20 01, twelve patients (13 fractures) suffered from high energy Pilon fractures wer e treated with an articulated external fixator (Orthofix, Italy). The fixators w ere placed medially across the ankle joint, if necessary, fixation of fracture w as enhanced with combination of limited internal fixation. The main injury was c aused by traffic accident and high altitude dropping. The distal two pins were i nserted into the neck of the talus and the tuberosity of the calcaneus so that s ubtalar joint was treated as an axis during ankle movement. At approximately pos toperative two weeks, the articular hinge was released and the patient began ank le exercises. The clinical outcomes and complications were investigated and the postoperative of X-ray examination of ankle were also evaluated. Results Twelve patients were followed up with a mean period of 12 months. No infections of woun d and pin sites and no neurovascular complication was found. According to Teeny & Wiss ankle joint scoring system, the symptom and functional evaluation of the ankle was scored from 74 to 94 (average 87). Clinical results demonstrated 2 exc ellent, 7 good, 4 fair. Quality of reduction of the articular surface showed 7 g ood and 6 fair using system of Marsh classification of reduction of the articula r surface of the ankle. Conclusion External fixation with an articulated fixator combined with limited internal fixation is a satisfying technique to treat high energy Pilon fractures. This technique helps to effectively decrease both wound and bone healing complications. With advantage of restoring anatomical articula r surface and enabling early ankle joint motion, this technique also helps to pr event ankle joint stiffness after fixation. The short term result of the above-m entioned fixation is encouraging.

Objective To compare the isometric muscle strength of muscle groups in the lower extremities of children with spastic hemiplegia among sides or ages. Methods17 spastic hemiplegic children were measured the muscle strength of hip, knee and ankle muscle groups with hand-held dynamometry (HHD). ResultsMuscle strength was weaker in the involved side than in the other side. In younger children, it was weaker of overall extremity, while in the older it was of the distal end mainly. ConclusionWhen applying strength training to spastic hemiplegic children, it is important to notice strength of all groups in lower extremity in younger children and the distal groups in older ones.

Objective To compare the long term outcomes of delayed or primary percutaneous transluminal coronary intervention(PCI) with concervative drug therapy for acute myocardial infarction(AMI).Methods The data of 276 patients with AMI hospitalized during January 1996 to October 2003 were analyzed retrospectively.The patients were divided into three groups including: primary PCI group(75 cases underwent primary PCI within 12 hours of symptom onset),delayed PCI group(73 cases underwent delayed PCI after 24 hours symptom onset) and conservative drug therapy group(128 cases without PCI treatment).Major adverse cardiac events(MACE) were recorded during the follow-up period(mean 4.3?2.7 years).Echocardiography was carried out and long-term mortality rate was recorded during follow-up.Results The Baseline characteristics of the three groups were similar except elevation in ST segment and in-hospital duration which were significantly different in the primary PCI group.The percentage of follow-up completion was 89.5%(247/276).The in-hospital mortality of the conservative therapy group was higher than both PCI groups.The LVEF of the delayed PCI group,primary PCI group and the conservation therapy group were 57.4%?3.4%,59.3%?7.5% and 54.7%?4.1% respectively.There was 1 deceased case in both the delayed and primary PCI group but 14 cases in the conservative group.There was no significant difference between the two PCI groups in terms of combined end point of death and clinical events different.Conclusion Compared with conservative drug therapy,delayed PCI can further improve the long-term prognosis of STEMI patients.

Objective:To investigate the effect of nimodipine on the cognitive ability of the Alzheimer disease (AD) patients and to presume its mechanism.Method:60 patients with AD received their examinations and treatments in our hospital from January to December,2006.The data included the patients' disease histories,physical examinations and radiological checks.All the patients were randomly divided into two groups,Nimodipine group ( N group) and controlled group (C group).N group was given nimotop 30mg tid orally,while C group was treated with neuroxin 200mg tid.The pa- tients' cognitive and daily life abilities were accessed by MMSE and ADL in the first day and the twelfth week from the be- ginning of the treatment.All the data were analyzed by SPSS 10.0.Result:Compared with those of the controlled group, the cognitive and daily living abilities of N group patients' were improved significantly in 12 weeks after the treatment by ni- modipine (P

Objective To assess the value of exercise treadmill testing (bruce protocol) in diagnosing early atherosclerotic lesions of the lower limb. Methods Between March and September 2008, 173 outpatients with high risks of peripheral arterial disease (PAD) were enrolled randomly from the cardiology clinic of Chinese PLA General Hospital. The patients were subjected to exercise treadmill testing (Bruce protocol) and ankle-brachial index (ABI) determination, as well as lower limb artery ultrasonography within one week. Using ultrasonic findings as diagnostic criteria, the diagnostic sensitivity, specificity, positive likelihood ratio and negative likelihood ratio of exercise treadmill testing for early atherosclerotic lesions of the lower limb were analyzed, and the diagnostic value of exercise treadmill testing was assessed using the ROC curve. Results After exercise, ABI decrement (R value) increased in subjects with high risks for PAD with atherosclerotic lesions of the lower limb aggravating. Using the presence of large atherosclerotic plaques (area > 20 mm2 ), atherosclerotic plaques and atherosclerotic lesions in lower limb arteries as positive diagnostic criteria, the area under curve of ROC was 0. 80 (95% CI: 0.72-0.88), 0.78 (95% CI: 0.71-0.85) and 0. 60 (95% CI: 0.44-0.76), respectively. Using the presence of large atherosclerotic plaques in lower extremities as positive diagnosis, R value was 0.80, with a sensitivity of 54. 0%, a specificity of 96. 7%, a LR+ of 16. 4, and a LR- of 0. 58, meanwhile, R value was 0. 85, with a sensitivity of 70.0%, a specificity of 91.9%, a LR + of 8.64, and a LR- of 0.33. Conclusions Exercise treadmill testing (Bruce protocol) in combination with ABI determination is a safe, accurate, objective tool for detecting early atherosclerotic lesions of the lower limb. Immediately after exercise, 0.85 is the cut-off R value appropriate for diagnosing large atherosclerotic plaques of the lower limb (area > 20 mm2).

Objective To evaluate the performance of polymerase chain reaction (PCR)‐based rapid detection of methicillin‐resistant S .aureus (MRSA) from the respiratory specimens of ICU patients in comparison with conventional sputum culture . Methods We collected 3 respiratory specimens from each patient simultaneously for bacterial culture ,fungal culture and PCR‐based detection of MRSA .The performance of the established PCR method was compared with the results of sputum culture in terms of sensitivity ,specificity ,positive predictive value (PPV) and negative predictive value (NPV) .Results The sensitivity , specificity ,PPV and NPV of PCR assay were 88 .9% ,73 .6% ,36 .4% ,and 97 .5% ,respectively ,which were lower than the reported results of PCR assay with nasal swabs .Conclusions The utility of PCR assay for active screening of MRSA from respiratory specimens still needs further supportive data .However ,PCR assay is somewhat informative in excluding MRSA infection or colonization because of its high NPV .

Objective To explore the preventive and therapeutic role of silencing type Ⅰ rat platelet-binding protein motifs depolymerization protein-like metalloproteinase 2(ADAMTS2)by siRNA on experimental liver fibrosis in vitro.By studying the mechanism of siRNA silencing of ADAMTS2,we also aim to evaluate the feasibility of ADAMTS2 as a target for anti-liver fibrosis therapy.Methods Three pairs of siRNAs targeting ADAMTS2 mRNA 2237,2597 and 690 targets were designed and synthesized by utilizing RNA design software.The most effective siRNA was chosen to transfect HSC-T6 cell line to test the tendency of hepatic stellate cell(HSC)activation and ex pression of ADAMTS2,COL1α1,COL(I),α-SMA,TGF-β1,MMP-2 and TIMP-3.These were quantified using real time-PCR,Western blotting,and MTT assays.Results Of the same dosage and time of injection,siRNA 2237 inhibited ADAMTS2 gene expression significantly more than other siRNAs.siRNA-ADAMTS2 2237 markedly inhibited ADAMTS2 gene and protein expression of HSCT6 with more than 80％ efficiency.Conversely,siRNA-ADAMTS2 2237 markedly reduced the gene and protein expressions of COL(I),α-SMA and TGF-β1 on HSC-T6 and inhibited the proliferation of HSC.Conclusions siRNA-ADAMTS2 2237 could effectively knockdown the gene and protein expression of ADAMTS2 in HSC-T6 cell lines.Silencing ADAMTS2 by siRNA significantly inhibited the activation,proliferation of HSC and the gene and protein expressions of COL(I),α SMA,and TGF-β1,and it may have a potential anti-fibrotic effect.ADAMTS2 might be an efficient target for anti-fibrotic therapy.

Objective To explore the incidence and clinical treatment of related complications caused by implantable venous access port(IVAP) in patients with breast cancer during chemotherapy.Methods The data of 755 patients with breast cancer recieved chemotherapy by which caused some related complications in our hospital from January 2014 to March 2016 were retrospectively analyzed.Results 753 patients IVAPs were implanted succussfully.The total placement time of implantable venous access port was from 110 days to 940 days,with median placement 147.33 days.The related complications of IVAP were catheter malposition(0.79％,6/755),catheter-related thrombosis(27.81％,210/755),catheter fracture(0.13％,1/755),port exposure(0.93％,7/755) and IVAP-related bloodstream infection(0.13％,1/755).The IVAP-related complications and thrombosis rate were significant higher when IVAPs implanted in the left internal jugular veincompared with that in right internal jugular vein(34.88％ vs.25.74％,33.10％ vs.24.68％).Conclusion Application of IVAP in patients with breast cancer during chemotherapy is a safe and effective operation.The most common complication is asymptomatic mural thrombus formation around the catheter,which should be paid attention to.

Objective To evaluate the clinical value and the early therapeutic efficacy of hysteromyomas treated with the radiofrequency ablation (RFA) by two-dimensional contrast-enhanced ultrasound(2D-CEUS) and three-dimensional contrast-enhanced ultrasound(3D-CEUS). Methods A total of 90 patients with 150 hysteromyomas were treated with RFA, including 138 intramural myomas and 12 submucous myomas (in which 5 had micr-pedicles). 2D-CEUS and 3D-CEUS were performed within one day before and after RFA treatment, respectively. The blood supply of focal zone(FZ) was observed by 2D-CEUS and 3D-CEUS. The volume of hysteromyomas and the coagulation necrosis range were measured by 3D-CEUS. The average necrotic rates of hysteromyoma were calculated. Results The 5 submucous myomas with micr-pedicles were removed completely after the RFA treatment. The 2D-CEUS appearances of other 145 hysteromyomas were diverse after the RFA treatment, in which 137 FZs had no contrast infusion,indicating complete ablation, 8 FZs appeared peripheral linear or small flaky enhancement, considering incomplete treatment. The 3D-CEUS performances were variant too, in which 132 FZs vascular network displayed as a "cavity", indicating complete tumor necrosis, the other 7 FZs appeared "branch shape" low enhancement and another 6 FZs showed nonuniform low enhancement, considering residual tumor tissue. The average necrotic rate of the 139 hysteromyomas was (97.1 ± 12. 9)% ,another 6 hysteromyomas was only (46. 4 ± 7. 0) %. Conclusions 3D-CEUS can display vascular structure and spatial relationship of the hysteromyomas, which can be used as the complement of 2D-CEUS. The combination of the two techniques can evaluate the earlier therapeutic efficacy of hysteromyomas by RFA more timely, intuitively and accurately.

ObjectiveTo investigate the changes and significance of urine kidney injury molecule-1(KIM-1) in liver transplant recipients concurrent with early-stage acute kidney injury (AKI).MethodsThe clinical data of orthotopic liver transplantation in 50 cases was retrospectively analyzed.According to the Acute Kidney Injury Network (AKIN) criteria and whether there was AKI for recipients after operation,the recipients were divided into AKI group (27 cases) and non-AKI group (23 cases).Serum creatinine (SCr),urine creatinine (UCr) and urine KIM-1were determined at the scheduled time points,and relationship between urine KIM-1and AK1was analyzed.By using the receiver operating characteristic (ROC) and the area under the curve (AUC),the diagnostic accuracy of urine KIM-1for AKI was evaluated.ResultsThe level of SCr reached the highest in two groups at 24 h postoperation,that in AKI group was significantly higher than in non-AKI group (P＜0.05),and then gradually decreased to the preoperative level.The level of urine KIM-1was significantly increased immediately at the time of portal vein reperfusion in two groups,and that in AKI group reached the peak at 2nd h after portal vein reperfusion,significantly higher than in non-AKI group (P＜0.01),which continued 12 h after the portal vein reperfusion.The results showed that the sensitivity was 82.6％ and the specificity was 88.9％ when the urine KIM-114.19 ng/g Ucr was taken as the cutoff to the diagnosis of AKI two h after portal vein repeffusion.ConclusionThe level of urine KIM-1is a reliable biomarker to diagnose AKI after liver transplantation.The intraoperative changes of urine KIM-1may be helpful to early prediction of AKI,for recipients with preoperative normal renal function.