Objective To discuss the timing and methods of operative treatment of acetabular fractures of AO Type C (double- column fractures). Methods From February, 1999 to January, 2004, we treated operatively 46 cases of AO Type C acetabular fractures, including 23 cases of C- 1 type, 14 cases of C- 2 type, and 9 cases of C- 3 type. 15 cases were treated through ilioinguinal approach, 10 cases through improved Kocher- Langenbeck approach, and 21 cases through combined anterior and posterior approaches. There were 3 groups of patients according to the time from injury to operation: 15 cases got operation within 1st week after injury (Group A); 23 cases within 2nd week (Group B); 8 cases within/after 3rd week (Group C). All of them were checked with radiography and 3D CT scan before and after operation. Results 34 cases( 73.9% ) obtained anatomical reduction, 8 cases( 17.4% ) got imperfect reduction, and 4 cases( 8.7% ) had unsatisfactory reduction. All the patients were followed up for 1 year to 4 years, averaging 31 months. According to D' Aubigne and Postel Hip Score, joint function was rated as excellent in 32 cases( 69.6% ) , good in 5 cases( 10.9% ) , fair in 5 cases ( 10.9% ) and poor in 4 cases ( 8.7% ) . As far as reduction was concerned, there was a significant difference (P0.05). As far as joint function was concerned, there was a significant amelioration in Groups A and B compared with Group C (P0.05) between group A and Group B. Conclusions Good knowledge of AO classification of acetabular fractures combined with particular radiological data can result in correct diagnosis of Type C acetabular fractures. Operations should be carried out within 2 weeks after injury and efforts should be made to ensure anatomical reduction. To achieve good clinical results in treatment of Type C acetabular fractures, suitable approaches and correct reduction and internal methods are essential

Objective To investigate the role of NF-?B in the pathogenesis of lupus nephritis (LN). Methods A microwave-based immunohistochemistry (APAAP) was used to detect the expression of NF-?B p65 and C-myc protein in renal tissue of LN and normal control. At the same time, the correlation between expression of NF-?B and renal injuries in LN was examined. Results The expression of NF-?B in LN was higher than that of normal control, the highest one was type Ⅳ LN. The number of positive cells expressing NF-?B in renal tissue of LN showed a strong correlation with C-myc protein expression, kidney activity of LN, histological changes and functional lesion in LN, respectively. Conclusions NF-?B may play an important role in the pathogenesis of LN, and the number of positive cells expressing NF-?B may be considered as a predictor for the kidney activity and progressive renal injury in LN.

Objective To detect the strain features of regional wall abnormalities in patients with coronary artery disease during each diastolic period, and its possibility to evaluate regional left ventricular cardiocyte viability and diastolic function.Methods 54 patients with anterior myocardial infarction (MI group) and 78 normal subjects (NOR group) underwent Doppler tissue imaging, which were performed in 2-chamber-view by strain curves synchronously.Results In the NOR group, strain value of 66 cases (84.62%) showed an gradually increasing negative value from the apex to base to middle of left ventricle, while in the MI group, there were 9 cases (16.67%) with such a trend. IR phase: in the NOR group, 564 segments (90.38%) were upward wave bands, but in the MI group, there were 123 segments (28.47%) having such waves ( P<0.05). RF phase: in the NOR group, 576 segments (92.31%) were upward and steep wave bands, but in the MI group, the number of upward waves were obviously less (102 segments,23.61%) ( P<0.01). SF period: compared with the NOR group, which was horizontal, the MI group had upward wave bands ( P<0.05).Conclusion Regional myocardial ischemia and infarction can cause significant regional diastolic wall abnormalities of strain value in active diastolic phase. Regional diastolic wall motion abnormalities can be evaluated quantitatively and synchronously with high sensitivity by strain curve which has the potential value in cardiocyte viability and diastolic function.

Objective To explore brain plasticity of upper extremities motor function recovery after stroke with diffusion tensor imaging (DTI). Methods 25 stroke patients with internal capsule lesions and affected corticospinal tract (CST), 4-8 weeks after onset, were divided randomly into rehabilitation group (n=13) and control group (n=12). Both groups received routine medication and the rehabilitation group also received rehabilitation. All the patients were scanned with DTI and assessed with upper extremity Fugl-Myer Assessment (UE-FMA) before and 3 months after treatment. The fractional anisotropy (FA), FA ratio (rFA) and FA asymmetry (FAasy) in cerebral peduncle, posterior limb of internal capsule (PLIC) and corona radiate were obtained. The bilateral corticospinal tracts were reconstructed with diffusion tensor tractography. Results The scores of UE-FMA increased in both groups after treatment (P<0.05), and increased more in the rehabilitation group than in the control group (P<0.05). There was significant difference in FA, rFA and FAasy in the corona radiate section of CST after treatment in the rehabilitation group (P<0.05), but was not in the cerebral peduncle and PLIC section. However, there was no significant differences in FA, rFA and FAasy in the control group. The ipsilesional CST fibers were more compact after treatment in the rehabilitation group. Conclusion Rehabilitation can improve the upper extremities function recovery after stroke, which may associated with the repairment of CST in the corona radiate section.

Objective To simulate the process of lag screw insertion on intact pelvises under guidance of conventional fluoroscopes or 2D and Iso-C3D computer-assisted navigations and evaluate the accuracy and practicability of the computer-assisted navigation. Methods Six dried intact adult pelvic specimens were selected and divided into three groups randomly. A total of 54 hollow screws were placed in bilateral pedicles of S1 and S2, anterior column of bilateral acetabulum, anterior column of bilateral acetabulum and pubic symphysis of intact adult dried pelvic specimens of three groups under guidance of conventional fluoroscopy, 2D and Iso-C3Dcomputer assisted navigations, respectively. The accuracy of the screw positions, the average operating time of each screw insertion and the average time of radiation exposure during the insertion of each screw were compared among three groups. Results There were significant differences in the accuracy of the screw positions, the average operating time and the average time of radiation exposure among three groups (P＜0.01). The navigation with Iso-C3D appeared to provide the highest accuracy and the shortest operating time of all guidance techniques. The mean operating time and the average time of radiation exposure of the conventional fluoroscope were the longest among three groups. The average time of radiation exposure of the 2D computer-assisted navigation was the shortest.Conclusions Iso-C3D computer-assisted navigation is the most accurate and expeditious means of all guidance techniques. The time of radiation exposure can be significantly reduced by both 2D and Iso-C3D computer-assisted navigations.

Objective:To optimize the clinical dosage regimen of amoxicillin and clavulanate potassium extended release ( ER) tablets based on the PK/PD parameters. Methods:Totally 30 healthy subjects ( half male and half female) were randomly divided into three groups, and orally administered the ER tablets respectively under fasting condition, before the meal and after the meal, and the optimal administration time was determined by comparing the pharmacokinetic characteristics. The subjects in the three groups were ad-ministered the ER tablets respectively at low, medium and high dosage, and the optimal dosage and dosing interval were determined based on the PK/PD parameters. Results:Under fasting condition, the AUC of amoxicillin [(32.2 ±15.0) μg·h·ml-1] was sig-nificantly lower than that before the meal [(41.7 ±1.92) μg·h·ml-1] and that after the meal [(42.6 ±17.7) μg·h·ml-1]. In contrast, the AUC of clavulanate acid after the meal [(1.89 ±0.54) μg·h·ml-1] was significantly lower than that under fasting condition [(2.55 ±0.76) μg·h·ml-1] and that before the meal [(2.58 ±0.76) μg·h·ml-1] (P<0.05). Amoxicillin and clavulanic acid displayed linear pharmacokinetics within the range of 1000-4000 mg and 62. 5-250 mg, respectively. After a single o-ral administration of amoxicillin and clavulanate potassium ER tablets at low, medium and high dose, the duration of blood concentra-tion above the minimum inhibitory concentration (MIC, 2. 0 μg·ml-1) (T> MIC) in 12 h was 5. 5, 7 and 10 h, and the percentage was 46%, 58% and 83%, respectively, and T> MIC in 12 h was 4. 5, 6 and 8 h, and the percentage was 38%, 50% and 67%, re-spectively when MIC was 4. 0μg·ml-1 . Conclusion:It is suggested that amoxicillin and clavulanate potassium ER tablets be taken at the start of a standard meal, 2 tablets per time, twice daily, which is sufficient to achieve T> MIC of 40% -50%.

Total 786 cases of acute uncomplicated appendicitis(UCAA) were included for analysis.All the cases were given antibiotics as a main treatment.Clinical cure rate and the number of cases requiring surgery were observed.Patients with conservative treatment were followed up and the recurrence was observed.Logistic regression was applied to analyze the risk factors of recurrence.Among 786 cases,774 (98.5％) were treated conservatively and achieved clinical cure;68 cases (9.0％) had recurrence during follow-up,the median time to recurrence was 11 months (1-33 months).Logistic regression analysis showed that age(OR =1.124,95％ CI:1.067-3.790,x2 =2.767,P =0.041) and appendix bezoar (OR =1.649,95％ CI:1.281-4.055,x2 =3.935,P =0.027) were independent risk factors for recurrence.Non-operative treatment for acute uncomplicated appendicitis shows a good short and long term effects.Surgical excision may be a better choice for the patients with high risks of recurrence.

Objective To investigate the effect of letrozole in decreasing the early-stage ovarian hyperstimulation syndrome (OHSS) occurrence during the luteal phase for patients of OHSS high-risk after oocyte retrieval.Methods A total of 176 high-risk OHSS patients were randomly divided into two groups after oocyte retrieval.Patients in experiment group (n=86) received 5 mg letrozole per day from the retrieval day and last for 5 days.Others in control group (n=90) received placebo.The serum concentration of FSH,LH,estradiol (E2),progesterone (P) and vascular endothelial growth factor (VEGF) from the day of hCG injection to days after injection (5 days,8 days,10 days) were measured.And the incidence of moderate and severe OHSS was observed.Results The concentration of E2 on the indicated days (5 days,8 days,10 days after hCG injection) in experiment group and control group were (5 727±2 089) versus (11 826±4 281) pmol/L,(1 613±879) versus (7 925±3 507) pmol/L,(193±90) versus (1 628±888) pmol/L; the concentration of VEGF on the indicated days in the two groups were (80± 14) versus (108± 19) ng/L,(66± 11) versus (126± 14) ng/L,(48±7) versus (148± 14) ng/L; the concentration of E2 and VEGF were lower than those in control group (all P＜0.01).The FSH concentration in experiment group were (2.1 ± 1.1) and (3.5± 1.3) U/L on the day of fifth and eighth day after hCG injection,which were significantly higher than (0.7±0.3) and (0.7±0.4) U/L in control group (P＜0.05); the LH concentration in experiment group were (0.26±0.19) and (0.72±0.60) U/L on the day of fifth and eighth day after hCG injection,which were significantly higher than (0.11 ±0.03) and (0.14±0.08) U/L in control group (P＜0.05).The incidence of moderate and severe OHSS was signicantly decreased after letrozole treatment compared with control group [2％ (2/86) versus 12％ (1 1/90),P＜0.05].Conclusion Administration of 5 mg/d letrozole for 5 days during the luteal phase can reduce the E2 and VEGF levels for the high-risk OHSS patients who needed cryopreserve all embryos,and also reduce the occurrence of early OHSS.

Objective To study the correlation between psychological state and coping styles of primary caregivers of stroke patients.Method 286 primary caregivers were screened out by the random sampling method for the investigation of their psychological states and coping styles using SCL-90 and the medical coping modes questionnaire(MCMQ).Results There were significant differences between primary caregivers and Chinese norm in terms of all factors(P<0.01).The major caregivers with higher education were scored significantly lower than those with less education on the factors of depression,anxiety,hostility,fear,psychoticism (P<0.01).There were significant different differences between primary caregivers and Chinese norm in coping style(P<0.01): the score on confrontation in the coping style lower than the norm while the score on avoidance in the coping style higher than in norm.The confrontation and avoidance in the primary caregivers were negatively correlated to the factors of SCL-90(P<0.05)and yielding in the coping style positively to the factors of SCL-90(P<0.05).Conclusions The primary caregivers of stroke patients are at the poor psychological states and they tend to take the passive and negative coping styles.The more they take active coping style,the better their mental states grow and vise versa.Therefore,the caregivers need professional training so that they can use the supports from their families and be encouraged to speak out their poor moods.Post-discharge visits to them,besides,are helpful for the improved psychological states for the improvement of their quality of life.

Objective To explore the relationship between corticospinal tract (CST) repairment and motor function recovery after rehabilitation in stroke patients by diffusion tensor imaging (DTI). Methods 15 stroke patients with internal capsule lesions and injured CST, 4-8 weeks after onset were included. They were scanned with DTI and assessed with the simple Fugl-Meyer Assessment (FMA) before and after 3-month rehabilitation. The fractional anisotropy (FA), FA ratio (rFA) and FA asymmetry (FAasy) in cerebral peduncle, posterior limb of internal capsule (PLIC) and corona radiate were obtained. The correlation of differences of FA, rFA and FAasy of CST with FMA was analyzed. Results The scores of FMA increased after treatment (P<0.01). The FA of the ipsilesional CST were significantly less than that of contralesional ones before and after rehabilitation. There was statistical differences in FA, rFA and FAasy in the corona radiate section of CST after treatment (P<0.05), but was not in the cerebral peduncle and PLIC section. However, there was no significant correlation of FA, rFA and FAasy of corona radiate section to scores of FMA. Conclusion DTI can respond to the repairment of corticospinal tract after stroke, especially in the corona radiate section.