Objective To evaluate the interobserver reliability and intraobserver reproducibility of the subaxial cervical spine injury classification system (SLIC) and identify its guidance on clinical treatment of spinal cord injuries. Methods Thirty consecutive patients with subaxial cervical injury ad-mitted into our hospital between December 2007 and July 2008 were enrolled in this study and underwent neurological examinations followed by X-ray, CT, and MRI examinations. SLIC was evaluated in aspects of fracture morphology, disco-ligamentous complex (DLC) status and ncurologic status. According to the morphology in image, the fractures were classified into normal, compression, burst, distraction and trans-lation/rotation. According to injury severity, DLC was sorted into intact, indeterminate and disrupted types. Neurologic status was classified into intact, nerve root injury, complete/incomplete spinal cord in-jury and continuous spinal cord compression. The clinical and radiographic data of 30 patients with subax-ial cervical injury were evaluated prospectively by four groups of surgeons to count SLIC scores and decide treatment based on SLIC scores. The evaluation was done again three months later. Cohen' s unweighted kappa coefficients were calculated for the key parameters of each classification system ( morphology, neurologic status, DLCstatus, total score, and proposed management) to analyze the reliability and repreducibility of SLIC. Based on SLIC, the treatment method was selected and the neurological function recovery and the complications observed. Results The interrater Kappa statistics of all subgroups ( morphology, DLCstatus, total score, proposed management) were within the range of moderate to substantial reliability (0.47-0.69). Kappa coefficient was 0.83 for neurologic status, with high reliability. There was no statistical difference upon Kappa values in two evaluations. The interrater Kappa statistics of all sub-groups ( morphology, DLCstatus, total score, proposed management) were within the range of moderate to substantial reproducibility (0.53-0.78). Kappa coefficient was 0.89 for neurologic stares, with high repreducibility. The recovery rate of neuroiogie function was 79.2%. There was no aggravation of neurological status, with low incidence of complications. Conclusions SLIC has advantages of high reliability and reproducibility, simple use, exact evaluation and can facilitate decision-making in treatment of subaxial cervical spine injures.

BACKGROUND:The human telomerase reverse transcriptase (hTERT) is one of preferred growth factors for regulating proliferation and directional differentiation, has multiple biological effects, and laids the foundation for geneticaly engineered immortalized stem cel lines. OBJECTIVE: To investigate the effect ofhTERT gene-modified umbilical cord mesenchymal stem cel transplantation on acute kidney injury induced by ischemia and reperfusion in rats. METHODS:The human umbilical cord mesenchymal stem cels were cultured in vitro. Rat models of acute kidney injury induced by ischemia and reperfusion were established. Rat models were randomly divided into three groups. Rats in the control group were injected with 1 mL L-DMEM medium through caudal vein. Rats in the negative transfection group were injected with 1 mL umbilical cord mesenchymal stem cel suspension after empty virus transfection through caudal vein. Rats in the hTERT transfection group were injected with 1 mL umbilical cord mesenchymal stem cel suspension after PLXSN-hTERT transfection through caudal vein. RESULTS AND CONCLUSION:At 3 and 28 days after transplantation, hematoxylin-eosin staining showed renal tubular damage score in the hTERT transfection group < negative transfection group < control group (P < 0.05). At 28 days after transplantation, the number of CM-Dil-positive cels in the hTERT transfection group > negative transfection group > control group (P < 0.05). At 1, 3, 14, and 28 days, serum creatinine and urea nitrogen levels in the hTERT transfection group < negative transfection group < control group (P < 0.05). The results confirm that hTERT gene-modified umbilical cord mesenchymal stem cel transplantation has a significant repair effect on acute kidney injury in rats.

[Objective]To investigate the characteristics of fatal pulmonary embolism (PE) due to peri-operative orthopedic surgery and provide clinical recommendations for surgeons.[Method]Form September 2000 to September 2006,15 cases of fatal PE were treated.All cases were retrospectively analyzed,assessed and compared regard to specific risk factors,diagnostic process,treatment results and preventive measures.[Result]Orthopedic surgery may lead to proximal deep vein thrombosis (DVT),especially in patients with spinal cord injury,lower extremity or pelvic fracture.Fatal PE is surprisingly common and is not necessarily heralded by dramatic symptoms or signs associated with DVT,but can lead to substantial morbidity and mortality.So the preventive,diagnostic and therapeutic strategy of PE of orthopedic surgery is different form chronic PE.[Conclusion]The morbidity of fatal PE duo to peri-operative orthopedic surgery is insidious but serious.Thrombolytic treatment can improve the survival rate for patients with acute pulmonary embolism.

Objective To evaluate the efficacy of video-assisted mini-thoracoscopy(VAMT) for radical resection of lung cancer.Methods From April 2002 to December 2008,radical resection of lung cancer was performed on 39 patients by VMAT in our hospital.A 1.5-cm and a 7-to 10-cm incision were made during the operation.Both standard surgical instruments and thoracoscopic set were used to treat the pulmonary vessels,perform lobectomy,and remove the lymph nodes in the mediastinum and pulmonary portal.Results The operation was completed in all of the cases.No peri-operative death occurred.The patients received chest drainage for 4 to 7 days after the operation(mean,4.5 days).Post-operative pathological examination showed primary non-small cell lung cancer(NSCLC) in 37 cases,metastatic cancer in 1,and carcinoid in 1.In the 37 patients with NSCLC,9 were stage Ⅰa,13 were Ⅰb,5 were Ⅱa,7 were Ⅱb,2 were Ⅲa,and 1 was Ⅲb.Follow-up was available in 35 patients for up to 2 to 12 months in 4,13 to 24 months in 15,25 to 36 months in 8,37 to 48 months in 6,and 49 to 60 months in 2 cases.Among the 35 cases,totally 4 patients died of tumor recurrence or metastasis,1 patient survived with tumor,and the other 30 survived without tumor.The 1-and 3-year survival rate of stage Ⅰ and Ⅱ were 100%(21/21) and 91%(10/11) respectively.All of the 3 stage Ⅲ patients died of recurrence or metastasis in 19,11,and 14 months respectively after the surgery.Conclusions VAMT is effective for radical resection of lung cancer in a short term.Combination of traditional procedure and VAMT is safe and reliable for the disease.

head and neck region. Postoperative recurrence rate was 42 10%, five year survival rate was 8 33%. Not a single case was found to be malignant degeneration of neurolemmoma or neurofibromatosis, nor as a result of radiotherapy. It is suggested that MNST is a primary soft tissue malignant tumor, and early complete excision is the key treatment. The biological characteristics of this tumor as revealed in this study suggest that it is different from what was reported in the foreign literature.

Objective To investigate the effects of rolipram on neurofunction and the ultrastructure of the spinal cord in rats with spinal cord contusion.Methods Thirty adult,female Sprague-Dawley (SD) rats received spinal cord contusion at the T10 level.They were then randomited into an experimental group and a control group immediately after the operation.Rats in the experimental group received subcutaneous injections of 0.25mg/kg of rolipram twice daily for two weeks.Control rats received the same dosage of 0.9％ sodium chloride solution on the same schedule.The rats'functional recovery was evaluated using the open-field locomotion rating scale of Basso,Beattie and Bresnahan (BBB score),once a week within the 1st month after spinal cord injury (SCI),and once every two weeks subsequently.The morphology of the spinal cord tissue around the lesion site was observed under the light microscope with HE staining at the 8th week postoperation,and the ultrastructure of the spinal cord was observed under the transmission electron microscope at the 2nd,4th and 8th week postoperation.Results At the 2nd and 3rd week after SCI the experimental group exhibited significandy greater improvement in average BBB scores than the control group.However,the average BBB scores in the experimental and control groups were not significantly different at 8 weeks after SCI.Under the light microscope,cavities were observed in the posterior dorsal column near the SCI in both the experimental and control groups.However thick,condensed glial scars in the injured area were observed only in the control group.The density of glial cells decreased more in the experimental group than in the control group.Transmission electron microscopy revealed that,compared with the control group,inflammatory edema was attenuated and fewer axons were damaged at the 2nd week postoperation in the experimental group.That group also showed less axon degeneration as well as more angiogenesis at the 4th and 8th week.Conclusion Rolipram can reduce secondary neuron degeneration,inhibit gliosis and the formation of glial scars,and promote angiogenesis.

Objective To investigate risk factors for postoperative delirium in elderly patients with hip fractures and determine whether the delirium can influence the outcome of hip fracture.Method A retrospective case control study was performed for 521 patients (≥60 years) with hip fractures treated surgically from January 2012 to December 2014.There were 170 males and 351 females, with the age of (79.3±8.3)years.Confusion assessment method (CAM) was applied to diagnose delirium after surgery, and the subjects were divided into delirium group (n=159) and control group (n=362) according to the presence of delirium.Univariate and multivariate analyses were performed to identify the riks factors for postoperative delirium, including age, gender, comorbidities, body mass index, American Society of Anesthesiologists (ASA) classification, type of fracture, haemoglobin, PaO2, albumen, type of anesthesia, type of anesthesia, amount of bleeding, time between admission to surgery, length of operation, type of operation and amount of blood transfusion.Perioperative complications and mortality within 1 year after operation were compared between the two groups.Results Univariate analysis revealed dementia, ASA classification, haemoglobin, PaO2, albumen, interval between admission to surgery, anesthesia method, operation time, and surgery methods were risk factors for postoperative delirium incidence (P<0.05).While multivariate analysis showed only dementia (OR=6.211, 95%CI 2.482-23.498), long interval between admission to surgery (OR=3.505, 95%CI 1.478-6.342), arthroplasty (OR=2.015, 95%CI 1.783-3.481), and PaO2≤60 mmHg (OR=2.766,95%CI 1.783-5.039) were the significant risk factors for postoperative delirium after hip surgery in the elderly.Incidences of lung infection, wound infection, cardiovascular events, cerebrovascular events and deep venous thrombosis in delirium group were higher than those in control group, but only incidences of lung infection and wound infection reached significant differences (P<0.05).Mortality in delirium group was higher than that in control group within 1 year after operation, but there was significant difference only within 3 months after operation (P<0.05).Conclusions Incidence of delirium is high after hip fracture surgery in the elderly.Dementia, long interval between admission to surgery, arthroplasty and PaO2≤60 mmHg are significant risk factors for postoperative delirium incidence, and the delirium patients are associated with high early mortality.

OBJECTIVETo compare the efficacy differences between acupuncture at Zhibian (BL 54) through Shuidao (ST 28) and regular acupuncture for polycystic ovary syndrome.

METHODSOne hundred and one patients, by using random digital table, were randomly divided into an observation group (49 cases) and a control group (52 cases). Patients in the observation group were treated with acupuncture at Zhibian (BL 54) through Shuidao (ST 28) as main acupoints, and accompanied acupoints were selected according to syndrome differentiation. Elongated needles (175 mm in length) were inserted at Zhibian (BL 54) with an angle of 200 with sagittal plane. The insertion depth was 100-115 mm, reaching Shuidao (ST 28) and making acupuncture sensation arrive at diseased location. Patients in the control group were treated at the same acupoints with regular acupuncture technique. The menstruation condition was ignored for patients in both groups. The treatment was given once a day, 15 times as one session, and 5 consecutive sessions were given. The basic temperature and level of sex hormone were observed before and after treatment in the two groups, and clinical efficacy was compared.

RESULTSThe cured rate was 65.3% (32/49) and the effective rate was 91.8% (45/49) in the observation group after treatment, which was significantly superior to 48.1% (25/52) and 63.5% (33/52) in the control group (both P<0.01). The number of patients with typical biphasic fever and patients with atypical biphasic fever in the observation group was higher, than that in the control group, but that of unidirectional temperature was less than that in the control group (P<0.05). After treatment, the follicle-stimulating hormone (FSH), luteinizing hormone (LH), LH/FSH, testos terone (T) were significantly reduced in the observation group (P<0.01, P<0.05); the LH and T were also apparently reduced in the control group (P<.01, P<0.05). The reduction of FSH, LH, LH/FSH and T in the observation group after treatment was more significant than that in the control group (P<0.05, P<0.01).

CONCLUSIONAcuouncture at Zhibian (BL 54) through Shuidao (ST 28) could significantly improve the basic temperature of patients with polycystic ovary syndrome, and regulate hormone level of reproductive endocrine, which is superior to regular acupuncture.

Acupuncture Points ; Acupuncture Therapy ; Adult ; Female ; Follicle Stimulating Hormone ; blood ; Humans ; Luteinizing Hormone ; blood ; Middle Aged ; Polycystic Ovary Syndrome ; blood ; therapy

Posterior pilon fracture is a special and unique type of ankle fracture,and its injury mechanism and treatment principles are different from those of the trimalleolar fracture in the Lauge-Hansen classification,and also different from those described for the classic pilon fracture.The fractures have a low incidence and generally poor prognosis.The prevalence of posterior pilon fractures is 6.4％ of all trimalleolar fractures,and 5.6％ of all pilon fractures based on computed tomography images.The pathological features of posterior pilon fractures are different from those of the traditional ankle fracture and the classic pilon fracture,and it is very important to differentiate a posterior pilon fracture from the others.Because of the low incidence and high variation in fracture morphology,there is controversy over the practicable classification of posterior pilon fractures based on clinical features,such as injury mechanism,fracture classification and surgical approach.An ideal fracture classification system can reveal the injury mechanism and severity,guide the treatment,and predict prognosis.At present,no classification method is based on the injury mechanism,and none can summarize fracture morphology and guide treatment.The purpose of this study was to review the injury mechanism,clinical characteristics,classifications,treatments,and outcomes of posterior pilon fractures,to promote surgeons’ understanding of posterior pilon fracture and reduce perioperative complication.

Delirium is a common complication after elderly hip fracture, and is associated with high rates of mortality and morbidity. There is no enough attention for delirium compared to deep vein thrombosis, pulmonary embolism, heart failure, etc. This paper reviews the definition, diagnosis, incidence, prognosis, treatment and other aspects of delirium in order to better under?stand delirium clinically. Delirium is an acute mental disorder of consciousness, attention, perception, thinking ability, memory, mental activity, and emotion. It is characterized by the disorder of sleep or wakefulness, and these changes are difficult to explain by dementia. The confusion assessment method (confusion assessment method, CAM) is generally accepted as the current diagnos?tic tools for delirium, and mainly depends on the patient's consciousness and cognitive function. The mechanisms of delirium are unclear, and it is influenced by many factors, such as agedness, cognitive impairment, pain, sleep rhythm disorders, and theories mainly include neurotransmitter theory, the central inflammatory response theory, the theory of stress response, sleep wake cycle, et al. The delirium is difficult to explain by using single, liner factor, but is elaborated by many various factors. However, the influ?ences of delirium on outcome for hip fracture are unclear, and it is definite that these patients have poor functional recovery, poor independent living ability, longer time in bed, demand for more care. The prevention should be implemented as mainly measures for delirium. Elimination of risk factors, including correct hypoxia, reduce pain, avoid water electrolyte disorders, improve sleep rhythm, and avoid using of opioids should be tried. In addition, adequate analgesia and appropriate anesthesia should used, and some inappropriate drugs should be avoided. Multidisciplinary cooperation mode, including doctors from orthopedics, anesthesiolo?gy, and geriatric department should be conducted to reduce the incidence of delirium as far as possible. Once diagnosed, some measures should be applied, such as maintaining of airway patency, adequate nutritional support, correction of water and electro?lyte disorders, anemia and low serum albumin, to ensure adequate physical and mental support, and to create a good environment for the ward, as well as to remove the possible etiological factors, such as anemia, low protein acidosis and electrolyte disturbance.