Objective To study the classification, management and outcome of the injury of hamatometacarpal joint. Methods Retrospective analysis was carried out in 17 patients with injury of hamatometacarpal joint. There were 16 males and 1 female aged 19-51 years old. 3 in left hand and 14 in right hand were injuried. The dominant hands of all were right hand. The injury of hamatometacarpal joint might be classified into 4 major groups based on the condition of the hamate, and subdivided into 2 subtypes based on the isolated dislocation(subluxation) or fracture-dislocation of metacarpal base. Carpometacarpal joint ligment injury without fracture of hamatum and the fourth or fifth metacarpal base dislocation without fracture was defined as typeⅠa. When there was a fracture of the fourth or fifth metacarpal base following typeⅠa was defined as typeⅠb. Avulsion fracture of the back of hamatum and the fourth and/or the fifth metacarpal base dislocation without fracture was defined as type Ⅱa. With the fracture of the fourth or fifth metacarpal base following the typeⅡa was defined as type Ⅱb. Splintered fracture of the back of hamatum with the fourth and/or fifth metacarpal base dislocation without fracture was defined as typeⅢa. With the fracture of metacarpal base following typeⅢa was defined as typeⅢb. The split fracture of coronal side of hamatum with the fourth and/or fifth metacarpal base dislocation and without fracture was defined as type Ⅳa. With fracture of the fourth and/or fifth metacarpal base following type Ⅳa was defined as type Ⅳb. There were 7 typeⅠb, 2 typeⅡa, 1 typeⅡb, 2 typeⅢb, 1 typeⅣa, 4 type Ⅳb in our group. We chose conservative or operative treatment according to the type of injury. Results The follow-up was 4-96 months. The patients had fracture union rate of 100%, and no traumatic osteoarthritis was occurred. There was a statistical significance when the motion of two-side joints was compared post surgery. There was no significant difference between bilateral hand in grip strength. Subjective evaluations of the patients were good or excellent. No complications was occurred. There is no case involved in any complications such as traumatic arthrositis, inflammation, neural injuries and adhesion of tendon. Conclusion The stable injury of hamatometacarpal joint should be ideally treated by closed reduction and immobilization in a well-moulded cast or splint. Satisfactory outcome can be got if keeping under strict surveillance. The unstable or intra-articular fracture should be treated by surgery. The outcome is also satisfactory and the rate of the complication of traumatic arthritis is low in short period follow-up. The outcome of fresh injury is much better than old one.

Objective To compare the effects of combined general-epidural anesthesia (CGEA) and general anesthesia (GA) on energy metabolism and oxygen cost of breathing.Methods Forty patients (25 male, 15 female) aged 42-61 yr weighing 42-75 kg scheduled for elective upper abdominal surgery were randomly divided into 2 groups : group CGEA (Ⅰ, n = 20) and group GA (Ⅱ, n = 20) . The patients were premedicated with midazolam 0.05 mg?kg-1 and scopolamine 0.3 mg i.m. . In groupⅠepidural catheter was placed at T9-10 A. test dose of 4ml of 2 % lidocaine was given. When the height of block was confirmed general anesthesia was started. In both groups anesthesia was induced with etomidate 0.3 mg?kg-1 , fentanyl 8 ?g?kg-1 and tracheal intubation was facilitated with atracurium 0.8 mg?kg-1 . Anesthesia was maintained with propofol in both group and intermittent epidural lidocaine in CGEA group and intermittent i. v. boluses of fentanyl in GA group. Muscle relaxation was maintained with atracurium infusion at 8 ?g?kg-1 ? min-1 during operation. Oxygen consumption ( VO2 ), CO2 production (VCO2 ) , energy expenditure ( EE) and respiratory quotient (RQ) were measured before anesthesia, during and after operation using indirect calorimetry (Datex, Deltatrac MBM-200) . Postoperative oxygen cost of breathing (OCB) was calculated during spontaneous breathing and controlled ventilation. Results VO2 , VCO2 , EE were significantly lower and RQ was significantly higher during operation than those before anesthesia in both groups (P

[Objective]To study those risk factors that are associated with adverse postoperative outcomes in old orthopaedic patients.[Method]In Xuanwu Hospital,medical records of 65 years or elder orthopaedic patients in-hospital from January 2002 to October 2004 were reviewed.Take the potential preoperative risk factors associated with adverse postoperative outcomes as variates ,postoperative adverse outcomes as dependent variates.Data were analyzed with SPSS for Windows 11.5.[Result]In the study,the postoperative mortality rate was 3.5%.13.6% of these patients developed one or more complications.American Society of Anesthesiologists (ASA) classification,abnormal cardiac function, abnormal renal function and weak condition of consciousness are the most important risk factors of postoperative mortality,abnormal cardiac function,arrhythmia,ASA classification,poor eating status and operative degree increase the incidence of postoperative complication.[Conclusion]The study demonstrates that there are good postoperative outcomes in most of geriatric orthopaedic patients.But in some degree,there exist the postoperative morbidity (13.6%) and mortality (3.5%).Among operative risk factors,preoperative general status and functional status much influence the postoperative outcomes.

Currently,the environment for establishing anesthesiologic undergraduate education no longer exists,and the side-effects of its narrow professional content are more and more apparent,so canceling undergraduate education of anesthesiology is becoming imperative.The education of anesthesia must be reformed.However,the direction of reform is not clear.Anesthesia long-term system education and Anesthesia and preoperative medical education are two optical reform directions with its own advantages and disadvantages.Comparing these two directions,the Anesthesia and preoperative medical education seems to be the better one.

Objective To investigate the effects of folic acid on apoptosis of neural cells after focal cerebral ischemia injury in rats and the mechanisms.Method Thirty two adult male Sprague-Dawley(SD) rats were randomly divided into sham operation group(SO),middle cerebral artery occlusion group(MCAO),MCAO+ low dose folic acid group(MCAO+FA-L) and MCAO+ high dose folic acid group(MCAO+FA-H).The model of middle cerebral artery occlusion(MCAO) was set up by using intraluminal filament method.The rats were sacrificed at D7 day after cerebral ischemia.The apoptotic rate of neural cells was examined by TUNEL test,and the expression of pERK1/2 protein was detected by Western blotting method,The MDA content and serum SOD and GSH-Px activities in rats were measured before and 28d after folic acid treatment and 7th day after ischemia.Results Compared with ischemia group,the apoptotic rate of neural cells and MDA content in both folic acid supplemented groups were decreased significantly(P

Objective To design technique of local flap transposition to refine the aesthetic appearance of reconstructed fingers by toes transfer.Methods Nine cases with 21 reconstructed finger were included,which involved 6 males and 3 females with an average age of 21.8 years(range,18-34years).A lingual contour flap with a lateral pedicle Was shifted from the inflated distal pulp to the narrow middle part of the"finger"to refine the aesthetic appearance.Overall results were evaluated in terms of the survival of the flap,the appearance improvement and the functional influence of the reconstructed finger.Results All of the flaps survived and healed perfectly.After a mean follow-up of 9.3 months(range,6-12months),the appearance of the reconstructed fingers were impmved apparently.There was little influence on the function of the finger.The results showed that all the patients gained more acceptable fingers.Conclusion From our experience,local flap transposition is a useful method for remolding of reconstructed fingers by toes transfer.

BACKGROUND: Lidocaine is deemed to can attenuate the inflammatory response, but the mechanisms are poorly understood. Nuclear factor-κB (NF-κB) is a key process of imflammatory response. OBJECTIVE: To determine the effect of lidocaine on activation and apoptosis of NF-κB in human neutrophiis in vitro. DESIGN, TIME AND SETTING: The controlled experiment was conducted at the Jiangsu Provincial Key Laboratory of Anesthesiology from October 2006 to February 2007. MATERIALS: Tumor necrosis factor (TNF)-α (0127:B8) was purchased from Sigma, USA. Peripheral blood samples were obtained from healthy donors after their informed consent. METHODS: Human neutrephilic granulocytes were assigned into five groups: ① saline control, ② TNF-α, ③ TNF-α+ lidocaine 1.0 mmol/L, ④ TNF-α+ lidocaine 2.0 mmol/L, and ⑤ TNF-α+ lidocaine 4.0 mmol/L groups. Incubation wasperformed for 3 hours.MAIN OUTCOME MEASURES: The effects of lidocaine on expression of NF- κB mRNA and I- κB mRNA in the cytosol extracts were analyzed by reverse transcription-polymerase chain reaction (RT-PCR), and content of p65 protein were analyzed by Western blot. Neutrophilic granulocyte apoptosis was detected on flow cytomatry after incubation 12 hours and 24 hours.RESULTS: The expression of NF- κB mRNA in the nuclear extracts was significantly decreased and I- κB mRNA in the cytosoI extracts was markedly increased in the lidocaine group. The expression of NF- κB was significantly better in the 2.0 mmol/L and 4.0 mmol/L lidocaine groups than in the 1.0 mmol/L lidocaine group (P< 0.05). No significant difference was detected between the 2.0 mmol/L lidocaine group and the 4.0 mmol/L lidocaine group (P0.05). Lidocaine could significantly inhibit peripheral blood neutrophilic granulocyte apoptosis induced by TNF-α (p < 0.05). The inhibitory effect was significantly better in the 4.0 mmol/L lidocaine group than in the 1.0 mmol/L lidocaine group (P < 0.05). CONCLUSION: Lidocaine (1.0, 2.0 and 4.0 mmol/L) can down-regulate the expressions of NF- κB subunit p65 mRNA and the content of p65 protein in human polymorphoneclear neutrophils, and can significant reverse the reduction of apoptosis induced by TNF-α.

Objective To analyze the economic effects of different rehabilitation patterns for children suffering from cerebral palsy. Methods A total of 153 cerebral palsy patients were divided into a hospital-community-family rehabilitation group(n = 52), a hospital rehabilitation group (n = 50) and a non-intervention control group (n = 51). Those in the first group were provided with a hospital-community-family rehabilitation therapy pattern, those in the sec-ond only hospital rehabilitation and the third no intervention. All the patients were evaluated using the Gross Motor Function Measure-88 (GMFM-88) Scale and the Cost Measure Scale at admission, and at the end of the 3rd and 6th months of treatment. Results There were no significant differences in gross motor function among the three groups at admission. At the end of the 3rd month and the 6th month there were significant differences between the children in the hospital-community-family rehabilitation program and those in the hospital rehabilitation program in terms of gross motor function. Their general percentage, monthly percentage and monthly relative percentage results were all significantly different. But there was no significant difference in the non-interventian control group since admission. Every unit of improvement in gross motor function cost $101.87±97.59, $75.11±45.75 in the hospital-community-family reha-bilitation program and $387.21±54.76, $170.31±123.16 in the hospital rehabilitation program at the end of the 3rd and the 6th month respectively. So the cost of the former was only about 30% of the latter. Conclusion Hospital rehabilitation is suitable for the early rehabilitation of cerebral palsy children. Hospital-community-family rehabilitation is better for long-term rehabilitation of cerebral palsy children, and what is more, it can decrease the rehabilitation ther-apy cost substantially. So a hospital-community-family rehabilitation pattern is more compatible with China's national situation.

Objective To study the effect of the uncertain deflection of the Delta4 phantom (ScandiDos AB,Sweden) in setting up on the Gamma index passing rate during the VMAT plan verification.Methods Two patients with head and neck cancer,two with lung cancers and one with pelvic cancer receiving VMAT radiotherapy were randomly chosen.By means of Eclipse8.6 TPS the treatment plans elaborated for the five patients were picked up to make the verification plans and Delta4 was used to perform dose verification On VARIAN Clinac Ⅸ.The Delta4 phantom was precisely set up first,and then it was deflected in a given angle towards the horizontal direction in relation to the center of the linear accelerator isocenter to perform the dose verification for 11 times successively.To figure out the relationship between the deflection angle of the Delta4 phantom and the Gamma index passing rate.Results As the Delta4 phantom was deflected by 0.0°,0.2°,0.4°,0.6°,0.8°,1.0°,1.2°,1.4°,1.6°,1.8° and 2.0° in sequence,the measured Gamma index passing rates presented a slight decline,but all greater than 90％ (DD 3％,DTA 3 mm).Conclusions In the VMAT plan verification,the Gamma index passing rate of Delta4 has no dependence on the uncertain deflection of the Delta4 phantom provided that the uncertain deflection of the Delta4 phantom is no greater than 2°,but the passing rates of DD and DTA vary significantly with the uncertain deflection of the Delta4 phantom.

A new transformation method for follow-up coordinate system is used and a matrix equation for transforming spatial transporting coordinate of scattering photons is given. The equation has recursion form and only relates to multiplication and will not lead to overflow in calculation. The equation is applied to Monte Carlo simulation in the light propagation in bio-tissues. The results show it can effectively save CPU time and improve simulation efficiency. The results are also in good agreement with the results from the traditional method.
Animals ; Computer Simulation ; Connective Tissue ; radiation effects ; Humans ; Light ; Models, Biological ; Monte Carlo Method ; Nephelometry and Turbidimetry ; methods ; Photons ; Refractometry ; methods ; Scattering, Radiation