Catheter Ablation ; methods ; Humans ; Hypertension, Renal ; surgery ; Kidney ; innervation ; surgery ; Sympathectomy

Objective To assess the clinical value of limited internal fixation combined with hinged super-articular external fixator for the treatment of elbow fracture. Methods 10 patents with elbow fracture were treated with hinged external fixator from March 2001 to November 2002. It involved 8 males and 2 females, aged from 22 to 46 years. There were 4 humeral intercondylar fractures of Riseborough type Ⅳ, the fractures were fixed with few cancellous or interfacial screws through the postero-medial approach, the olecranon and the attached triceps were reflected proximally after the olecranon osteotomy. Among the other 6 severe fracture-dislocations of the elbow, 2 complicated with fracture of the coronoid process; 1 fracture of the Regan type Ⅲ, whose fragments were over 50% of the coronoid process, was fixed with screws; another 1 fracture of the Regan type Ⅱ, whose comminution was less than 50%, was sutured with the joint capsule from proximal to distal part; 2 combined with radial head fracture of Mason type Ⅳ, both selected the lateral elbow approach, 1 with resection because of comminution, the other was fixed nearly the 2/3 of its whole dimension; and 2 with olecranon fracture were fixed with tension-band wire. Results All 10 patients were available at final follow up, the mean duration was 12 months (range, 6-18 months). According to the Morry scoring system, there were 6 excellent, 3 good, 1 fair, and the effective rate was 90%. 8 cases united in the first-stage, the other 2 achieved delayed union because of open fracture. Conclusion The technique of hinged external fixator for the fractures around elbow not only can help to stabilize the fractures but also allows early rehabilitation. In comparison with other methods, it can better improve the function of elbow, so it is an effective treatment for this kind of injury.

Objective To assess the clinical value of hybrid external fixator combined with limited internal fixation for distal tibial fracture.Methods 22 patients with distal tibial fracture were treated with hybrid external fixator and limited internal fixation from March 2002 to January 2005.In those cases,17 patients were male and 5 patients were female,their age was from 20 to 48 years old,with an averge of 33 years old,all fracture sites were not beyond the ankle joint for 5 cm.Among those cases,18 patients were intraarticular fracture and between them 4 patients belong to Ruedi typeⅡ,14 patients belong to Ruedi type Ⅲ.4 patients were extraarticular fracture.18 patients were close injury and of them 16 patients belong to modified Tscherne typeⅡ,2 patients belong to modified Tscherne typeⅢ.4 patients were open fracture,2 patients belong to GustiloⅡand 2 patients belong to Gustilo Ⅲ.Displaced articular fragments were fixed with cannulated lag screws or Kischner wires,the reduction of extraarticular fracture by adjusting external fixator to acquire.Results All patients were followed-up from 8 to 28 months,mean 18 months and average heal time was 3.2 months.Using Tornetta criteria,excellent 10,good 5,fair 3,with 83% excellent and good rate for intraarticular fracture.Excellent 3,good 1,for extraarticular fracture.There were 20 patients with wound primary healing,2 patients delayed healing and they all were open fracture.Complications included 10? anterior angled malunion in 1 case,and pin tract infection in 2 cases.Conclusion Using this metheod treated distal tibial fracture can reduce soft tissue injury,can obviously reduce the wound infectious rate and admit early motion of ankle joint,so it is beneficial to early restore the ankle joint's function.

Objective To investigate the effect and mechanism of serotonin (5-HT) and secretin(SEC) on afferent discharge of vagus in rats. Methods Spontaneous afferent discharge of subdiaphragmatic vagus nerve was recorded in urethane anesthetized rats. The effects of 5-HT, 5-HT3 receptor antagonist and 5-HT+SEC on the discharge of subdiaphragmatic vagus nerve were investigated by intravenous injection of different dosage of 5-HT(3, 10, 30 ?g/kg), Granisetron (1 mg/kg) and 5-HT+SEC. Results Intravenous 5-HT caused obvious exciting effect on spontaneous afferent discharge of subdiaphragmatic vagus nerve. The 5-HT3 receptor antagonist significantly inhibited the effects of 5-HT. 5-HT+SEC could augment the effect of 5-HT on spontaneous discharge. Conclusion The exciting effect of 5-HT on afferent discharge of subdiaphragmatic vagus nerve is possibly mediated by 5-HT3 receptor related to vagus nerve afference. Secretin can augment the exciting effect of 5-HT on spontaneous discharge of vagus afferent nerve.

Objective To determine the changes in action potential peak value and maximal nerve conduction velocity of rabbit sciatic nerve after being exposed to different doses of high intensity ultrasound (HIU) and establish the experimental basis for the use of HIU in patients with refractory pain. Methods Eighty New Zealand white rabbits of either sex weighing 2.0-2.5 kg, aged 5-10 months were randomly divided into four groups with 20 rabbits in each group :group Ⅰ 0 second;group Ⅱ 15 seconds;group Ⅲ 25 seconds and group Ⅳ 50 seconds. The animals were anesthetized and placed in the prone position. Sciatic nerves were exposed to 4 different doses of HIU (7.1 MHz, 40 W/cm2 f55 0 s, 15 s, 25 s, 50 s) in the four groups. The animals were allowed to recover. At 5 intervals (1 and 2 weeks, 1, 3 and 6 months) after exposure to HIU, 4 animals in each group were anesthetized and recording electrodes were placed on sciatic nerves at 2 cm distal to the site of HIU radiation, tibial and sural cutaneous nerves. The amplitude (peak value) and latency of action potential and maximal conduction velocity of the nerves were recorded. Sciatic nerves were obtained from one of the four animals for light and electron microscopic examination. Results The larger was the dose of HIU, the more time was needed for the injuried nerve to recover. In group Ⅰ (0 s) there were no significant changes in action potential peak value and maximal nerve conduction velocity at any interval after exposure to HIU;in group Ⅱ (15 s) there were slight changes in the electrophysiological parameters and the changes recorded on tibial nerve returned to normal soon while those recorded on sural cutaneous nerve returned to normal one month later; in group Ⅲ (25 s) there were significant changes in the electrophysiological parameters and it took 3 months for tibial nerve but 6 months for sural cutaneous nerve to recover;in group Ⅳ (50s) the nerves were completely blocked, no action potential was recorded and no recovery was observed after 6 months. Light and electron microscopic examination showed that in group 1 no significant changes of nerves were observed; in group Ⅱ there was slight deformation of myelin sheath which returned to normal 2 weeks later; in group Ⅲ sheath was broken or lost, and axon degeneration was observed at 1 week after exposure to HIU and the changes disappeared 1 month later; in group Ⅳ necrosis of the nerve was observed and no recovery was observed 6 months later. Conclusion HIU can be used for the treatment of refractory pain. Analgesia can be achieved with loss of only part of motor function. The nerve can be permanently blocked by HIU if necessary.

Objective To explore the clinical effect of periarticular knee fractures combined with anterolateral ligament (ALL) avulsion fracture.Methods From June 2014 to November 2015,13 patients with ALL avulsion fracture in periarticular knee fractures were fixed by the star plate,cannulated or screws suture anchor,including 9 male and 3 female with the mean age of 39.5 years (range from 28 to 51 years).6 patients were diagnosed distal femoral fracture,4 tibial plateau fracture,and 3 tibial intercondylar eminence avulsion fracture which all combined with ALL avulsion fracture.Postoperatively,all patients were treated with the adjustable knee brace for 3 months.Results All patients were followed up for 4-20 months,the mean follow-up time was 13.5 months.The average surgical time was 130 min (range from 90 to 210 min).In all 13 patients,ALL was found and identified.Bone union was obtained in all patients,and the bone union time was 11.4 weeks (10-12 weeks).7 cases were fixed with star plate,5 cases were fixed with hollow screw,and 1 case was fixed with anchor.All follow-up patients underwent anteroposterior and lateral X-rays.Pain,swelling and functional recovery of the knee joint were observed.Patients were assessed postoperatively with International Knee Documentation Committee (IKDC) score,Lysholm score,and Tegner activity scale to evaluate the clinical effect.At the last follow-up,all patients had full range of motion of the knee joint which from 0° to approximate 120°.The Lysholm,objective IKDC were 86.5 and 84.6 respectively.Among the 13 patients evaluated,9 patients were graded A,and 4 patients were graded B by subjective IKDC.The Tegner activity scale at the last follow-up was 6.7.Incision of poor healing in 1 case,and got healed after 32 d cleaning dressing.Conclusion This study confirmed the presence of the ALL.The fixation of ALL avulsion fracture in periarticular knee fractures can be an effective procedure at a minimum follow-up of 13.5 months.

Objective To investigate mortality risk factors in patients with severe cardiorenal syndrome treated with continuous hemofiltration therapy. So we can optimally select patients who may benefit more from this therapy. Methods The clinical data of 68 severe cardiorenal syndrome patients admitted to the ICU of Beijing Shijitan Hospital from May 2012 to May 2015 were retrospectievly analyzed and evaluated. These patients were divided into two groups based on survival or death during hospitalization. Logistic regression analysis was employed to identify independent risk factors for death of patients with severe cardiorenal syndrome during ICU stay. Results There were 36 cases in the death group and 32 cases in the survival group. In the death group, the age,mechanical ventilation rates, vasoactive drug application rates, leukocytes, neutrophils, C-reactive protein,left ventricular end-diastolic diameter and left ventricular end-systolic diameter were significantly higher than those in the survival group,while hemoglobin, serum creatinine, left ventricular ejection fraction, average single amount of dehydration in continuous hemofiltration process were significantly lower than those in the survival group. Logistic regression analysis showed that age, vasoactive drug application rates, APACHEⅡscore and leukocytes were independent risk factors of mortality. Conclusions Cardiac function, mechanical ventilation therapy, average single amount of dehydration in continuous hemofiltration, hemoglobin, C-reactive protein were closely related to the prognosis of severe cardiorenal syndrome patients. The patient′s age,infection, vasoactive drug application, APACHEⅡ score were important risk factors of mortality during hospitalization.

SUMMARY Herewereportedapatientwithwarfarin-inducedautoimmunehepatitis(AIH),andex-plored new concerns for the pharmaceutical care of warfarin.A 57-year-old woman was admitted to hospi-tal for repeated anorexia,abdominal pain and abnormal liver function.She received prosthetic heart valve replacement because of rheumatic heart disease,and had started warfarin medication since 2 years before.Her liver function was elevated with highest alanine aminotransferase 861 U/L, aspertate aminotransferase 604 U/L,and total bilirubin 1 06.7 μmol/L.Her anticoagulant therapy was switched to low molecular weight heparin and the liver function returned to normal.The liver function was elevated when she started to take warfarin again.The patient was then on liver protection therapy,and warfarin was stopped again for the liver biopsy for diagnosis reason.Through medication consultation and evalua-tion,pharmacists were invited to work together with the physicians and helped to differentiate the reason for abnormal liver function, and provided therapeutic suggestions. Also the pharmacists gained experiences in the treatment of AIH,and discovered a new and severe adverse drug reaction for warfarin. In treating this case,the pharmacists’active involvement into the treatment and evaluation of the effect on the patient reflected the advantage and importance of the multidisciplinary cooperation for pharmacists and physicians when complex diseases are faced.

Objective To investigate the effects of neurolytic celiac plexus block(NCPB) on stress response during the early stage of partial hepatectomy(PH) postoperation in rats.Methods Thirty healthy SPF-grade male Sprague-Dawley rats were randomly divided into control group and NCPB group,and then were constructed the 70％ PH model.NCPB group received NCPB with 0.5 ％ lidocaine before closing abdominal,and control group received the same procedures,but 0.9％ physiological saline was injected instead of 0.5 ％ lidocaine.The serum concentration of CRP,GC,ACTH,NA and AD,and the levels of serum TNF-α and IL-1β were determined at 6 hours,12 hours and 24 hours after PH.The western blot assay was performed to examine the expression of GR in the peripheral blood mononuclear cells (PBMCs).Results The obvious stress response was produced within 24 hours after PH in rats,postoperative serum CRP,GC,ACTH,NA and AD concentrations increased in the different extent,but the NCPB group were significantly lower than those in the control group in the corresponding time point (P ＜0.01 or P ＜0.05).The expression levels of GR in PBMCs in the control group were significantly decreased after PH,and markedly lower than those in the NCPB group in the corresponding time point(P ＜ 0.01).The serum TNF-o and IL-1β levels were gradually increased in the control group and NCPB group within 24 hours after PH.But at the respective time points,the levels in the NCPB group were significantly lower than those in control group(P ＜ 0.01 or P ＜ 0.05).Conclusion Intraoperation NCPB can effectively inhibit postoperative stress response at the early stage after PH,and thereby help to reduce the degree of systemic inflammatory response.

Objective To observe the effect and safety of treating senile abnormal lipid metabolism with LU Zhi-zheng's dampness-removing,turbid-resolving and heart-communicating formula.Methods 60 patients were randomly divided into a treatment,treated with LU's formula,one dosage per day,and a control group,treated with gypenosides,60mg/tablet,three times per day,with 30 patients in each group.Both groups were treated two therapeutic courses,which were 8 weeks.Results Except HDL-C,other indexes including TC,TG,LDL-C in the treatment group were all obviously improved after the treatment [the statistical values were (5.81 ± 1.70) mmol/L,(3.05±2.30) mmol/L,(3.39± 1.11 ) mmol/L respectively,P＜0.01 or 0.05],which were also better than the control group [the statistical values were ( 6.16 ± 1.91 ) mmol/L,( 3.03 ± 1.89 ) mmol/L,(3.81±0.63) mmol/L,P＜0.01 or 0.05].Symptoms improvement such as chest oppression,dizziness,heaviness of head,headache,sticky mouth without thirsty,constipation,nausea and vomiting,and heaviness of limbs in the treatment group were also better than the control group,with mean rank were 23.83、38.10、36.10、34.70、36.77、39.82、33.38、34.17 respectively.No abnormal changes were found in indexes of blood routine,urinary routine,stool routine,ECG,ALT,AST and Cr.Conclusion LU Zhi-zheng's dampness-removing,turbid-resolving and heart-communicating formula improved clinical symptoms and signs of abnormal lipid metabolism patients,its therapeutic effects were better than gypenosides.