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.

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

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 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 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 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.

Objective To investigate the relationship between expression of cyclooxygenase-2 (COX-2), Bcl-2 and chemosensitivities in lymph node metastases (LNMs) of gastric carcinoma. Methods The chemosenisitivities to 9 drugs were measured by MTT assay, and the expression of COX-2, Bcl-2 was determined immunohistochemically in 40 paired primary tumor (PT) and lymph node metastases(LNMs)of gastric carcinoma. Results The positive rate of COX-2 and Bcl-2 in PT were 52.5%, 45.0% respectively, and in LNMs, the positive rate were 72.5% and 60.0%. The expression of COX-2 was higher in LNMs than in PT(χ~2=4, P<0.05). There was no statistically difference in the expression of Bcl-2 between PT and LNMs(χ~2=3, P>0.05). There was positive correlation of COX-2, Bcl-2 between PT and LNMs(r=0.3403, 0.4560, beth P<0.05). There was positive correlation between COX-2 and Bcl-2 in PT and LNMs (r=0.6014, 0.5330, both P<0.01). In PT the inhibition rate for 5-FU, VCR and eADM in COX-2 high expression group were lower than those in low expression group (t=2.29, 2.18, 2.41, all P< 0.05). The inhibition rate to 5-FU, PTX and eADM was significantly lower for the Bcl-2 high expression group in PT (t=2.46, 2.23, 2.22, all P<0.05). In LNMs, there were lower inhibition rates for VCR and MTX in COX-2 strong expression group (t=2.17, 2.35, both P<0.05); the inhibition rates to 5-FU, VP-16, PTX and MTX were significantly lower for the Bcl-2 strong expression group in LNMs (t=2.32, 2.29, 2.50, 2.25, all P<0.05). Conclusions COX-2 and Bcl-2 are involved in MDR of gastric carcinoma. The LNMs of gastric carcinoma are heterogeneous with respect to expression of COX-2, Bcl-2 and response to chemosensitivities. Effective adjuvant chemotherapy in gastric carcinoma depends on targeting the metastatic component of the tumor.

Objective To determine the effect of Vibrio vulnificus cytolysin (VVC) inducing ap-optosis in human umbilical vein endothelial cell(HUVEC) and its possible mechanism. Methods The en-tire vvhA gene that encoding VVC from V. vulnificus strain GTC333 was amplified by PCR and sequenced af-ter T-A cloning. E. coli BL21DE3pET-42a-vvhA, a prokaryotic expression system of the vvhA gene, was then con-structed. Ni-NTA affinity chromatography was applied to purify the target recombinant protein rVVC, and SDS-PAGE plus Bio-Rad Agarose Image Analyzor were used to measure the output of rVVC and to determine the purity of rVVC extract. The activity of rVVC dissolving rabbit erythrocytes was detected by hemolysis test. DPNH chromotometry and TphBNa chromotometry were performed to examine the contents of LDH and K+ in the supernatants of rVVC-treated HUVEC cultures, respectively. The effect of rVVC inducing apepto-sis of HUVEC was detected by flow cytometry, rVVC was labeled with FITC and the location of FITC-labe-ling rVVC in HUVEC was observed by laser canfocal microscopy. Results The cloned whA gene had 96.09% and 98.26% similarities of nucleotide and amino acid sequences compared to the corresponding se-quences in GenBank. rVVC, with a dosage of 1 μg/ml, could dissolve rabbit erythrocytes (P<0.01). 10 μg/ml rVVC was able to promote the increases of K+ content (P<0.01) but no change of LDH content could be found in the cell supernatants. HUVEC was apoptotic after the cell was treated with 1～100 μg/ml of rVVC for 2 h. In the 5～240 min duration of co-incubation of FITC-labeling rVVC and HUVEC, the rV-VC gradually moved from surface to inner side of the membrane and then entered the cytoplasms. When FITC-labeling rVVC treated HUVEC for 30 min, most of the rVVC was found to be intracellular location. Conclusion rVVC has cytolytic activity. VVC has an ability to enter HUVEC and causes injury of HUVEC via inducing apoptosis, which may be the major pathogenic mechanism of VVC.

OBJECTIVETo study the ischemic times of the main artery injury in the limbs and the influence on the limbs survival rate, and to analyze the reasons for the formation of the ischemia time.

METHODSFrom June 1996 to November 2012, 83 patients with completely severed limb main artery treated in our hospital were retrospectively studied. There were 77 males and 6 females, including 81 adults (ranging in age from 16 to 52 years old, with a median age of 35 years old) and 2 children (4 and 5 years old respectively). Seventy-five patients were treated with end to end anastomosis, 7 patients were treated with great saphenous vein transplantation, and 1 patient was treated with artificial blood vessel transplantation. The prior to admission ischemia time, after admission ischemia time and total ischemia time for successful and unsuccessful patients, as well as the causes of the formation of the ischemia time were studied. Limb survival rate of different ischemic time was counted. Sharpness injury or blunt injury ischemia time and amputation rate were researched statistically. All data were analyzed using SPSS statistical software.

RESULTSThere were 72 limbs survived, 11 amputated. The average ischemia time was (7.45±5.94) h for limb-salvage group and (13.73±14.00) h for amputation group. Prior to admission ischemia time between amputation and limb-salvage group had no significant difference. After admission the ischemia time in amputation group was longer than limb-salvage group. The amputation rate for ischemia time 21 to 44 h group was higher than other three groups (≤ 5 h, 6 to 10 h, 11 to 20 h) (P=0.023, 0.038, 0.044). Amputation reasons can be divided into anastomosis failure in the operation, vascular thrombosis 2 to 4 days after operation and late infection.

CONCLUSIONVascular injury limbs can tolerate longer ischemia time and the limb salvage succeed. Only too long ischemia time (> 20 h), limb amputation rate increases significantly. The main cause of long time ischemia is delayed diagnosis in the hospital. Whether limb-salvage success mainly depends on the degree of trauma and the quality of the anastomosis than ischemia time.

Adolescent ; Adult ; Amputation ; Extremities ; blood supply ; Female ; Humans ; Ischemia ; surgery ; Limb Salvage ; Male ; Middle Aged ; Retrospective Studies ; Time Factors ; Vascular System Injuries ; surgery