BACKGROUND:The treatment of calcaneal fractures using open surgery is likely to cause greater trauma. OBJECTIVE:To explore the clinical effect of steinmann pin poking closed reduction axial combined with lateral multiple hol ow screws internal fixation in repair of Sanders II, III type calcaneal fractures. METHODS:The clinical data of 73 patients with Sanders II, III type calcaneal fractures were retrospectively analyzed and divided into conventional group (n=36) and experimental group (n=37) according to the treatment method. Patients in these two groups were respectively treated with conventional open reduction internal fixation and steinmann pin poking closed reduction axial combined with lateral multiple hol ow screws internal fixation. RESULTS AND CONCLUSION:Compared with the conventional group, the hospital stays of patients in experimental group were shorter, hospital costs reduced. There were no obvious changes in the foot rating from the American Association of Ankle Injuries, B?hler angle and Gissane angle. The incidence of complications was significantly decreased. These results demonstrate that the treatment of Sanders II, III type calcaneal fractures with conventional open reduction and bone plate internal fixation and steinmann pin poking closed reduction axial combined with lateral multiple hol ow screws internal fixation can obtain the basic equivalent clinical effect, however, the treatment of steinmann pin poking closed reduction axial combined with lateral multiple hol ow screws internal fixation have more obvious advantages, such as a shorter hospital stays, less hospital costs, and also can effectively control the complications.

Objective To compare the single-and double-injection techniques for sciatic nerve block.Methods Sixty ASA physical status Ⅰ or Ⅱ patients of both sexes,aged 18-64 yr,weighing 48-72 kg,undergoing elective unilateral foot and ankle surgery,were randomly divided into 2 groups (n =30 each) using a random number table:single-injection group (group S) and double-injection group (group D).Labat-winnie approach to sciatic nerve block was performed under the guidance of a nerve stimulator.When ankle dorsal or plantar flexion developed,group S received a single injection of 0.5％ ropivacaine 30 ml.When ankle dorsal and plantar flexion developed,0.5％ ropivacaine 15 ml was injected each time in group D.The failure of location was recorded.The time spent performing the procedure,onset time and duration of sensory and motor blockade,and the total time for the block were recorded.The effectiveness of block (success,failure) was assessed.Results The failure rate of location was 10％ in group D.The success rate of block was 93％ in group S,and was 96％ in group D,and there was no significant difference in the success rate of block between the two groups.Compared with group S,the onset time of sensory and motor blockade was significantly shortened,the time spent performing the procedure was prolonged,and no significant change was found in the total time for the block,duration of sensory and motor blockade in group D.Conclusion Single-injection technique is recommended for the sciatic nerve block in the patients undergoing lower extremity surgery.

Objective To investigate the alteration of chaperone hsp40 and its effects on the dealyed neuron death in the CAI neurons after transient cerebral ischemia.Method Twenty-minute transient global ischemia rat model was used.Following different repeffusion period,all the 28 wistar rats were divided into sham-operation group ,4-hour recovery group,24-honr recovery group and 72-hour recovery gronp,7 ratsin in each group,Immunochemistry and laser scanning confocal microscopy were used to observe the distributional alteration of hsp40 in the neurons.Differential centrifuge and westemblot analysis were used to analyze the quantitative alteration of hsp40 and its redistribution in the neurons.Results lnanunechemistry and laser scanning confocal microscopy showedthe reduction of hsp40 first in cytosol,then in the nucleus until all the neurons in the CAI region died.Differential centrifuge and westemblot analysis showed the quantity of hsp40 decreased from (1.00_+0.21) to (0.23±0.13)(P<0.01) after 24-hour repeffusion;the quantity of hsp40 in the protein aggregates increased from (1.00±0.18) to(8.61±1.89)(P<0.01) after24-hour reperfusion.Conclusions The reduction of hsp40 in the neurons of hippocampus CA1 region is an important factor resulting in protein aggregates formation.

Objective To investigate the regulatory effects of glucocorticoids on the local renin-angiotensin system in osteoblasts by using MC3T3-E1 cells.Methods Cellular immune histochemistry was carried out to observe the renin-angiotensin system in osteoblasts.And then after 12-hour culture in serum-free solution,MC3T3-E1 cells were divided into four groups:control,dexamethasone (DXM),dexamethasone + mifepristone (DXM+MIF)and mifepristone (MIF).Components of the renin-angiotensin system including angiotensin type 1 receptor (AT1R),angiotensin type 2 receptor (AT2R)and angiotensin converting enzyme (ACE)in osteoblasts were detected at the mRNA and protein levels using Western blot and PCR.The activity of ACE was also measured after 36-hour intervention.Results The results of immunohistochemistry showed that AT1R,AT2R and ACE were all expressed in osteoblasts.The activity of ACE increased obviously after dexamethasone intervention compared with that in the control group,which was blocked by mifepristone.The mRNA levels of AT1R,AT2R and ACE were increased by dexamethasone compared with those in the control group,which was inhibited by mifepristone.The protein levels of AT1R,AT2R and ACE were enhanced by dexamethasone compared with those in the control group, which was blocked when the cells were co-intervened with mifepristone.However,ACE activity and the mRNA and protein levels of AT1R,AT2R and ACE did not change when the cells were intervened with mifepristone alone (P>0.05).Conclusion The local renin-angiotensin system in osteoblasts is activated by dexamethasone through glucocorticoid receptors on osteoblasts,which may be one of the pathogenesis of glucocorticoid-induced osteoporosis.

Objective To investigate neurosurgeons' knowledge,attitude and practice toward deceased organ donation and provide a reference to increase organ donation rate.Method In July 2015,150 questionnaires were issued to neurosurgeons from 36 hospitals in the Jilin province.Result 142 effective questionnaires were obtained.Neurosurgeons' knowledge toward deceased organdonation was relatively good in the whole.100％ (142/142) neurosurgeons were in favor of organ donation in public hospitals.95.8％ (136/142) neurosurgeons were willing to cooperate in organ donation and 100％ (142/142) approved legislation on brain death in China.97.2％ (138/142) were in favor of economic compensation for organ donor's family.100％ (142/142) neurosurgeons encountered to potential organ donors in the process of practice,but 71.8％ (102/142) prompted potential organ donors' families actively and initiatively to donate.Compared with physicians with junior titles,senior physicians had more active coordination donation behavior (x2 =12.133,P=0.002).The neurosurgeons,who had higher correct answer rate about the knowledge of organ donation,were more likely to take the initiative to coordinate organ donation (x2 =16.131,P＜0.001).Conclusion Professional training for neurosurgeon organ donation will contribute to promote potential organ donors in neurosurgery into actual organ donors.

Objective To compare the effect of distally based perforator-plus sural fasciocutaneous flap for soft tissue reconstruction of the lower leg in pediatric and adult populations.Methods Data of 165 patients treated with distally based perforator-plus sural fasciocutaneous flap between April 2001 and February 2011 were retrospectively reviewed.There were 125 males and 40 females,at age range of 3-78 years.The patients were divided into pediatric group (＜ 14 years,n =50) and adult group (≥ 17 years,n =115) according to the age.The two groups were compared in terms of flap-viability-related complications (partial necrosis,marginal necrosis and overall complication rate) and their potential risk factors (sex,location of defect,causes of defect,pivot point site and top-edge location).For the patients followed at least 12 months,the reconstruction outcomes,donor-site morbidities(hypertrophic scar,pruritus,pigmentation,numbness of skin graft area and paresthesia of skin graft area),and swelling of the limb were compared between the groups.Results All patients were followed up for 2 weeks to 72 months.Partial necrosis of the flap,marginal necrosis of the flap,and overall complications in pediatric group accounted for 14％,4％ and 18％ respectively,higher than 11.3％,1.7％ and 13.0％ in adult group,but the differences were insignificant (P ＞ 0.05).Sex ratio,pivot point site and top-edge location were not significantly different between the groups (P ＞ 0.05).Pediatric group versus adult group presented a significantly lower proportion of pretibial defects,but significantly higher proportions of the defects over the achilles tendon and heel (P ＜ 0.05).A significantly higher proportion of spoke injury and lower proportions of tamp injury and sports injury were observed in pediatric group than in adult group (P ＜0.05).Reconstruction outcomes were not significantly different between the groups (P ＞ 0.05).Pediatric group versus adult group presented significantly higher incidences of hypertrophic scar and pruritus at the donor site,but a significantly lower incidence of limb swelling (P ＜ 0.05).Conclusion Reliability and repair effect of the distally based perforator-plus sural fasciocutaneous flap are similar between pediatrics and adults,while the pediatrics are more likely to have hypertrophic scar and pruritus at the flap donor site.

Apnea test (AT) is a key step in the diagnosis of adult brain death, which provides important basis for the loss of brainstem function in patients with adult brain death. In recent years, with extensive development of adult brain death determination and organ donation transplantation, discussion and research of AT have been gradually promoted. In formulation of adult brain death criteria, countries have paid more attention to the standardization and normalization of AT implementation, and medical staffs have improved the AT implementation process. This article reviews the current AT implementation standards, conventional AT procedures and complications, modified AT exploration, AT implementation with extracorporeal membrane oxygenation, and treatments and auxiliary examinations after AT failure, in order to deepen the understanding and cognition of adult brain death determination physicians on AT, and promote AT development in a more standardized and orderly way.

Objective:To analyze the factors influencing the poor effect of short-term electrical spinal cord stimulation in the treatment of postherpetic neuralgia (PHN).Methods:The medical records of PHN patients of either sex, aged 40-85 yr, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, who received short-term electrical spinal cord stimulation from July 2017 to July 2022, were retrospectively collected. The therapeutic effect was evaluated using the modified MacNab criteria at 3 months after operation, and the patients were divided into good efficacy group (excellent and good efficacy) and poor efficacy group (fair and poor efficacy). General information, disease course, lesion site, complicated diseases, ossification of the yellow ligament in the diseased spinal segment, severity of pain in the herpetic stage, standard antiviral therapy in the herpetic stage (for more than 7 days) and use of neurotrophic drugs in the herpetic stage (for more than 7 days) were collected. Multivariate logistic regression analysis was used to screen the influencing factors for the poor effect of electrical spinal cord stimulation in the treatment of PHN.Results:A total of 168 patients were eventually enrolled, among which 69 had poor curative effect, and the rate of poor curative effect was 41.1%. The results of multivariate logistic regression analysis showed that the patient′s age ( OR=2.230, P=0.015), course of disease ( OR=2.191, P=0.027), complication with diabetes mellitus( OR=8.859, P=0.010), ossification of ligamentum flavum at the same segment ( OR=6.602, P=0.019), severity of pain in the herpetic stage ( OR=5.788, P=0.038) and non-standard antiviral therapy in the herpetic stage ( OR=6.765, P=0.021) were the influencing factors for the poor effect of electrical spinal cord stimulation in the treatment of PHN. Conclusions:Age, course of disease, complication with diabetes mellitus, ossification of ligamentum flandum at the same segment, severity of pain in the herpetic stage and non-standard antiviral therapy in the herpetic stage are the factors influencing the poor effect of short-term electrical spinal cord stimulation in the treatment of PHN.

In recent years,mechanical thrombectomy has been the most important research progress in the treatment of acute cerebral infarction,especially the positive results of five endovascular therapy studies in 2015 has rewritten its clinical guidelines.However,the focus of these studies was mainly on the small vessel infarction(SVI),and the inclusion criteria of these studies include the following aspects:ASPECTS ≥6 points,Alberta Stroke Program Early CT Score within 6 hours after stroke onset,the infarct volume＜70 mL within 6-24 hours after stroke onset,and the presence of image mismatch or the presence of mismatch between clinical condition and perfusion imaging.The above studies excluded patients with ASPECTS＜6 points or infarct volume ≥70 mL of large core infarction(LCI).With the continuous progress of the endovascular treatment of acute ischemic stroke(AIS),the mechanical thrombectomy therapy strategy has crossed from the"time window"to the"tissue window",meanwhile,the therapeutic goal of mechanical thrombectomy has also moved from treating SVI to a new era of treating LCI that has been a very hot topic recently.Whether endovascular treatment is beneficial for patients with LCI remains uncertain.This paper aims to make a comprehensive review concerning the relevant research progress in endovascular therapy for anterior circulation large core ischemic stroke,including the imaging determination and study inclusion criteria of LCI,the postoperative blood pressure management,and the factors influencing ineffective recanalization and prognosis.(J Intervent Radiol,2023,32:1256-1262)