[Objective]To investigate the characteristics and treatment strategy for fresh high energy fracture dislocation of tarsometatarsal joints in a retrospective study.[Method]From September 2002 to April 2008,43 patients with fresh high energy fracture dislocation of tarsometatarsal joints were treated with cannulated screw combined with Kirschner wire fixation or Kirschner wire fixation alone.There were 35 males and 8 females,with a mean age of 37.5 years(range,18 to 55 years).The injury was caused by a road accident in 15 patients,by a heavy crash in 21 patients,and by a fall from a height in 7 patients.According to the Myerson damage typing,there were 9 cases of type A,2 cases of type of B1,25 cases of type B2,4 cases of type CI and 3 cases of type C2.Eight were open injuries(6 of Gustilo-Anderson type I and 2 of type Ⅱ)and 35 closed injuries.Internal fixation were undertaken at an average of 4.6 days after injury(range,2.5 hours to 21 days).At 4-6 weeks all the patients began functional exercises after removal of the plaster casts.At 16-18 weeks all the patients began to walk with partial weigh loading after removal of the internal fixators.[Result]All the 43 patients were followed up for 26 months on average(range,13 to 38 months).No infection,breakage,loosening of internal fixator,nonunion or longitudinal arch collapse was found.According to ZHOU'S assay standard.excellent result was achieved in 26 cases,good in 14 cases,and fair in 3 cases,with excellent to good results of 95.3%.Six patients had post-traumatic arthritis,which was complicated with injured articular surface.[Conclusion]Fresh high-energy fracture dislocation of tarsometatarsal joints can be diagnozed correctly.Early diagnosis and correct classification,proper operation timing,anatomical reduction,rational internal and external fixation and timely functional training are essential for patients to achieve good clinical result.

[Objective]To introduce the clinical experiences and efficiency in surgical treatment of irreducible traumatic spondylolisthesis of lower cervical vertebrae combined with facet dislocation with decompression,reduction and internal fixation through anteroposterior approaches.[Methods]A total of 34 cases of irreducible traumatic spondylolisthesis of lower cervical vertebrae combined with facet dislocation(25 males and 9 females,with age range of 21-61 years)treated from October 2005 to February 2009 were analyzed.Twenty-one cases showed double joints interlocking and 13 cases single facet joint interlocking,which was indentified by the three dimensional CT scan.All cases were treated with decompression,reduction and internal fixation through anteroposterior approach.Among them,13 cases were done through one stage anterior delompression,posterior unlock,fusion and stabilization as well as anterior fusion and stabilization in turn,21 cases were done through one stage posterior unlock,fusion and stabilization as well as anterior decompression,fusion and stabilization in turn.The Frankel grade scores was used as the judging criteria for the recovery of the spinal cord.[Results]All patients were followed up from 7 to 35 months,and the mean follow-up time was 16 months.Lateral mass screw and pedicle screw insertion were successful in all cases.After operation,the joint interlocking and dislocation were all released and reduced.There were no death,infection,interfixation failure or neurological function deterioration.Solid fusion were obtained in all cases in the follow-up.Incomplete spinal cord lesions had some recovery of nervous function postoperatively.Besides,one grade was improved in 23 cases by Frankel grade scores and 2 grades in 8 case.There were no improvements in 3 cases.[Conclusion]Decompression,reduction and internal fixation through anteroposterior approaches is an appropriate treatment method for the irreducible traumatic spondylolisthesis of lower cervical vertebrae combined with facet disclocation,with the advantages of relatively safe operation and strong stability.Most complications can be prevented under correct control of anatomic features and adjacent structures of the cervical lateral mass and pedicle as well as careful operation.

[Objective]To discuss the operative treatments and evaluate the effects of reconstruction interlocking nail(RIN)in treating femoral shaft fractures associated with ipsilateral peritrochanteric fractures of the femur.[Method]A retrospective study was done on 37 patients with femoral shaft fractures combined with ipsilateral peritrochanteric fractures treated by RIN from September 2002 to Janurary 2009.This study involved 32 males and 5 females,with an average age of 36 years (range,24 to 69 years).Thirty-three patients had high-energy injury (26 of road accident,7 of falling from height),and 4 low-energy injury.Among them,13 patients had fractures in the upper one-third of the femoral shaft,18 in the middle one-third and 6 in the lower one-third.Six patients had open fractures (Gustilo scale Ⅰ in 1,and Ⅱ in 5).According to Garden classification for femoral neck fractures,there were 19 cases of type Ⅱ,9 cases of type Ⅲ and 2 cases of typ Ⅳ.According to AO classification for femoral intertrochanteric fractures,there were 3 cases of type A1.1,1 case of type A2.1.According to Seinsheimer classification for femoral subtrochanteric fractures,there was 1 case of type Ⅰ,and 2 cases of type ⅡA.The mean duration from injury to surgery was 3.7 days (range,4 hours to 13 days).After operation step-by-step functional rehabilitation was encouraged.[Result]The follow-up periods ranged from 14 to 38 months (average,24 months).Bony union was achieved in all patients.The average bony union time was 13 weeks for fractures of femoral shaft,14 weeks for femoral neck,12.6 weeks for intertrochanteric and 15.5 weeks for subtrochanteric fractures.Femoral head necrosis occurred in one case.No such complications as infection,loosening of nails,coxa vara,or malunion was found.According to Harris Scoring system,32 cases (86.5%)were rated as good or excellent.[Conclusion]The treatment of femoral shaft fractures associated with ipsilateral peritrochanteric fractures of the femur with RIN is a good method because of its advantages of small trauma,stable fixation,high union rate,few complications and good results.It may have fewer internal fixators.Carefully choosing suitable patients,sophisticated operation skills and active functional exercise after operation are keys to success.

Objective To evaluate the possible factors that may influence the resting energy expenditure (REE) in patients with newly diagnosed esophageal cancer. Methods Totally, 40 patients with newly diagnosed esophageal cancer were prospectively collected from November 2008 to June 2009 in Xinhua Hospital. Nutritional risk screening 2002 (NRS 2002) was performed. REE and body composition were measured using indirect calorimetry and bioeletrical impedence method, respectively. Results Twenty-seven (67.5%) patients were found with nutrition risk, and NRS score was negatively correlated with prealbumin ( r = - 0.444, P = 0.004) and albumin levels (r = - 0.386, P = 0.014). Measured REE and predicted REE values were ( 6770 ± 1360) and (6021 ± 841 ) kJ/d, respectively (P ＜ 0.001 ). Among all 40 patients, 57.5% of them were hypermetabolic,30.0% were normal, and 12.5% were hypometabolic. Stepwise linear regression analysis showed that fat free mass was the only significant determinant variable for REE (P ＜ 0.001 ). Conclusion Fat free mass is a factor than can influence the energy metabolism in patients with newly diagnosed esophageal cancer.

BACKGROUND: Diabetic nephropathy is one of the most serious vascular complications of diabetes mellitus. Compound preparation of huangqi and dahuang, a traditional Chinese medicine, has been used to preventing or treating diabetic nephropathy for several years, and has a certain protective effect on the kidney of diabetes mellitus patients. But its exact mechanism remains unknown and needs to be studied more.OBJECTIVE: To investigate the effect of compound preparation shenkang wan on the proliferation and secretion of extracellular matrix in cultured rat mesangial cells induced by high glucose.DESIGN: Randomized and controlled study.SETTING: Center of Integrated Traditional and Western Nephrology of Zhujiang Hospital and Medicine Department of Nanfang Hospital, Southern Medical University.MATERIALS: The serum pharmacological experiment was performed in Animal Experimental Center of Southern Medical University in A pril 2005.The cell culture experiment was conducted in Cell culture room of Southern Medical University from April 2005 to July 2005. Totally 16 normal Wistar male rats, weighted varied from 190 g to 220 g, were used in the study.METHODS: Sixteen normal Wistar male rats were randomly divided into 4 groups: normal serum group, capoten group, shenkang wan group (high dose and low dose); shenkang wan was mainly constituted of huangqi,dahuang, leech, gordon guryale seed and corn stigma and made in Pharmacy Department of Zhujiang Hospital of Nanfang Medical University, agent number: 20031214). ① The rats in capoten group and high and low dose shenkang wan group were given the corresponding drugs respectively according to 5 mg/kg, 2.4 g/kg, 1.2 g/kg weight. The rats in normal serum group were given the same volume water. After treated 7 days, all rats were hocused and separated medication serum. ② Mesangial cell was cultured in vitro with different concentrations of glucose (10, 20, 30 and 40 mmol/L).The proliferation of mesangial cell was observed with the methyl-thiazoltelrazolium colorimetric assay at 24, 48, 72 hours and 96 hours. ③ Then the cultured mesangial cells were divided into six subgroups :Low glucose control group (10 mmol/L glucose), high glucose group (30 mmol/L glucose);normal serum group (30 mmol/L glucose); capoten group (30 mmol/L glucose); shenkang wan group (high dose and low dose, 30 mmol/L glucose).After cultured 72 hours, the proliferation of mesangial cell was detected with the methyl-thiazol-telrazolium colorimetric assay, the secretion and mRNA gene expression of fibronetin levels in mesangial cell were respectively detected by enzyme linked immunosorbent assay (ELISA) and reverse transcription-polymerase chain reaction (RT-PCR) method.MAIN OUTCOME MEASURES: ①Proliferation of mesangial cell induced by different concentrations glucose. ② Proliferation and secretion and mRNA gene expression of fibronectin in every group.RUSULTS: ① Effect of different concentrations glucose on the prolifera-tion of mesangial cell: Compared with low concentrations glucose(10 mmol/L), 20 mmol/L glucose could accelerate the proliferation ofmesangial cell during 96 hours experiment period, but only had a statisti-cally significant difference at 72 and 96 hours (P ＜ 0.05). 30 mmol/L glu-cose could significantly accelerate the proliferation of mesangial cell thanthat of 10 mmol/L glucose from 24 hours to 96 hours (P ＜ 0.05 or P ＜ 0.01),and this effect was increasing with time in 72 hours and reduced after 72hours. 40 mmol/L glucose could significantly increase the proliferation ofmesangial cell than of low concentrations glucose in 48 hours (P ＜ 0.05),and this effect was reduced after 48 hours and even conversed to restraineffect. ② Effect of different medication serum on the proliferation ofmesangial cell: The optical density value in high glucose group is obviouslyhigher than that of low glucose control group (P ＜ 0.01). Compared withhigh glucose group, the optical density value in capoten, shenkang wangroup (high dose and low dose) was decreased markedly (P ＜ 0.01 or P＜ 0.05). While the optical density value in normal serum group was showedno difference with the high glucose group (P ＞ 0.05). ③ Effect of differentmedication serum on secretion of fibronectin in mesangial cell: Content offibronectin in high glucose group was increased more markedly than that oflow glucose group (P ＜ 0.01). Compared with high glucose group, contentof fibronectin in capoten and shenkang wan group (high dose and low dose)was showed a significantly decrease (P ＜ 0.01 or P ＜ 0.05), while contentof fibronectin in normal serum group was showed no difference with thehigh glucose group (P ＞ 0.05). ④ Effect of different medication serum onexpression of fibronectin mRNA in mesangial cell: The optical density val-ue of fibronectin strip in high glucose group was brighter than that in lowglucose group and the ratio of it and β-actin were increased markedly too(P ＜ 0.01). Compared with high glucose group, the optical density value offibronectin strip in capoten and shenkang wan group (high dose and lowdose) was showed a significantly decrease and the ratio of it and β-actinwas reduced distinctly too (P ＜ 0.01), while the ratio of it and β-actin innormal serum group was showed no difference (P ＞ 0.05).CONCLUSION: High glucose could accelerate proliferation, increase thesecretion and mRNA gene expression of fibronectin in mesangial cell,while shenkang wan could inhibit proliferation and secretion of the extra-cellular matrix in mesangial cell induced by high glucose.

Objective To explore the images and diagnostic evaluation of X-ray combined with ultrasound in paralytic intestinal obstruction caused by antipsychotic agents. Methods The data of X-ray and ultrasound of 124 cases of clinically diagnosed paralytic intestinal obstruction caused by antipsychotic agents were analyzed retrospectively, as well as their rates of confirmed diagnosis. All the 124 patients were examined by erect abdominal radiography and fluoroscopy,68 of the 124 patients by ultrasound. Results According to their typical images,the rate of X-ray confirmed diagnosis was 87.9%(109/124) with 15 missed diagnosis and the rate of missed diagnosis was 12.1%( 15/124);the rate of ultrasound confirmed diagnosis was 82.4%(56/68) with 12 missed diagnosis and the rate of missed diagnosis was 17.6%(12/68). There was no significant difference between X-ray and ultrasound (P＞ 0.05 ). Compared with X-ray or ultrasound ,X-ray combined with ultrasound in the diagnosis of paralytic intestinal obstruction could increase the rate of confirmed diagnosis (100.0% ,68/68),and decrease the rate of missed diagnosis (0),the difference was statistically significant (P＜ 0.05 ). Conclusions X-ray examination is the first choice to diagnose paralytic intestinal obstruction caused by antipsychotic agents,but ultrasound has the advantage of finding fluid in abdominal cavity. To reduce missed diagnosis, X-ray should be combined with ultrasound.

Objective To study the comprehensive therapeutic effect of interventional embolization chemotherapy in advanced cervical cancer. Methods 136 patients with advanced cervical cancer were selected as research object,and they were randomly divided into control group(radiotherapy group) 68 cases and observation group(interventional embolization chemotherapy group) 68 cases,then the total effective rate,incidence of adverse reactions,secondary operation rate and serum CA125 ,SCC and CY211 of two groups before and after the treatment were analyzed and compared. Results The total effective rate( 83. 8% vs 66. 2% ) and secondary operation rate(89.7% vs 48.5% )of observation group was higher than that of control group, incidence of adverse reactions (63.2% vs73.5 % ) was lower than that of control group,serum CA125 [(37. 89 ± 16. 78) vs(52. 36 ± 16. 98) U/ml], SCC[(0. 68 ± 0. 42) vs (1.52±0.36)μg/L]and CY211[(4.86 ±2.21)vs(8.45 ±2.85)ng/L]were all lower than those of control group. ( P ＜0.05 or P ＜0.01) , there were significant differences. Conclusion The comprehensive therapeutic effect of interventional embolization chemotherapy in advanced cervical cancer was better,and it was one of effective methods in advanced cervical cancer.

ObjectiveTo analysis the different types of bacteria in patients with a varying severity of acute cholangitis.Methods241 patients who presented with actue cholangitis between Jan 2008 to Oct 2011 to our hospital were retrospectively studied.These patients were divided into three groups according to the Tokyo Guideline.The bile specimens were obtained intraoperatively.The parameters were compared by SPSS 16.0 package program for statistical analysis.Results75.1 percent of the patients were positive for bacteria in the bile.There were 241 strains of bacterium which included 139 Gram-positive bacteria,99 Gram-negative bacteria and 6 strains of microzyme.Escherichia coli,Enterococcus faecalis,Enterococcus casseliflavus,Pseudomonas aeruginosa and Klebsiella species were the most frequently isolated bacteria.The positive rates for bacteria were significantly different between patients with mild and severe cholangitis (P＜0.05).There was no significant difference between patients with moderate and mild cholangits (P=0.141),or moderate and severe cholangitis (P=0.647).Gram-negative bacteria were more common than Gram- positive bacteria in patients with moderate and severe acute cholangitis (P＜0.05).In patients with moderate and severe acute cholangitis,there was more patients with multiple and mixed bacterial infection.ConclusionsEscherichia coli and Enterococcus species were more common in patients with acute cholangitis.The positive rate of bacteria in the bile in severe acute cholangitis was higher than that in mild acute cholangitis.In patients with moderate and severe cholangitis,Gram-negative bacterial infections and multiple and mixed bacterial infections were more common.

Objective To evaluate the efficacy of circinal stapled suture and manual suture in cervical esophagogastric anastomosis in esophageal resection.Methods The clinical data of 187 patients with esophageal cancer who were admitted to the Cancer Hospital of Sichuan Province from January 2010 to January 2012 were retrospectively analyzed.All the patients were divided into the stapled suture group (98 patients) and manual suture group (89 patients).The time of anastomosis,operation time,time for dieting,duration of hospital stay,the incidence of postoperative complications and positive rate of esophageal remnant cancer cells of the 2 groups were compared.All data were analyzed using the t test or chi-square test.Results The time of anastomosis,operation time,time for dieting and duration of hospital stay were (7.8 ± 1.4) minutes,(227 ± 60) minutes,(6.3 ± 0.9) days and (14 ±4)days in the stapled suture group,which were significantly shorter than (28.5 ±2.3)minutes,(301 ±81)minutes,(8.4 ± 1.0)days and (22 ±9) days in the manual suture group (t =75.44,7.14,7.71,7.41,P ＜0.05).The incidence of anastomotic fistula was 1％ (1/98) in the stapled suture group,which was significantly lower than 8％ (7/89) of the manual suture group (P ＜ 0.05).The incidence of anastomotic stricture was 5％(5/98) in the stapled suture group,which was lower than 7％ (6/89) in the manual suture group,but no significant difference was detected (P ＞0.05).The positive rate of esophageal remnant cancer cells was 0(0/98),which was signifiantly lower than 4％ (4/89) in the manual suture group (P ＜0.05).Conclusion Circinal stapled suture in esophagogastric cervical anastomosis not only reduce the time of anastomosis,operation time and duration of hospital stay,but also decrease the incidence of anastomotic fistula and the positive rate of esophageal remnant cancer cells.

Objective To compare the effects between percutaneous transhepatic gallbladder drainage (PTGD) plus delayed laparoscopic cholecystectomy (LC) in comparison with emergency LC for elderly patients with acute cholecystitis.Methods From June 2011 to December 2014,the clinical data of elderly patients with acute cholecystitis receiving PTGD plus LC and emergency LC were retrospectively studied.Results In this study 38 patients received PTGD plus LC,59 patients received emergency LC.Patients in PTGD + LC group had longer operative time (67 ± 14) min and higher conversion rate (5 cases)than those in LC group (51 ± 13) min,1 case (t =5.741,x2 =5.057,P ＜ 0.05),but had quicker bowel function recovery time (24.5 ±6.4) h,shorter hospital stay (4.2 ± 1.8) d,less complications (3 cases)than those inLC group (27±5.2) h,(6.2±1.9) d,17 cases (t =2.11,t=5.165,x2 =6.18,P＜0.05).Conclusions Percutaneous transhepatic gallbladder drainage plus delayed cholecystectomy is safe for elderly patients with acute cholecystitis.