BACKGROUND:Open fractures often present soft-tissue defects, high-risk infection, and fracture with bone defect, often lead to more postoperative complication, defect of limb function, and bring great difficulties to clinical treatment. There is some controversy in the treatment of such fracture. Relevant animal experiment and clinical study become the hotspot in recent years. OBJECTIVE:To review some controversy about open fracture treatment and latest research. METHODS:A computer-based online search of China National Knowledge Infrastructure database and PubMed was performed for articles published from January 2005 to January 2015. Key words included “Open fracture, Evaluation and prognosis of injury, Antibiotics, Debirdement, Treatment of fracture, Wound repair”. More than 100 literatures were retrieved, and 47 articles met the inclusion criteria. RESULTS AND CONCLUSION:After a large number of animal experiments and clinical application, open fracture debridement, prevention of infection, implant selection and evaluation of prognosis had been deeply studied, especialy the study of implant treatment of bone defects. Metal three-dimensional printer has changed the traditional concept of implant. Nano titanium dioxide /PEEK bioactive composite materials have become a hot research in recent years.

Syncope is a common emergency condition,which can cause harmful danger to the physical and mental health,quality of living and learning of children.Even,syncope -related body traumatic injuries and anxiety and depression often occur in these children,and some have a high risk of sudden death.So,early diagnosis is of great sig-nificance.Head -up tilt table test is considered the gold standard for the diagnosis of syncope,it plays a significant role in diagnosis,differential diagnosis,treatment and evaluation of therapeutic effects.

Objective To explore the relationship between the pathologic features of the cancer and postoperative recurrence in patients with early stage gastric carcinoma.Methods 139 patients with early stage gastric carcinoma underwent radical resection in our hospital from 1984 to 1995. All cases were followed up for more than 5 years. ? 2 test was used for statistical analysis.Results 7 cases died of hematogenic metastasis, 3 cases died of lymph node metastasis, and stump carcinoma was found in the other 3 cases. The recurrent rate was significantly higher in submucosal tumors (14.1%) than in mucosal tumors (1.9%), in lymphatic and vascular vessel invasion-positive cases (37.5%) than in negative cases (7.6%), in lymph node positive (31.3%) than in negative (6.5%), in synchronous multiple gastric cancer (33.3%) than in solitary tumors (7.9%)(P

Objective To investigate the risk factors for coronary artery lesions (CALs) in children with Kawasaki disease (KD) in Lanzhou. Methods One hundred and seventy-four children with diagnosed KD were divided into CAL group and non-CAL group based on the existence of concurrent CALs. The age, gender, fever duration, intravenous immunoglobulin (IVIG) start time, IVIG dose, C-reactive protein (CRP), serum albumin, erythrocyte sedimentation rate (ESR), platelet (PLT), red blood cell count (RBC), hemoglobin and so on were compared. Results Among the 174 children, 46 children (26.44%) were complicated by CALs and 128 children were not. The differences of average fever duration, IVIG starting time, IVIG dose, PLT, CRP, ESR and RBC were statistically signiifcant (P<0.05). Conclusions When KD children has the fever durations>10 d, start of IVIG af-ter 10 days of fever, increase of PLT, CRP and ESR and decrease of RBC, clinicians should be alert to the risk of concurrent CAL.

ObjectiveTo assess the clinical features of noncompaction of ventricular myocardium (NVM) in children. Methods The clinical data from ifve children with NVM were analyzed, including clinical manifestations, ultrasonic cardio-gram(UCG), electrocardiogram, chest X-ray, the process of diagnosis and treatment, and follow up.Results In ifve patients (3 boys and 2 girls) aged 3 months to 12 years, four of them were hospitalized because of pneumonia with heart failure. None of the ifve patients had thromboembolism. Heart enlargement was observed in all ifve patients on chest X-ray. By 2D ultrasonography, 2 patients had cardiac apex involvement, and 3 patients showed involvement of left ventricular wall and interventricular septum. In one patient, congenital partial defect of the endocardial cushion was observed. All patients were followed up for 3 to 36 months. One patient died of heart failure, 3 patients survived, and one patient was lost to follow-up.Conclusions The common clinical manifestation of NVM is the heart failure. UCG is preferred for NVM diagnosis. In children with refractory pneumonia and heart failure, NVM should be suspected.

BACKGROUND: Osteoblasts have become a kind of important seed cells in bone tissue engineering. However, it is difficult to harvest osteoblasts, and the purity and calcification ability of osteoblasts isolated by different methods are inconsistent. OBJECTIVE: To compare the purity and calcification ability of osteoblasts induced from mouse bone marrow mesenchymal stem cells, MC3T3 cell lines, and cultured primarily from the neonatal mouse cranium. METHODS: Mouse bone marrow mesenchymal stem cells were isolated by differential adhesion method, and after passaing, passage 3 cells were cultured in osteogenic induction medium for 21 days. MC3T3 cell lines were cultured in osteogenic induction media 1 and 2 for 21 days. Osteoblasts were cultured primarily from neonatal mouse cranium by type Ⅰ coll agenase digestion method. Calcium nodules of osteoblasts obtained by three methods were observed by Alizarin red staining to detect osteogenic activity of cells. RESULTS AND CONCLUSION: (1) There were average 16.3 calcium nodules per low-power field after osteogenic induction of bone marrow mesenchymal stem cells. (2) There were sparsely distributed calcium nodules in MC3T3 cells after induction with osteogenic induction medium 1, accounting for 1.7 calcium nodules per low-power field, while there were dense calcium nodules in MC3T3 cells after induction with osteogenic induction medium 2, accounting for 44.6 calcium nodules per low-power field. There was a significant difference in the calcium nodule formation ability between the two groups (P < 0.01). (3) After primary culture, there was only 0.6 calcium nodule per low-power field. (4) Except for the insignificant difference between osteogenic induction medium 1 and primary culture groups, there were significant differences in pair-wise comparison of any other two groups. Except the insignificant difference between group I of MC3T3 inducing conditional media and primary culture osteoblasts, there were significant differences in the osteogenic ability between groups (P < 0.01). In conclusion, it is a better method to culture MC3T3 cells in osteogenic induction medium 2 containing dexamethasone, because many uncontrol able factors are involved in the isolation and culture of bone marrow mesenchymal stem cells.

Objective To evaluate the effect of simvastatin and atorvastatin on clinical progression of benign prostatic hyperplasia (BPH) in elderly patients with metabolic syndrome (MS).Methods A total of 135 patients with BPH and MS aged 60 years and over were divided into three groups:simvastatin group (n=45,40 mg/d),atorvastatin group (n=45,20 mg/d) and control group (n=45).BMI,waist circumference,blood pressure,levels of fasting blood glucose (FBG),glycosylated hemoglobin (HbA1c),triglyceride (TG),total cholesterol (TC),low-density lipoprotein-cholesterol (LDL C),high sensitivity C-reactive protein (hs-CRP),interleukin 6 (IL-6),testosterone,estradiol,prostate specific antigen (PSA) and international prognostic scoring system (IPSS) and prostate volume were detected before and 12 months after treatment.Results Compared with control group,patients receiving simvastatin or atorvastatin for 12 months showed that the levels of serum TC,TG,LDL-C,hs-CRP,IL-6,IPSS were decreased(all P＜0.05),the level of serum HDL-C level were increased (all P＜0.05),and prostate volume was reduced(P＜0.05).The decrease in prostate volume was more in patients receiving simvastatin than receiving atorvastatin [(10.86±5.65) ml vs.(5.91 ± 3.03)ml,P＜0.05].Multiple stepwise regression analysis showed that the reduction of prostate volume was positively related to the decreases of serum TC and IL-6 levels,and to the increase of serum HDL-C level.Conclusions Simvastatin and atorvastatin have the efficacy reducing prostate volume and improving obstruction symptoms of lower urinary tract,and slowing the clinical progression of BPH and simvastatin is more effective than atorvastatin on reducing prostate volume.The efficacies of statins might be through lowering cholesterol level and antiinflammatory effect.

Objective To explore the relation of stroke and metabolic syndrome (MS), and provide theoretical evidence for prevention of stroke and MS. Methods Five hundred stroke patients accompanied with MS were enrolled, and divided into different types according to the distribution of the components of metabolic syndrome and abnormal metabolic condition. The systolic blood pressure(SBP) ,diastolic blood pressure( DBP),fasting glycemia ( FPG ), triglycerides ( TG ), total cholesterol ( TC ), low density density lipoprotern-cholesterol (LDL-C), high density density lipoprotern-cholesterol (HDL-C)of each patient were detected and recorded. Results Among these stroke patients with MS, most patients were 60 - 69 years old ( 39.60% ), and there was no significant difference between two gender( P = 0. 545 ). Among each component of MS, hypertension was most related to MS;patients complicated with hypertension + hyperlipidemia + hyperglycemia were the most major proportion of stroke patients with MS(48. 00% ). Conclusion MS and its components are all risk factors for stroke,and the more complication the patients had,the more patients suffered from stroke with MS. Targeted interventions of different type of abnormal condition has important prevention effect on MS and stroke.

Objective To investigate the clinicopathological characteristics and prognostic factors of hepatolithiasis associated with intrahepatic cholangiocarcinoma (HLAIHCC).Method A ret rospective study was conducted on 36 patients who suffered from histopathologically confirmed HLAIHCC.These patients received surgical resection of the tumor from June 2006 to September 2009.Results The overall 1,3,5 year survival rates for patients with HLAIHCC were not significantly better than those patients with ICC (63.6％,36.4％,and 30.3i％ vs.65.4％,34.3％,and 28.6％,P=0.57).For the patients who received curative resection,the 1-,3-,and 5-year survival rates (81.4 ％,61.7 ％,and 58.6 ％) were significantly better than those who received palliative resections (x2 =20.426,P＜0.001).The white blood cell count was significantly higher in the HLAIHCC group than in the ICC group (x2 =19.70,P＜0.001) and tumor size was significantly smaller in the ICC group than in the HLAIHCC group (P=0.04).Serum CA19-9 level (P=0.049) and resection margin (P=0.019) were independent risk factors of prognosis.Conclusions This study showed HLAIHCC to have different clinicopathological characteristics from ICC.Curative resection was the optimal surgical treatment for HLAIHCC.Serum CA19-9 level and resection margin were independent risk factors of prognosis.

ObjectiveTo investigate the risk factors for syncope in children with orthostatic intolerance (OI).Methods The clinical data from 136 children with OI were retrospectively analyzed. The children were divided into syncope group and non-syncope group based on the existence of syncope. Results Among the 136 children, 77 children (56.62%) had syncope and 59 children (43.38%) did not have syncope. The differences in BMI, prevalence of inducement of prolonged standing, prevalence of accompanied symptoms of blurred vision/ blacking out, cold sweating and pallor, prevalence of the history of motion sickness and blood flow velocity of MCA were statistically significant between two groups (P<0.05). Conclusions Children with OI who has low BMI, inducement of prolonged standing, accompanied symptoms of blurred vision/ blacking out, cold sweating and pallor, the history of motion sickness, and fast blood flow velocity of MCA, are prone to syncope.