Objective To analyze the results of treatment of complicated tibial plateau fractures with open reduction and internal fixation with bilateral plates .Methods 29 elder patients with C type tibial platform fractures underwent internal fixation with bilat-eral plates and bone grafting .Fixation with bilateral plates was performed during operation with dynamic compression plate or 1/3 Tubular steel plate placed medially and the dissection plate or LISS system ones inserted laterally after the underlying separation . Meanwhile ,sufficient bone grafting during operation could effectively support reduction of articular surface .Results All patients were followed up of an average of 13 .8 ± 2 .43 months .According to Rasmussen score standard ,the excellent and good rate was 82 .7% .There was significant difference of TPA and PA between postoperation and postoperation one year later .Conclusion It is a simple and effective method to treat complicated elder tibial platform fractures with bilateral plates .It will improve the effect and re-duce complications significantly to perform sufficient bone grafting intraoperatively ,and make the drainage unobstructed and do the early functional exercises postoperatively .

Objective To assess the left ventricular(LV) volumes and function acquired by realtime (RT) three-dimensional echocardiography (3DE) versus magnetic resonance imaging (MRI) in elderly patients.Methods A total of 31 patients aged≥60 years [mean (72.1±6.6) years] with various cardiovascular diseases were evaluated by MRI versus RT-3DE on the same day.RT-3DE was performed with a Philips iE-33 echocardiographic system,and LV volumes and function were analyzed with the assistance of TomTec software.The results of LV volumes and function obtained by manual tracing were compared with Signa 1.5-T MRI data.The acquisition of RT-3DE datasets was feasible in all 31 patients.Results The average MRI-detected LV end diastolic volume (LVEDV) was (139.1 ±40.8) ml,LV end systolic volume (LVESV) was (77.8±41.7)ml,LV ejection fraction (LVEF) was (47.9±14.3)％.The average RT-3DE-detected LVEDV was (119.5±37.7) ml,LVESV was (65.5±36.1) ml,LVEF was (47.9± 14.3)％.Compared with MRI values,LVEDV was underestimated by RT-3DE (P＜0.01,r=0.79,y=0.73 x+17.8,SEE=23.5 ml),with a mean difference of (-19.6±25.6)ml; LVESV was also underestimated by RT-3DE (P＜0.01,r=0.89,y =0.77 x+ 5.6,SEE=16.8 ml),with a mean difference of(-12.3± 19.1)ml.Ejection fraction determined by MRI was the same as that by RT-3DE (P＞0.05,r=0.91,y=0.75 x+ 13,SEE=5.61％),with a mean difference of (1.1±7.4) ％.There was good interobserver reproducibility in LV volume detected by RT-3D.Conclusions Compared with MRI,RT-3DE has more accuracy and repeatability in assessment of LV volume and ejection fraction in elderly patients.

Objective To assess the accuracy and repeatability of real-time three-dimensional eehoeardiography (RT-3DE) for the measurements of left ventricular (LV) mass in elderly patients compared with magnetic resonance imaging (MRI).Methods A total of 31 patients (26 men) aged ≥60 years (72.1±6.6) years with various cardiovascular diseases were evaluated by MRI and RT- 3DE on the same day.RT-3DE was performed with a Philips iE-33 echocardiographic system, and LV mass was analyzed with the assistance of TomTec software.The results of LV mass obtained by manual tracing were compared with Signa 1.5-T MRI data.The acquisition of RT-3DE datasets was feasible in all 31 patients.Results A good correlation was observed between RT-3DE data with manual border detection and MRI for LV mass (r=0.869, y=0.943 x+11.69, SE= 19.09 g, P< 0.01), with a mean difference of (4.7±37.7)g.The average LV mass was (123.9±35.0)g (74.4-208.1 g) evaluated by MRI, and was (128.6±37.9)g (67.0-222.9 g) evaluated by RT-3DE.There was good inter- or intra-observer correlation between RT-3DE by two sonographers for LV mass.Conclusions The assessment of LV mass from RT-3DE data is feasible in elderly patients.The mass can be determined with high accuracy and low interobserver variability in elderly patients with adequate eehocardiographic image quality.

Objective To probe into the reasons for and results of remedial surgical therapy in thoracic aortic dissection patients after first endovascalar repair.Methods From July 2000 to December 2012,12 cases received second interventional surgery.The average time from second therapy to first surgery was ( 14 ± 11 ) months.Main reasons for second endovascular therapy were sustained type Ⅰ endoleak at proximal landing zone and type A dissection caused by retrograde tear.Therapies included hybrid operations in 8 cases and absnlute endovascular therapy in 4 cases.Results The 30 day mortality after the second intervention was 5.6％ ( 1/12),total mortality rate was 16.7％ (2/12).In 7 cases with endoleak,small endoleak remained after remedial therapy (57.1％ ) in 4 cases.Among 4 cases with secondary type A aortic dissection,successful staged hybrid operation with mid-sternal thoracotomy was adopted in 3 cases,one died of pulmonary emtbolism during follow-up period,1 case with Bebcet disease still had proximal type Ⅰ endoleak after second hybrid operation,and died from tear of aorta.Conclusions Endoleak and secondary type A aortic dissection are the main cause necessitating second intervention after primary endovascular therapy for thoracic aortic dissection.Hybrid operation remains the best choice to treat postoperative complications after endovascular therapy for thoracic aortic dissection.

Objective To evaluate early results of Endurant stent-graft in the treatment of abdominal aortic aneurysms (AAAs).Methods From July 2010 to June 2011,68 patients (57 men,11 women; mean age 74.3 years) were treated with Endurant stent-graft at our center.26 cases had hostile proximal neck in the anatomy.According to ASA classification,15 cases were class Ⅱ ; 32 cases were class Ⅲ and 21 cases were class Ⅳ.Results Intraoperative immediate technical success was achieved in all cases.At completion angiography,a type Ⅱ endoleak was detected in 18 (26％) of the 68 patients.The mean operation time was (96 ± 29) min,the mean blood loss was (99 ± 68 ) ml,and the mean contrast usage was (122 ± 65) ml.No intraoperative conversion to open surgery,stent migration,types Ⅰ/Ⅲ endoleak,other major complications,or death was encountered.49 patients (72％) had a postimplantation syndrome with fever,leukocytosis,and increase of C-reactive protein levels,which completely resolved within two weeks.The mean follow-up time was (8 ± 5) months.Conclusions Endurant stent-graft seems to be safe and effective in endovascular aneurysm repair,even in patients with hostile aortoiliac anatomy.

Carcinoma ; genetics ; metabolism ; pathology ; surgery ; China ; Humans ; Male ; Oncogene Proteins, Fusion ; genetics ; Prostatic Hyperplasia ; genetics ; metabolism ; pathology ; surgery ; Prostatic Neoplasms ; genetics ; metabolism ; pathology ; surgery ; Proto-Oncogene Proteins c-ets ; genetics ; metabolism ; Reverse Transcriptase Polymerase Chain Reaction ; Serine Endopeptidases ; genetics ; metabolism

Objective To explore the relationship between the endovascular aortic repair (EVAR)in patients with abdominal aortic aneurysm (AAA) and postoperative systemic inflammatory response syndrome (SIRS).Methods In this study,93 AAA patients undergoing EVAR were enrolled.Analysis was performed to evaluate the incidence of SIRS during peri-operation period.Logistic multiple regression analysis was performed to determine the parameters predicting SIRS.Results The incidence of SIRS was 58.1％.Aneurysm size,mural thrombus,iliac artery lesion,number of stent,operating time,volume of contrast agent,blood loss and length of stay were all significantly correlated with SIRS (P ＜ 0.05).In a logistic regression model,history of kidney disease or operation,aneurysm size,ruptured aneurysm and number of stents were strongly and independently associated with SIRS.Conclusions SIRS is common in AAA patients after EVAR.Optimizing treatment strategies avoiding risk factors for SIRS benefits AAA patients.

Objective To investigate the effects of selenium and iodine deficiency on the contractibility of rat thoracic aorta and probe into its mechanisms.Methods Isolated vascular methods were used to study the effects in different groups.Results The contraction of rat thoracic aorta of the groups with selenium and iodine deficiency was less than that of the normals(P(0.05));sodium selenite(0.1mol/L) had no effect on rat aortic contraction,but was significantly synergic with the contraction induced by KCl combined with NE(P

Objective To identify differently expressed genes and pathways between Kashin-Beck disease (KBD) cartilage and healthy cartilage,and to explore the mechanism of articular cartilage lesions of KBD.Methods Cartilage specimens were collected from 9 patients with KBD and 9 healthy controls.Total RNA was extracted from cartilage specimens,and transcribed into cDNA.KBD and control groups were labeled by Cy3 and Cy5,respectively.Agilent genome-wide microarray was applied to compare the expression profile of KBD cartilage and healthy cartilage.The microarray data was analyzed by single gene and pathway expression analysis to identify differently expressed genes and pathways between KBD and healthy controls.Results ①Tweenty nine genes were significantly up-regulated in KBD group (averaged ratio =6.68 + 1.98,P ＜ 0.05),mainly involved in apoptosis,metabolism,extracellular matrix,cytoskeleton and cell movement.Additionally,extracellular matrix-related FBLN1 gene was down-regulated in KBD group(ratio =0.14 + 0.06,P ＜ 0.05).②Five apoptosis and 6 hypoxia-related pathways presented higher expression levels in KBD compared to healthy controls(all P＜ 0.05).Conclusions We find significant expression differences of apoptosis and hypoxia-related genes and pathways between KBD cartilages and healthy cartilages,suggesting that hypoxia might contribute to chondrocytes apoptosis of KBD.Further studies may be needed to investigate the relationship between hypoxia and articular cartilage lesions of KBD.

Objective To compare the expression profile of mycotoxin-related environmental response genes (MERGs) in the articular cartilage of patients with Kashin-Beck disease (KBD) and healthy controls,and explore the relationship between MERG and KBD.Methods Articular cartilage specimens were collected from 9 healthy human subjects and 9 adult KBD patients.Agilent microarray was used to evaluate the expression levels of MERG in cartilage specimens,and the expression ratios of MERG between KBD and healthy controls were calculated.GSEA software was used to calculate the NES scores and P values of gene ontology(GO).Results ①T-2 toxin,deoxynivalenol,zearalenone,aflatoxin B1,fumonisin B1 and ochratoxin A related 15 MERGs presented expression differences between KBD and healthy controls(ratios ＞ 2.0 or ＜ 0.5).Thirteen MERGs were up-regulated in KBD,including BAX,BCL2,COL5A2,FER1L3,GSTT2,IGFBP2,IGFBP4,PDE8B,SOCS3,THBS1,TMSL8,VGLL3 and TUBB2A (ratio ＞ 2.0).Two MERGs,POSTN and FABP4,were down-regulated in KBD (ratio ＜ 0.5).The 15 MERGs were involved in various biological processes; such as collage synthesis,apoptosis,metabolism,growth & development and so on.②Mycotoxin related 4 apoptosis GOs and 5 growth & development related GOs were up-regulated in KBD compared to healthy controls(NES ＞ 0),including ANTI_APOPTOSIS,REGULATION_OF_PROGRAMMED_CELL_DEATH,APOPTOSIS_GO,REGULATION_OF_APOPTOSIS,ORGAN_MORPHOGENESIS,ANATOMICAL_STRUCTURE_DEVELOPMENT,ORGAN_DEVELOPMENT,SYSTEM_DEVELOPMENT and REGULATION OF DEVELOPMENTAL_PROCESS (NES ＞ 0 and P ＜ 0.05).Conclusions There are multiple mycotoxins related environmental response genes presenting significant expression difference between KBD cartilage and normal cartilage.Mycotoxin can affect the expression of MERGs in KBD articular cartilage,which might lead to dysfunction of chondrocytes,and articular cartilage lesions.