OBJECTIVETo explore clinical outcomes of posterior malleolar fractures with medial-extension type through posterioromedial and posteriorlateral incision.

METHODSFrom January 2008 to January 2011,25 patients with posterior malleolar fractures with medial-extension type were treated by hollow lag screw. Among them, 15 patients were treated through posteromedial incision,including 9 males and 6 females,aged from 21 to 67 years old with an average of 48.1 +/- 1.3; there were 5 cases with type A, 6 cases with type B and 4 cases with type C,according to Denis-Weber classification. Ten patients were treated by through posterior-lateral incision,including 6 males and 4 females, aged from 23 to 64 years old with an average of 46.9 +/- 1.5; there were 3 cases with type A, 5 cases with type B and 2 cases with type C,according to Denis-Weber classification. Operation time, blood loss, length of incision, times of X-ray exposure and complications of two groups were recorded and compared, Baird-Jackson effective evaluation were applied for evaluate clinical outcomes.

RESULTSAll patients were followed up from 12 to 49 months with an average of 20.6 months. There were significant differences in operation time, blood loss, times of X-ray exposure and complications between two group (P < 0.05). While there was no obvious meaning in clinical outcomes between two groups (P > 0.05).

CONCLUSIONTreating posterior malleolar fractures with medial-extension type through posteromedial approach can expose and fix fracture under direct vision, has advantages of shorter operation time, less X-ray exposure and blood loss, is a good choice of surgical approach.

Adult ; Aged ; Ankle Fractures ; Bone Screws ; Female ; Fracture Fixation, Internal ; instrumentation ; Fractures, Bone ; surgery ; Humans ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; methods ; Tarsal Bones ; injuries ; surgery

Objective To evaluate DOG1 as an immunohistochemical marker for GIST.Methods From Jan 1987 to Sep 2008,210 consecutive cases including 137 GISTs as well as 73 non-GIST sarcoma were evaluated for clinicopathological characteristics and immunostained for DOG1 antibodies.Result Immunoreactivity for DOG1 was detected in 110 of 137 GIST cases (80.3%),3 out of 11 CD117negative GISTs were DOG1-positive.Only 1 of 73 non-GIST case was positive for DOG1.The expression of DOG1 in GIST is associated with the location of tumor,cell density,nuclear pleomorphism and Fletcher grading criteria.The postoperative 1-,3-,5-year overall survival for DOG1 negative and positive patients was 81.3%,74.5%,74.5% and 98.5%,85.9%,83.2%,respectively,P = 0.034.Conclusion DOG1 was a sensitive and specific marker for GIST in gastrointestinal mesenchymal tumors (GIMT).

Aim To investigate the role of locus coeruleus(LC)-norepinephrinergic system and sympathetic nervous system in immunosuppression under cold stress, using 6-hydroxydopamine(6-OHDA) as chemical sympathectomy.Methods Rats were maintained in cold chamber at 4℃ for 4 h.The 51Cr release assay from YAC-1 cells was used to determine the splenic NK cell activity, the double staining of ABC method was employed to observe the immunoreactive expression of Fos, arginine-vasopressin(AVP), oxytocin(OT) and tyrosine hydroxylase(TH), and conventional radioimmunoassay was used to measure plasma corticosterone (CORT) concentrations.Results Central sympathectomy with intracerebroventricular(i.c.v.) injection of 6-OHDA r educed significantly the elevation of plasma corticosterone level, the expressio n of Fos in hypothalamic paraventricular nucleus(PVN) and in locus coeruleus(LC ), as well as the suppression of NK activity induced by cold stress at 4℃ for 4 h. Peripheral sympathectomy with intraperitoneal (i.p.) injection of 6-OHDA al so reversed the cold stress-induced suppression of NK cytotoxicity, but without significant effect on Fos expression in brain. Double staining showed that amon g the Fos-positive neurons in PVN only a few co-expressed Fos and AVP or Fos a nd OT, while in LC the majority of Fos-positive neurons co-expressed Fos and T H.Conclusion The mechanism of suppression of NK activity induce d by cold stress may be mediated through HPA axis activated partially by central LC-norepinephrinergic system and through the peripheral sympathetic nervous system.

mRNA in ARE and GW9662 group were 2.276 ±0.534 and 0.362 ±0.026,respectively.Compared with control group,PPARγmRNA level in both of ARE and GW9662 group reached statistical significance (t =4.785,P =0.001 ;t =2.395,P =0.044).PPARγprotein expression in ARE group,GW9662 +ARE group and control group were 27 688.33 ±3 593.06,21 816.00 ±1 644.07,17 716.33 ±2 273.95,respectively,which was higher in ARE group than that in control and GW+ARE group (t =5.159,P =0.001 ;t =3.038,P =0.016). NF-κB p65 mRNA expression in GW9662 +ARE group was 0.346 ±0.149,which in ARE group and GW9662 group were 0.392 ±0.1 87 and 1 .720 ±0.338,respec-tively.The differences of NF-κB p65 mRNA expression level between ARE,and control or GW9662 group were statistically significant (t =3.592,P =0.007;t =7.851 ,P =0.000).While,the differences of Caspase-3 mRNA and protein expression levels among the four groups were not statistically significant (F =1 .1 81 ,P =0.376;F =0.647,P >0.05).Conclusion ARE may restrain NF-κB through up-regulating PPARγto inhibit the proliferation and invasive potential of LLC in vitro, which suggests that PPAR-γmay be a novel therapeutic target for lung cancer.

Objective To evaluate the effect and safety of catheter constant drainage combined with pericardial perfusion lentinan in treatment of patients with malignant pericardial effusion caused by lung cancer.Methods One hundred and eighteen patients with malignant pericardial effusion caused by lung cancer were divided into 2 groups by table of random digit,the treatment group (56 cases) was treated by pericardial perfusion lentinan after catheter constant drainage by central venous catheter,and the control group (62 cases) was treated by pericardial perfusion cisplatin after catheter constant drainage by central venous catheter.The therapeutic effect and adverse reaction were contrasted between the two groups.Results There was no significant difference in effective rate between treatment group and control group [89.3％(50/56) vs.83.9％ (52/62),x2 =0.736,P =0.391].The adverse reaction rate of treatment group was significantly lower than that of control group [8.9％ (5/56) vs.24.2％ (15/62),x2 =4.871,P =0.027].There was no significant difference in recurrence rate between treatment group and control group [14.3％(8/56) vs.11.3％(7/62),x2 =0.004,P =0.948].Conclusions Catheter constant drainage combined with pericardial perfusion lentinan for malignant pericardial effusion caused by lung cancer is safety and effective,and can be widely applied to clinical application.

Objective:To observe the analgesic effect of Yunzhi polysaccharopeptide (PSP) and analyze its mechanism. Methods: The hot plate test in mice and the tail stimulation vocalization test in rats were used.Results: PSP administered po at a dose of 1.0 g/kg for 7 days could produce a significant analgesic effect, which could last for more than two hours. The analgesic effect of PSP disappeared after lesion of mediobasal hypothalamus. Conclusions: PSP could elicit a central analgesic effect.

Objective:To explore clinical outcomes of posterior malleolar fractures with medial extension type through posterioromedial and posteriorlateral incision. Methods:From January 2008 to January 2011,25 patients with posterior malle-olar fractures with medial extension type were treated by hollow lag screw. Among them ,15 patients were treated through pos-teromedial incision,including 9 males and 6 females,aged from 21 to 67 years old with an average of 48.1±1.3;there were 5 cases with type A,6 cases with type B and 4 cases with type C,according to Denis Weber classification. Ten patients were treated by through posterior lateral incision,including 6 males and 4 females,aged from 23 to 64 years old with an average of 46.9±1.5;there were 3 cases with type A,5 cases with type B and 2 cases with type C,according to Denis Weber classification. Operation time,blood loss,length of incision,times of X ray exposure and complications of two groups were recorded and com-pared,Baird Jackson effective evaluation were applied for evaluate clinical outcomes. Results:All patients were followed up from 12 to 49 months with an average of 20.6 months. There were significant differences in operation time ,blood loss,times of X ray exposure and complications between two group (P<0.05). While there was no obvious meaning in clinical outcomes be-tween two groups (P>0.05). Conclusion:Treating posterior malleolar fractures with medial extension type through posterome-dial approach can expose and fix fracture under direct vision ,has advantages of shorter operation time ,less X ray exposure and blood loss,is a good choice of surgical approach.

BACKGROUND: Neuropeptides, a kind of endogenous active substance in nerve tissues, can modulate physiological functions of multiple body systems.OBJECTIVE: To observe the effects of vascular bundles or sensory nerve tracts implanted into tissue-engineered bone for rabbit large bone defects on the expression levels of calcitonin gene-related peptide (CGRP) and neuropeptide-Y.METHODS: Fifty-four New Zealand rabbits were enrolled to make model of large bone defects, and then, the animal models were randomly divided into three groups, including sensory nerve tract, vascular bundle, and control groups (n=18 per group), followed by implanted with sensory nerve tracts, vascular bundle, and tissue-engineered bone without sensory tracts or vascular bundle, respectively. The defected bone received gross and Masson staining at 4, 8 and 12 weeks after modeling, to compare the expression levels of CGRP and neuropeptide-Y in each group.RESULTS AND CONCLUSION: mRNA expression levels of CGRP and neuropeptide-Y in the sensory nerve tract and vascular bundle groups were significantly higher than those in the control group at different time points after modeling (P < 0.05). mRNA expression levels of CGRP and neuropeptide-Y in the tissue-engineered bone began to be increased and peaked at the 8th week, and then decreased (P < 0.05), which were the lowest at the 4th week (P < 0.05).Immunohistochemical staining results showed that CGRP was mainly found in the bridge, periosteum of newly born bones and around blood vessels; while neuropeptide-Y mainly localized in the medullary cavity and around blood vessels. These results indicate that the implantation of vascular bundle and sensory nerve tracts for bone defects can upregulate the expression levels of CGRP and neuropeptide-Y, and promote bone repair. However, sensory tract implantation may cause sensory impairment; thereafter, vascular bundle implantation is more suitable for ideal tissue-engineered construction to meet physical requirements.

Objective To investigate the association of impaired glucose regulation and adiponectin (APN)with the clinical severity of coronary lesions.Methods A total of 210 cases of suspected coronary heart disease were examined by coronary artery angiography.The patients were differentiated as 4 groups:42 patients with normal glucose tolerance (NGT),36 patients with impaired fasting glucose(IFG),92 patients with impaired glucose tolerance (IGT;including 44 cases with postpraudial 2h plasma glucose(2 hPG) ＜ 10 mmol/L as IGT1 subgroup and 48 cases with 2h PG ≥ 10 mmol/L as IGT2 subgroup),and 40 patients with combination of IFG and IGT.Accordingly,body mass index (BMI),blood pressure,blood lipid,insulin,APN and CRP were measured to evaluate by Gensini score.Results The incidence of coronary heart disease and Gensini scores in IGT and IGT+IFG groups were significantly higher than those in either IFG or NGT subset(P＜0.05).APN in both IGT and IGT+IFG subsets was significantly lower than that in IFG or NGT subsets(P＜0.05),CRP values were significantly raised in both IGT and IGT+IFG subgroups compared with the other 2 subgroups(P＜0.05).Statistical difference in Gensini scores and APN was found between the 2 IGT subgroups (P＜0.05).Gensini scores were negatively correlated with APN level.Multivariate regression analysis showed that both APN and HOMA-IR values were independently correlated with the Gensini scores.Conclusion The lowered APN may serve as a more sensitive factor in predicting the coronary lesions in patients with IGR,especially in IGT cases.It woula be beneficial to cardiovascular complication by controlling the postprandial blood glucose level below 10 mmol/L.

Objective To explore the clinical outcomes of laparoscopic appendectomy in acute and chronic appendicitis,and sum up the surgical experiences of lapaproscopic appendectomy.Method In this study 129 cases of appendicitis at the Department of Gastroentrological Surgery,Peking University People's Hosptial were collected retrospectively from June 2008 to December 2009.The clinical results of laparoscopic and open procedures for acute appendicitis and the outcomes of laparoscopic operation for acute and chronic appendicitis were compared.Results For acute appendicitis,the length of hospitalization [(4.8 ± 2.6) d vs.(7.0 ± 1.3) d,t =0.679,P =0.006] was significantly shorter in laparoscopic group than that in open surgery group.In addition,the mean length of operation time [(77 ± 33) min vs.(55 ± 23) min,t =3.431,P ＜0.01] were longer,postoperative first passing flatus [(2.3 ± 1.2) d vs.(1.4 ±0.9) d,t =4.665,P ＜0.01] and oral intake [(2.3 ± 1.4) d vs.(1.2 ±0.6) d,t =4.517,P＜0.01] were later for acute appendicitis patients than for chronic appendicitis in laparoscopic group.Conclusions Laparoscopic appendectomy for acute appendicitis is a safe and effective procedure,though it might cause more postoperative complications such as intra-abdominal abscess and small intestinal obstruction in patients with acute appendicitis.