BACKGROUND:Ankle fractures combined with deltoid ligament injury are not uncommon in clinical practice, prone to misdiagnosis and missed diagnosis, resulting in ankle instability, chronic pain and traumatic arthritis. In recent years, because of the research and development of anatomy and biomechanical characteristics of deltoid ligament, the treatment and surgical methods of ankle fracture combined with deltoid ligament injury have progress and development, but it remains controversial. OBJECTIVE:To evaluate the clinical effect of suture anchor repair in the treatment of ankle fracture combined with deltoid ligament injury. METHODS: Twenty-seven patients with ankle fracture combined with deltoid ligament injury were selected between January 2010 and January 2013. The lateral maleolus and posterior maleolus fracture patients were treated with open reduction and internal fixation, and al the deltoid ligament injury patients were treated with anchor repair. The tibiofibular syndesmosis isolated patients received internal fixation with a cancelous bone screw. RESULTS AND CONCLUSION:Al 27 patients were folowed-up for 11-35 months, averagely 23 months. The evaluation according to the American Orthopaedic Foot and Ankle Society score system showed that the excelent and good rate was 74.1%. The results indicate that anchor could perfectly restore the stability of ankle joint.

Objective To investigate the occurence of glomus tumor and investigate its diagnosis and treatment. Methods 13 cases of glomus tumors were analyzed retrospectively. There were 9 females and 4 males. All 13 cases were surgically treated under megaloscpe. Results All the cases were testified as glomua tumors by pathology. There was no recurrence during the follow up of 6 months to 1 year. All the patients were symptom free. Conclusion Glomus tumor has specific features on clinical presentation. Mierosurgieal excision under megaloscpe is fill elective method.

Antiplatelet therapy and stent implantation have been the dominant treatment to reduce the mortality of patients with coronary artery disease.Recently,studies have showed that adverse cardiac events still occur in part of patients with coronary artery disease after the antiplatelet treatment with aspirin and/or clopidogrel.Thus,resistance to aspirin and clopidogrel has attracted increasing attention.It will be great benefit to these patients who were identified resistance and made tailoring antiplatelet therapy So far many platelet function tests has been used in clinical to monitor the reaction of the antiplatelet drugs for prevention and treatment of thrombosis in patients with coronary artery disease.These monitoring tests may be chosen based on different antiplatelet drugs including aspirin,clopidogrel and GP Ⅱ b/Ⅲ a antagonist.The results of antiplatelet drug resistance may be different due to different platelet function methods,thus the related clinical adverse events needs further verification.

Though the primary data on fully covered self-expandable metal stents (FCSEMS) in the treatment of benign biliary strictures caused by chronic pancreatitis and anastomotic stricture following orthotopic liver transplantation is encouraging,the risks including stent translocation,biliary infection,pancreatitis and inability to remove stents should be considered before replacing plastic stents with FCSEMS for the first-line treatment of benign biliary strictures in routine practice.FCSEMS is effective in treating benign pancreatic ductal strictures,but it is also associated with a high rate of stent translocation.To overcome this problem,FCSEMS with better conformability and flared ends need to be designed.There is a theorectial risk of pancreatic ductal infection caused by the blockage of side branches of the pancreas by covering membrane of the stents.However,no such complication was reported.Given the uncertain long-term efficacy and safety of FCSEMS for benign pancreatic ductal strictures,their use may be reserved for the management of retractory,symptomatic benign strictures only in selected groups of patients.

Objective To investigate the clinical features of young female patients with acute myocardial infarction (AMI) who were referred to Peking Union Medical College Hospital. Methods A total of 24 consecutive AMI female patients (age≤44 years) who underwent coronary angiography were retrospectively retrieved from the database, and 70 AMI patients whose age ≥ 65 years and who also underwent coronary angiography were enrolled as a control (elderly) group. Clinical features were compared between the two groups. Results Of the 24 young female AMI patients, MI from non-atherosclerosis was identiifed in 9 patients (non-ATS group). Compared to the remaining 15 young female AMI patients (ATS-group), non-ATS group was younger (P<0.05), with lower BMI (P<0.05) and less traditional risk factors of coronary heart disease (P<0.05). Coronary angiography showed more normal artery (P<0.05) and lesions on left main (P<0.05). However, when compared to the elderly group, the young female ATS-group was associated with less hypertension (P<0.01), smoking (P<0.05), traditional risk factors (P<0.01) and lower level of blood pressure (P<0.05), fasting glucose (P<0.05), serum creatine (P<0.01), TC (P<0.05), and LDL-C (P<0.01) at admission. Coronary angiography showed single vessel disease was the most common lesion. Conclusions Acute myocardial infarction in young female might be caused by non-atherosclerosis. Those due to atherosclerosis differ in coronary risk factors and angiographic features from the elderly female AMI patients.

Objective To evaluate the function of p27 gene on the neointimal formation after balloon injury in rabbit carotid artery. Methods The cultured vascular smooth muscle cells (VSMCs) were infected with Adp27. Using MTT assay we measured the proliferation of VSMCs. Balloon injured rabbit carotid arteries were also infected with Adp27, and then we evaluated the ratio of intima to media. Results MTT assay of rabbit VSMCs proliferation demonstrated an obvious inhibition in Adp27 treated group. And p27 overexpression had an effect on the cell cycle. It could induce cell cycle arrest in G1 phase and reduce the cells in S phase. Overexpression of p27 could also reduce the neointimal hyperplasia by 27.43%. Conclusion The p27 gene can reduce the neointimal formation after balloon injury in rabbit carotid artery effectively.

Objective To evaluate the influence of percutaneous coronary intervention (PCI) on NT-proBNP and Hs-CRP level of the elderly with coronary heart disease. Methods Twenty-four patients who underwent PCI, and thirty patients who underwent coronary angiography (CAG) were enrolled in this study. Plasma NT-proBNP and Hs-CRP concentrations before and at 0, 1 h, 24 h and 72 h after PCI were assayed in all patients. Results There were no significant difference in plasma NT-proBNP level at baseline level between the PCI and CAG group, and also no significant change in the CAG group after the procedure. Plasma NT-proBNP level was increased significantly from 231.31?233.52 pg/mL to the peak concentration of 663.75?614.93 pg/mL at 24 h after PCI. Statistical differences were observed between the baseline levels and at 24 h as well as 72 h after the operation in the PCI group. Plasma NT-proBNP concentrations also showed significant differences between the PCI and CAG group at each time point after the procedures. Remarkable elevation in plasma Hs-CRP level was observed at 72 h after procedure in all patients. Conclusion Elevation of plasma NT-proBNP concontrations might be induced by transient myocardial ischemia in PCI. NT-proBNP may be a marker of myocardial ischemia and may be useful to detect untypical ischemia in the elderly. Plasma Hs-CRP increased at 72 h after PCI and CAG, which may be related to inflammation reaction induced by vessel puncture.

Objective To introduce and evaluate the methods of ultrasound-guided compression repair (UGCR) or ultrasound-guided compression-puncture hematocele repair (UGCPHR) in treatment of post-catheterization femoral arterial pseudoaneurysms. Methods Two patients with femoral arterial pseudoaneurysms (3.0 cm?3.0 cm) were treated with UGCPHR, a 18-gauge blunt needle self-retrained with a syringe was placed into the pseudoaneurysm flow lumen along the primary cleft, to compress this site to cut-out continuously the blood flow into the lumen, then to draw all the hemocele out with the syringe, to slowly decompress after continuing the compression for 20-30 minutes, and to repeat this procedure if blood flow signals still existed. Results All the five cases were treated successfully, without large hardening nodules. Four cases were treated successfully at one time, one case was successfully with UGCPHR after failure with UGCR. Conclusion For the treatment of post-catherization femoral arterial pseudoaneurysms, UGCR or UGCPHR depending on the size of pseudoaneurysms is effective, safe and technically simple, without local largely hardening nodules formation in post-repair or any effects on interventional diagnosis and treatment in short periods along the same passway.

Objective To investigate the role of mitochondrial KATP channel in the mechanism of the protective effect of ischemic preconditioning (IP) against ischemia-reperfusion (I/R) injury.Methods Forty-eight Wistar rats of both sexs weighing 250-350 g were used in this study. Forty rats were randomly divided into 5 groups ( n = 8 each): group A I/R; group B IP+ I/R; group C diazoxide (DZ mito-KATP channel activator) + I/R; group D 5-HD (mito-KATP channel blocker) + IP + I/R and group E 5-HD + DZ + I/R. Another 8 animals were used for electron microscopic examination of normal mitochondria as control. The animals were anesthetized with intraperitoneal pentobarbital 30 mg?kg-1. The hearts were immediately excised and passively perfused in a Langendorff apparatus with K-H solution at 5.8 kPa perfusion pressure and 36.5-37.5℃ via aortic cannulation. A fluid-filled latex balloon was via left atrium in left ventricle for the measurement of left ventricular function. I/R was induced after 30 min stabilization by clamping aortic cannula for 40 min followed by 30 min reperfusion. In group B and D the isolated hearts underwent 2 episodes of 5 min ischemia followed by 5 min reperfusion before I/R. In group C and E DZ 50 ?mol?L-1 was infused for 10 min and in group D and E 5-HD 100 ?mol?L-1 was infused for 10 min before I/R. HR, LVSP, LVEDP and coronary flow (CF) were measured at the end of stabilization (T0 , baseline), immediately before I/R (T1 ) and at 10, 20 and 30 min of reperfusion (T2.3.4.), and left ventricular developed pressure (LVDP= LVSP- LVEDP) was calculated. Myocardial tissue was obtained at the end of 30 min reperfusion for electron microscopic examination of mitochondria. Mitochondrial ultrastructure was assessed by Flameng scoring system (0 = normal, 4 = severely damaged) .Results Ischemic and DZ preconditioning significantly increased LVDP and decreased LVEDP and Flameng score. 5-HD pretreatment partly antagonized the protective effect of IP and completely antagonized that of DZ against I/R injury. Conclusion Ischemic preconditioning protects the heart against I/R injury mainly by activating mitochondrial KATP channel.