Objective To analyze 3 different methods for treatment of Tossy Ⅲ acromioclavicular dislocation. Methods Sixty-two patients with Tossy Ⅲ acromioclavieular dislocation who had been treated by 3 different treatment methods in our department were analyzed. Of them, 18 cases were treated with Kirschner wire and tension wire fixation plus repair of coracoacromial and acromioelavicular ligaments(Group A), 21 with clavicle claw steel plate fixation plus repair of acromioelavicular ligament (Group B ), and 23 with intersecting Kirschner wire plus repair and strengthening of acromioclavieular ligament(Group C). Results After follow-ups for 9 to 24 months (with an average of 15. 6), therapeutic effect(by Karlsson system), operation duration, intraoperative blood loss and cost were evaluated for all the pa-tients. The differences in the therapeutic effect between all groups were not significant ( P ＞ 0.05 ). Group C needed less operation time and had less bleeding than groupA ( P ＜ 0. 05), and group C needed less oper-ation time and cost and had less bleeding than group B ( P ＜ 0. 05). Conclusion Intersecting Kirsehner wire plus repair and strengthening of aeromioclavieular ligament is an efficient, convenient and less costly method for treatment of TossyⅢ aeromioclavicular dislocation.

Objective To study the rules of circumferential margin invasion(CMI)in middle and(or)lower rectal cancers by pathological large slices stained with HE and labeled with CK20,and provide a pathological basis for clinical therapy of rectal cancer.Methods Forty-one patients with middle or low rectal cancer were randomly selected in 8 months.The surgically resected specimens were detected after they were made into the pathological large slices stained with HE and labeled with CK20.Results The mesentery CMI positive rate in the pathological slices with HE staining and CK20 labeling was 21.95%,and 29.27% respectively.The mesentery CMI positive rate in moderately-and well-differentiated group was lower than in poorly-differentiated group(P＜0.05).Moreover,the mesentery CMI rate was higher in the specimens with lower edge less than 5 cm away from the dentate line than that in those with lower edge more than 5 cm away from the dentate line(P＜0.05).There was no significant correlation between CMI with the factors such as gender,age,pathological general types,tumor infiltration depth,lymph node metastasis,and surgical procedures(all P＞0.05).Conclusion There were risk factors for the CMI such as low location,poor differentiation and so on.The CMI patients should be treated with standardized adjunctive therapy after operation.

[Objective]To observe the histological characteristics of autologous chondrocytes/human articular cartilage derived scaffold (HACDS) composites for repairing chondral defects in rabbit models. [Methods]A full-thickness articular-cartilage defect (diameter 4 mm,thickness 2 mm) was created in the femoral condyle of rabbits. The rabbits were divided into two groups: control group,HACDS scaffold only,and experimental group,chondrocytes/HACDS scaffold. Fifteen months after implantation,the specimens were observed by inverted phase contrast microscopy,and assessed by staining with haematoxylin-eosin,alcian blue,toluidine blue,safranin O,as well as by the immunohistochemistry of collagen type Ⅱ.[Results]Histologically,the generated neo-cartilage integrated well with its surrounding normal cartilage and subchondral bone in the defects of experimental group at 15 months post-implantation,whereas only fibrous tissue was filled in the defects of control group. Histochemical and immunohistochemical analysis revealed that alcian blue,toluidine blue,safranin,and were obviously positive in the experimental groups. However,alcian blue,toluidine blue,and safranino O were negative in the control group.[Conclusion]The current histological examination demonstrated that an engineered cartilage composed of autologous chondrocytes on HACDS scaffold could be successfully obtained and further applied to repair an articular cartilage defect in a rabbit model.

Objective To investigate the effects of transforming growth factor-?1(TGF-?1), fibroblast growth factor-2 (FGF-2), platelet derived growth factor-bb(PDGF-bb) and hepatocyte growth factor(HGF) on adult human articular chondrocytes(AHAC) proliferation and phenotype maintaining. Methods Isolated AHAC were cultured in DMEM/F-12 supplemented with 10% human AB serum, 50 ?g/ml ascorbic acid-2-phosphate, 0.4 mmol/L proline, 5 ?g/ml insulin and 1 mmol/L non-essential amino acids (NEAA). The cells of 2nd passage were used for proliferation kinetics studying: 2.0?103 cells/well were seeded on 96-well plate, 24 h later, the cells were stimulated with various growth factors or combinations of these growth factors respectively, and the proliferation kinetics were analyzed by MTT colorimetric method. The passaged chondrocytes' phenotype were assessed by safranine O staining and immunostaining for type Ⅰ,Ⅱcollagens and aggrecan. Results All four growth factors: FGF-2, TGF-?1, PDGF-bb and HGF, could promote the proliferation of AHAC, and the optimal concentrations,when used separately, were 50 ng/ml, 1 ng/ml, 1 ng/ml, 20 ng/ml respectively. While 5 ng/ml FGF-2 combined with 1 ng/ml TGF-?1 could achieve the best proliferation effect, additionally adding PDGF-bb, HGF or both could not enhance more. With the combination of FGF-2 and TGF-?1, the AHAC could expand over 2000-fold and passage over 10 times. Chondrocytes of 9th passage still excreted type Ⅱcollagen and glycosaminoglycan(GAG). Conclusion 5 ng/ml FGF-2 combined with 1 ng/ml TGF-?1 is a very appropriated circumstance for in vitro expanding of AHAC.

Objective To probe into the application of vacuum sealing drainage (VSD) in flap with slender narrow pedicle and to observe the survival,the shaping of blood vessel,congested edema and the expression of CD34 in the flap,and to analyze the underlying mechanism of VSD on the flap survival.Methods 64 SD rats were randomly divided into 8 groups:4-hour group,8-hour group,1-day group,2-day group,3-day group,4-day group,and 6-day group.A flap was designed and put on either side of a rat's back.The both width and length of the flap were 0.8 cm and the pedicle sized in the diameter of 3.5 cm.Both sides of the flaps on the rats' backs were randomly arranged into control side and experimental side.VSD was fixed sideways to each group after the shaping of flaps.Each of the equipments was dismantled respectively in the corresponding time after the operation.Afterwards the color and swelling degree of the flaps were observed,a sample was cut and the flap survival area was measured altogether on the 7th day.Flap histology and the expression of CD34 were observed mainly through HE dyeing and immunohistochemistry.The statistical data were treated to figure out the flap survival rate and to determine whether statistical differences existed in the microvessel density (MVD).Results As the time of the negative pressure suction went on,the survival area of the experimental side flap was increasing day by day and came to the maximum on the third day (95±4)％,but no statistical difference was discerned between on the third day and on the sixth day (P＞0.05).As the time of the negative pressure suction went on,the MVD in the flap was also increasing.Statistical differences (P＜0.05) existed between the experimental side of the instant group,4-hour group and the 8-hour group and those of 3-day group,4-day group,and 6-day group.Conclusions The application of VSD can advance the survival of the flap,whose survival area can reach its maximum within 3 days under application.Besides,it can promote the increase of MVD in the flap.

Adult ; Datura metel ; poisoning ; Foodborne Diseases ; therapy ; Humans ; Male ; Middle Aged ; Young Adult

ObjectiveTo investigate the extracorporeal clearance rate of imipenem in severe infection patients in the mode of continuous vena-venous hemofiltration (CVVH) during continuous renal replacement therapy (CRRT), in order to approach if the concentration of imipenem in plasma could achieve effective levels of anti-infection, and to explore the effect of time and anticoagulation measure on imipenem clearance during CRRT treatment.Methods A prospective observational study was conducted. All adult severe infection patients complicating acute kidney injury (AKI) in the Department of Critical Care Medicine of the Fourth Hospital of Hebei Medical University from March 2013 to September 2014, who were prescribed imipenem as part of their required medical care, and CRRT for treatment of AKI were enrolled. 0.5 g doses of imipenem was administered intravenously every 6 hours or 8 hours according to random number table, and infused over 0.5 hour. The unfractionated heparin was used for anticoagulation in the patients without contraindications, and no anticoagulation strategy was used in the patients with high risk of bleeding. At 24 hours after first time of administration, postfilter venous blood and ultrafiltrate samples were collected at 0, 0.25, 0.5, 0.75, 1, 2, 5, 6, and 8 hours after imipenem administration. The concentration of imipenem in above samples was determined with liquid chromatography-mass spectrometer/mass spectrometer (LC-MS/MS).Results A total of 25 patients were enrolled. Thirteen patients received imipenem intravenously every 6 hours, and 12 patients, every 8 hours. The anticoagulation was conducted with heparin in 13 cases, and 12 cases without anticoagulation. The intra-day precision, inter-day precision, matrix effect, and recovery rate in low, medium, and high concentration of plasma and ultrafiltrate, and the stability of samples under different conditions showed a good result, the error of accuracy was controlled in the range of±15%. With the application of Prismaflex blood filtration system and AN69-M100 filter, under the mode with CVVH, the total clearance rate of imipenem was (8.874±2.828) L/h when the actual dose of replacement fluid was (31.63±1.48) mL·kg-1·h-1, the total CRRT clearance rate of imipenem in vitro was (2.211±0.539) L/h, which accounting for (30.1±15.7)% of the total drug clearance. In 6 hours interval dosage regimen, the percentages of the time> 4×minimum inhibitory concentration (MIC) at specific 4×MIC of 2, 4, 6, and 8μg/mL of imipenem were more than 40% of the dosing interval. But in the 8 hours interval dosage regimen, when the level was above the 4×MIC of 4μg/mL, maintaining time would drop below 40% of the dosing interval, with significant differences compared with that in 6 hours interval dosage regimen [4×MIC = 2μg/mL: (60.84±20.25)%vs. (94.01±12.46)%,t = 4.977,P = 0.001; 4×MIC = 4μg/mL: (39.85±15.88)% vs. (68.74±9.57)%,t = 5.562, P = 0.000; 4×MIC = 6μg/mL: (27.58±13.70)% vs. (53.97±8.36)%,t = 5.867,P = 0.000; 4×MIC = 8μg/mL:(18.87±12.43)% vs. (43.48±7.83)%,t = 5.976,P = 0.000]. No significant change in sieving coefficient of imipenem was found within a short time (6 hours), which indicated that there was no effect of anticoagulation on clearance of imipenem by AN69-M100 filter, and no statistical significance was found with repeated measure analysis (F = 0.186, P> 0.05).ConclusionsThe clearance rate of imipenem is increased significantly in vitro under the mode of CVVH with the actual dose of replacement fluid was (31.63±1.48) mL·kg-1·h-1 in severe infective patients with severe sepsis complicating AKI, affecting the level of plasma drug concentration, need to adjust the dosage regimen. When the time of the dosing interval was shortened, the concentration of imipenem in patients' plasma could be increased significantly. In a short period of time, the sieving coefficient of imipenem through AN69 filter is not affected by anticoagulation measures and time cleaning efficiency will not decline.

BACKGROUND:Nowadays,the internal fixation materials for the clinical treatment of femoral intertrochanteric fractures are broadly divided into two categories: intramedulary fixation system and extramedulary fixation system.Artificial femoral head replacement can be selected for unstable intertrochanteric fractures.However,the effects of diverse treatments usualy lack of macroscopical evaluation.OBJECTIVE:To investigate and compare the clinical effects of different surgical treatments for femoral intertrochanteric fractures in the elderly.METHODS:168 elderly patients with intertrochanteric fractures,who were treated in the Department of Orthopedics,Beijing Municipal Corps Hospital of Chinese People's Armed Police Forces from June 2005 to June 2010,were enroled in this study.They were treated by screw plate fixation system (dynamic hip screw,dynamic condylar screw),intramedulary fixation system (Gamma 3 nail,expandable intramedulary nail) and artificial femoral head replacement,including 69 males and 99 females,at the age of 75-94 years,averagely 81.4 years.According to Evans type,there were 20 cases of type Ⅰ,43 cases of type Ⅱ,57 cases of type Ⅲ,33 cases of typeⅣ and 15 cases of type Ⅴ.Operative time,blood loss,weight-bearing ambulation time,and hip function were compared and evaluated in patients of each group.RESULTS AND CONCLUSION:After treatment,patients were folowed up for 14-39 months.At 12 months after treatment,Harris score was used to assess hip function in the affected side.Fracture was healed within 12 months.There was no significant difference in excelent and good rate among four groups (P＞0.05).Operative time and blood loss were significantly better in the expandable intramedulary nail group than in the other groups (P＜ 0.05).Weight-bearing ambulation time was significantly better in the artificial femoral head group than in the other groups (P＜ 0.01).Results suggest that according to fracture typing,in combination with osteoporosis in elderly patients,suitable repair method could improve therapeutic effects for femoral intertrochanteric fractures,and reduce postoperative complications.Dynamic hip screw is firstly selected for Evens types Ⅰ and Ⅱ stable intertrochanteric fractures.The intramedulary fixation system can be selected for unstable intertrochanteric fractures as Evans types Ⅲ-Ⅴ.Artificial hip arthroplasty is good for elderly patients with unstable intertrochanteric fractures as wel as severe osteoporosis.

Objective To analyze MRI features of peripheral primitive neuroectodermal tumor (pPNET) in comparison with pathological findings. Methods The clinical manifestation, pathological features and the MRI appearances of 7 patients with pathologically proved pPNET were analyzed retrospectively. Results Among 7 patients, 2 patients located in intracalvarium, 2 in lower extremities, 1 in vertebral canal and extended outside of vertebral canal, 1 in cavitas pelvis and involved sacrum, and the rest 1 in the retroperitoneal space. The lesions in soft tissue manifested as iso-intensity on T1WI, slight hyper-intensity on T2WI with cystic degeneration and hemorrhage. Pseudo-capsule was seen in 1 patient. The solid parts of pPNET enhanced markedly after the contrast agent was injected. The adjacent bones were usually involved. pPNET in bone presented as osteolytic destruction of bone with large soft tissue mass. Immunohistochemical examination showed CD99 expression in all 7 patients, synaptophysin (Syn) expression in 4, Chromogranin (CgA) expression in 3, neuron specific enolase (NSE) expression in 2, vimentin (Vim) expression in 2 and EMA in 1 patient. Conclusion MRI has important reference value in diagnosis of pPNET, but final diagnosis still depends on the pathological and immunohistochemical examination.

Objective To investigate the diagnostic value of 1H magnetic resonance spectroscopy (1H-MRS) in mammary tumors and to discuss the technique factors which influence the detection rate.Methods The 1H-MRS features of 47 mammary tumors, of which 24 malignant tumors and 23 benign tumors confirmed by pathology were analyzed. All of the tumors were detected before Gd-DTPA enhancement. Results Eleven of 24 malignant tumors showed increased choline resonance peak at 3.24 ppm while 4 of 23 benign ones at 3.24 ppm .The positive value were 45.8% and 17.4% respectively. The sensitivity and specificity were 45.8% and 82.6% respectively by using 1H-MRS to discriminate benign from malignant tumors. The main factors influencing the detection rate were low suppressed lipid, low suppressed water and low single-noise rate.Conclusion Choline is not special features of malignant tumors. Choline can be obtained despite the nature of tumor if they grow rapidly. The low sensitivity of choline to be detected mainly dues to technique factors.