BACKGROUND:Combination of mid-third clavicle fracture with acromioclavicular joint dislocation is a rare injury. The internal fixation treatment of this injury remains controversial.
OBJECTIVE:To investigate the treatment of a rare injury of mid-third clavicle fracture combined with acromioclavicular joint dislocation.
METHODS:Three patients with mid-third clavicle fracture with acromioclavicular joint dislocation from 2005 to 2011 were analyzed retrospectively. The three patients were treated with clavicle anatomic locking plate+wire subcoracoid cerclage, clavicle anatomic locking plate+clavicular hook plate and clavicle anatomic locking plate+dual Endobutton plate coracoclavicular ligament reconstruction, respectively. The treatment effects of these three methods were compared, including the operation time, blood loss, and the shoulder function evaluation.
RESULTS AND CONCLUSION:One case was misdiagnosed as simple mid-third clavicle fracture. Al the three patients were fol owed-up for more than 12 months, and the clavicle fracture healed in al three cases. The internal fixators were moved out at 12, 9 and 11 months, the Endobutton plate was stil in the body, and no redislocation happened in al cases. The pain, daily function, activity and muscle strength were compressively assessed before and after internal fixator removal. The scores of the three patients were 64, 71 and 92 before surgery, and 68, 79 and 95 after surgery. Patient treated with double Endobutton and locking plate had the best recovery. Double Endobutton plus clavicle plate are good choice as internal fixation in the treatment of mid-third clavicle fracture combined with acromioclavicular joint dislocation.

Objective To evaluate the efficacy and safety of parent-controlled analgesia for postoperative pain management in pediatric patients. Methods Five hundred and seven ASA Ⅰ or Ⅱ pediatric patients aged 10 months to 8 yr, weighting 8.5-34.0 kg, undergoing lower limb operations performed under general anesthesia combined with caudal block were assigned into 2 age groups: group PCIA-P ( < 6 yr, n = 308) and group PCIA ( ≥6yr, n = 199). Anesthesia was induced with intravenous midazolam 1 mg/kg, ketamine 2 mg/kg and propofol 2 mg/kg. Laryngeal mask airway (LMA) was introduced or the patients were intubated. After induction, caudal block was performed with 0.25% bupivacaine 2.5 mg/kg with adrenaline 1:400 000. The patients received PCA with morphine after operation. The PCA pump was controlled by parent in group PCIA-P and by patient in group PCIA. The PCA regimen included a background infusion of morphine at a rate of 15μg~(-1)·kg~(-1)·h, a bolus of 15μg/kg and a 10 min lockout interval. The vital signs, pain score, sedation score, number of attempts, morphine dosage and side effects were recorded. Results The two groups were comparable with respect to the rate of satisfactory analgesia, level of sedation, number of attempts, morphine dosage and side effects. The rates of satisfactory analgesia were 72.7% and 80.2% in group PCIA-P vs 77.9% and 78.9% in group PCIA at 24 and 48 h after operation respectively ( P > 0.05) . Conclusion Parent-controlled analgesia could be used safely and effectively in children after orthopedic surgery.

Objective To study the chemical constituents of Epimedium sutchuenense.Methods The compounds were repeatedly separated and purified on column chromatography of silica gel,polyamide,Sephadex LH-20,and ODS.The structures were identified on the basis of spectral methods.Results Ten compounds were isolated from 70% ethanol extract of E.sutchuenense and were identified as sutchuenoside A(Ⅰ),sutchuenoside B(Ⅱ),daidzein(Ⅲ),baohuoside-Ⅰ(Ⅳ),kaempferide 3-rhamnoside(Ⅴ),icariin(Ⅵ),anhydroicaritin-3-O-?-L-rhamnopyranosyl(1→2)-?-L-rhamnopyranoside(Ⅶ),p-hydroxybenzoic acid(Ⅷ),daucosterol(Ⅸ),and ?-sitosterol(Ⅹ),respectively.Conclusion Compounds Ⅰ and Ⅱ are novel ones named as sutchuentins A and B respectively.Compounds Ⅲ,Ⅴ,Ⅶ,and Ⅷ-Ⅹ are isolated from this plant for the first time.

ObjectiveTo explore the effects of different anesthesia approaches on hemorheology in patients with pregnancy-induced hypertension (PIH) during cesarean section.MethodsOne hundred and sixty-five patients with PIH were divided into epidural anesthesia (81 cases,control group) and combined spinal epidural anesthesia (84 cases,experiment group).The hemorheology and Apgar score were compared.Results The anesthesia and post-parturition,the levels of whole blood low shear viscosity,whole blood middle shear viscosity,whole blood high shear viscosity,erythrocyte aggregation index,plasma viscosity,fibrinogen were improved compared with those before anesthesia [experiment group:(6.3 ± 0.7 ),(6.6 ± 0.6)mPa·s vs.(8.1 ± 1.8) mPa·s,(3.8±0.6),(3.9±0.4) mPa·s vs.(5.2±0.9) mPa·s,(3.1 ±0.8),(3.2±0.7) mPa·s vs. (4.5 ± 1.2) mPa·s,3.0 ±0.4,3.1 ±0.7 vs.2.8 ±0.7,(1.2 ±0.2),(1.1 ±0.5) mPa·s vs.(1.8 ±0.6) mPa·s,(5.3 ± 0.8),(5.3 ±0.7) g/L vs.(4.7 ±0.8) g/L;control group:(7.9 ±0.8),(7.5 ±0.7)mPa·s vs.(8.2± 1.3) mPa·s,(4.5±0.4)、(4.5 ±0.4) mPa·s vs.(5.4±0.7) mPa·s,(3.7±0.8),(3.5±0.8 ) mPa· s vs. (4.6 ± 0.5 ) mPa· s,2.8 ± 0.6,2.9 ± 0.3 vs.2.7 ± 0.6,( 1.6 ± 0.4),( 1.7 ± 0.1 ) mPa· s vs.(1.9 ±0.8) mPa ·s,(5.0 ±0.9),(4.8 ±0.8) g/L vs. (4.7 ±0.5) g/L,P ＜0.05],and all the level of hemorheology in experiment group were improved compared with control group (P ＜ 0.05).There was no significant difference in 1,5 min Apgar scores between two groups (P ＞ 0.05).ConclusionThe epidural anesthesia and combined spinal epidural anesthesia can improve hemorheology of patients with PIH during cesarean section,but the combined spinal epidural anesthesia is more effective and favorable for pregnancy outcome.

BACKGROUND:Treatment of complex tibial plateau fracture is a difficulty in orthopaedic trauma. Comprehensive assessment and appropriate surgical plan before surgery are the key points of surgery.
OBJECTIVE:To investigate the application value of three-dimensional reconstruction and virtual surgical techniques in assessing and surgical planning of complex tibial plateau fracture before surgery.
METHODS:The CT scan data of 30 patients with tibial plateau fracture were imported into the Mimics 13.0 software to establish the three-dimensional digital models of complex tibial plateau fracture, and three-dimensional measurements and reclassification was performed according to three-column classification were made. Virtual surgeries such as bone window operation, reduction of the fracture and bone grafting were made in these models.
RESULTS AND CONCLUSION:Reconstructed three-dimensional digital models of complex tibial plateau fracture could indicate the characteristics of fracture accurately, could be observed at any direction, and could help doctors to reclassify the fracture according to three-column classification. Virtual surgeries of bone window operation, reduction of the fracture and bone grafting made in computer by Mimics 13.0 were confirmed to be vividly simulate the clinical surgery, and helpful in estimating the amount of bone grafting. Three-dimensional reconstruction and virtual surgical techniques play an important role in assessing and surgical planning of complex tibial plateau fracture before surgery, which should be a conventional step in the management of complex tibial plateau fracture.

Objective To determine the safety location of the bony tunnel in reconstruction of the coracoclavicular ligaments on the basis of digital characterization of the anatomy of the clavicle and coracoid process.Methods Unilateral shoulder spiral CT scan was conducted in 30 patients without injury to the clavicle or coracoid process.They were 15 men and 15 women,aged from 20 to 71 years old (average,49.3 years).Thirty 3D digital models of the clavicle and coracoid process were constructed using the CT scan data by Mimics13.0.Half of the models were of the left shoulder and half of the right.Anatomic measurements of the clavicle and coracoid process were carried out on these models.Virtual transclavicular-transcoracoid bony tunnels were established according to the anatomy of the conoid ligament.Parameters of these bony tunnels were measured before the safety location was calculated.Results The mean clavicular length was 147.70 ± 5.34 mm in males and 133.09 ± 6.61 mm in females; the distance between the lateral edge of the clavicle and the center of the conoid tuberosity (CCD) was 35.90 ± 3.16 mm in males and 30.48 ± 0.54 mm in females; the distance between the lateral edge of the clavicle and the center of the trapezoid tuberosity (CTD) was 22.68 ± 1.23 mm in males and 18.69 ± 1.65 mm in females,with significant differences between genders (P ＜ 0.05).There were no significant differences between male and female regarding the ratio of the CCD to the clavicular length,the ratio of CTD to the clavicular length,or the mean internal rotational angle of the coracoid process (P ＞ 0.05).According the attachments of the conoid ligament on the clavicle and coracoid,from the superior-posterior edge of the clavicle to the anterior midpoint of the coracoid basement,the bony tunnels were established.These tunnels nearly bisected the cross section of the clavicle and coracoid basement,35.23° ± 2.36° medially inclined to the sagittal section and 5.91° ± 2.14° posteriorly inclined to the coronal section of the body.Conclusions To ensure that the bony tunnel should pass through the center of the clavicle and coracoid,it should be drilled from the superior-posterior edge of the clavicle and located at the clavicular attachment of the conoid ligament,tilting about 35° medially and 6° posteriorly to aim at the anterior midpoint of the coracoid basement.

Objective To optimize the method of isolating ,culturing and screening fetal mouse liver stem cells in vitro ,and to identify the potential of bi‐directional differentiation .Methods The fetal liver stem cells of mouse were isolated by the density gra‐dient centrifugation and cell difference adherence method ,the proliferation of stem cells was determined by cell plate cloning tech‐nique and MTT method;stem cells were induced for differentiation by adding DMSO and HGF .Results The isolated stem cells showed adherence within 24 h ,which were orbicular‐ovate ,closely packed ,activated within 1~2 weeks ;the positive rates of CD133 , CD49f and EPCAM were (97 .95 ± 1 .21)% ,(92 .71 ± 3 .49)% and (50 .73 ± 3 .45)% respectively ;AFP and CK19 proteins were expressed;red glycogen granules were seen by PAS after induced differentiation;ALB and HNF‐4αwere expressed .Conclusion Fe‐tal hepatic stem cells are successfully isolated by the density gradient centrifugation combined with difference adherence method ,and the isolated cells have strong stemness and proliferation ability ,as well as the ability of bi‐directional differentiation towards hepato‐cytes and bile duct epithelial cells .

Objective To examine the change of TGF-?1 in the bloods of rats which were induced by tetrachoride during the different times and to explain the mechanism of the change.MethodsThe experimental liver fibrosis induced by tetrachloride in rats was treated by matrine compound injection.Serum TGF-?1 and pathological changes in liver tissue were observed in control group,model group and therapy group during the time of the 4th,6th and 9th week.ResultsThere was an obvious change of TGF-?1 in the blood in different time and different groups.ConclusionMatrine compound injection has an antifibrogenetic action and TGF-?1 can reflect the change of liver fibrogenesis of different time as an index.

Objective To investigate the association between a 27-bp variable number of tandem repeat(VNTR) polymorphism of the endothetial nitric-oxide synthase(eNOS)gene and transient ischemic attack(TIA) of brain.Methods Polymerase chain reaction was performed for the genotypes of all patients and control subjects.Data were compared between patients and control subjects using ?~(2)test. Results The genotype ab distribution and allele a frequencies of eNOS gene were significantly higher in TIA group(25.0%,14.3%) than in control group(16.3%,9.2%)(P

The ankle sprain is very common in clinic. It will be sprained again if it is not handled properly, and even develop into chronic ankle instability which will affect people's daily life and exercise. This paper discussed the soft tissue techniques, especially kinesio taping, applied for ankle sprain in clinical. As a non-invasive therapy, soft tissue taping can relieve the symptoms of ankle sprains, stable ankle, improve ankle function and prevent recurrent ankle sprain, which is worthy of further research and application.