BACKGROUND:Open reduction is general y not advocated for the treatment of children clavicle fracture, because the thick and tough periosteum remains intact and attached by the ligament attachment. In clinic, twin-ring external fixation and simple suspension are commonly used, but there is no reliable basis on which method can get better effect.
OBJECTIVE:To compare the stability of twin-ring external fixation and simple suspension for the treatment of children clavicle fracture.
METHODS:The patients with children clavicle fracture and treated by twin-ring external fixation and simple suspension were selected from June 2008 to December 2012, including 17 patients treated with simple suspension and 22 patients treated with twin-ring external fixation. The X-ray film examination was performed regularly to observe the fracture healing and shoulder function.
RESULTS AND CONCLUSION:The 17 patients treated with simple suspension had good healing;three cases had gap between fracture ends at 1 week after treatment, and re-suspension to increase the height and final y two fracture ends contacted in one case;for the other two cases, there was stil gap between fracture ends, and changed for twin-ring external fixation, the fracture ends contacted. Al the 22 patients in the twin-ring external fixation group obtained healing;five cases had performance of upper extremity neurovascular compression on the fracture side after fixation;after releasing, three cases had recovery, and two cases were treated with simple suspension, the fracture ends began to contact;six cases had armpit redness;four cases had early sleep difficulties;two cases had gap between fracture ends at 1 week after treatment, and after re-adjust, the fracture ends contacted in two cases. The results showed both two methods could not cause appearance deformity, and both could get healing. The simple suspension fixation is easy to operate with reliable effect, and it is comfortable which make it easy to accept by the children, it has the advantages of early for functional exercise, less tissue damage, does not affect the blood supply;the twin-ring external fixation is easy to compress the axil ary arteries and nerves on both sides, thus resulting in upper extremity swel ing, numbness and skin redness, and it can cause discomfort night sleeping and poor comfort which is not easy for children to accept. But, no matter what method we take, the review after 1 week, as wel as the line between proximal and distal part and the contact between fracture ends is stil important.

Objective To investigate the effects of mild hypothermia induced by endovascular cooling with heating exchange catheters on severe traumatic brain injury in patients. Methods Twenty patients with severe traumatic brain injury aged 18-60 yr were randomly divided into 2 groups (n=10 each):ice bay cooling group (group IBC) and endovascular cooling group (group EVC).The state of consciousness was scored on a Glasgow coma scale (GCS).The patients had GCS scores of 3-8. The patients underwent emergency surgery.A probe of intracranial pressure monitor was placed during operation.In group EVC intravascular heat exchange catheters were inserted via femoral vein and connected to intravascular heat exchange system (CoolGard 3000, Alsius, USA). In group EVC body temperature was reduced to 34℃ and maintained at this level for 48 h. MAP, HR, body temperature and intracranial pressure (ICP) were continuously monitored and cerebral perfusion pressure (CPP) was calculated. Blood samples were taken from peripheral vein for determination of serum concentrations of neuron specific enolase (NSE), myelin basic protein (MBP) and S-100B (by enzyme linked immunosorbent assay) and GCS scores were assessed at 10 min before (baseline) and 12, 24, 48 and 72 h after operation. The state of consciousness was again assessed 3 months after operation and scored on Glasgrow outcome scale(GOS). Results ICP was significantly lower and CPP was higher after operation in group EVC than in group IBC. Serum concentrations of NSE, MBP and S-100B were significantly lower after operation in group EVC than in group IBC. Conclusion Mild hypothermia induced by endovascular cooling with heating exchange catheters can effectively reduce severe traumatic brain injury in patients.

BACKGROUND:Insulin-like growth factor-1 (IGF-1) is an important mitogen and an indispensable regulator during normal hair cell development. Extracellular signal regulated kinase 1/2 (ERK1/2) is also expressed in mammalian vestibular organs.OBJECTIVE: To investigate the changes of the expression and the distribution of IGF-1, IGF-1 receptor (IGF-1R) and ERK1/2 in guinea pig's vestibular epithelium following gentamycin injury.DESIGN: A randomly controlled study.SETTING: Department of Otorhinolaryngology, General Hospital of Chengdu Military Area Command of Chinese PLA.MATERIALS: Twenty healthy and adult guinea pigs, weighing 300 to 350 g, provided by the Experimental Animal Center,Fourth Military Medical University of Chinese PLA, were randomly divided into four experimental groups and a control group with 4 in each group.METHODS: The experiment was performed at Department of Otorhinolaryngology Research Laboratory of Xijing Hospital,Fourth Military Medical University of Chinese PLA from January 2002 to May 2002. In the experimental groups,gentamycin was intraperitoneally administered daily (80 mg/kg) for 10 consecutive days. For the control group, 1 mL of 0.9% sterile saline was administered in the same way. The guinea pigs, in which unsteady gait or nystagmus appeared,could be involved in the further experiments. Before being sacrificed, the animals' gait, nystagmus and the amount of food-intake were observed every day. The animals were anesthetized deeply with 50 mg/kg pentobarbital 1, 7, 14 or 21days after the last gentamycin administration and then decapitated. Bilateral otic vesicles were harvested and immersed in 4% paraformaldehyde. Then the specimens were decalcified in 10% ethylenediamine tetraacetic acid (EDTA),thereafter embedded in OCT gel and serially sectioned at a thickness of 10 μm in the cryostat. The behavioral changes of guinea pigs were observed. The morphological changes of vestibular epithelium were examined by hematoxylin and eosin (HE) staining. The expression and distribution changes of IGF-1/1R and ERK1/2 were investigated immunohistochemically. MAIN OUTCOME MEASURES: The behavioral, morphological, expression and distribution changes of IGF-1/1R and ERK1/2 of guinea pigs in each group.RESULTS: Twenty involved guinea pigs entered the stage of final analysis. ① All the guinea pigs' vestibular functions were impaired after gentamycin treatment, then partially restored without any pharmaceutical treatment. ②Morphological injury was obvious after gentamycin treatment, and improved 1 week later. ③The expression of IGF-1/1R was low in the control group, and in the 1-day group it increased significantly to its maximum. After that, its expression decreased gradually, but was still higher in the 21-day group than that in the control group. There were significant differences in the expression of IGF-1/1R among different groups (F =51.8,45.7,P ＜ 0.05). The expression changes of IGF-1 and its receptor were similar. ④The expression of ERK1/2 was low in the control group, and increased gradually after gentamycin toxicity. In the 7-day group, the immunoreactivity reached its maximum. Then the levels of ERK1/2 decreased gradually, but were still higher in the 21-day group than that in the control group. There were significant differences in the expression of ERK1/2 among different groups (F =103.7,106.4, P ＜ 0.01), but no significant differences existed in the expression between ERK1 and ERK2 among different groups (P ＞ 0.05).CONCLUSION: The expression of IGF-1/1R and ERK1/2 in vestibular epithelium increased after gentamycin treatment,and IGF-1 may play an important role as an endogenous mitogen through a paracrine or autocrine manner in the early stage of hair cell self-repair of guinea pigs. ERK1/2 may play an important role in signal transduction during vestibular hair cell self-repair after gentamycin toxicity in guinea pigs.

Objective To investigate the effects of different BIS values on postoperative cogni-tive dysfunction (POCD)and S100βprotein(S100β)in the early stage of postoperation.Methods Fifty patients who were scheduled for selective abdominal surgery under general anesthesia (male 34 cases, female 1 6 cases,aged 65 to 75 years,ASA Ⅰ or Ⅱ)were randomly divided into two groups:light anesthesia group (group L,n =25,BIS value was maintained at 50 to 59)and deep anesthesia group (group D,n =25,BIS value was maintained at 30 to 39).BP,HR,SpO 2 ,ECG,PET CO 2 ,inhaled anes-thetic concentration and BIS values were recorded on time points of 5 minutes after the patients ente-ring the operating room (T0 ),before endotracheal (T1 ),intubation (T2 ),incision (T3 ),two hours after incision (T4 ),three hours after incision (T5 )and at the end of surgery (T6 ).The procedure du-ration,anesthesia time,dosages of propofol,fentanyl,midazolam and VAS scores on 1 d after sur-gery were also recorded.Blood samples were collected on time points of 10 min before anesthesia,im-mediately after surgery and 24,48 h after operation.S100β concentration were detected.Mini-mental State Examination (MMSE)score and Trail Making Test (TMT)completion time were recorded on 1 d before surgery and 1,3,7 d after surgery.Results BIS value of group D were lower than group L on T2 ,T3 and T4 .The propofol dosage of group D was significantly greater than that in group L (P <0.05 ).The concentration of serum S100βincreased significantly immediate and 48 h after operation in both groups compared with 10 min before anesthesia(P < 0.05).It was still higher 24 hours after op-eration than before anesthesia.But there was no statistic difference.Compared with the end of surger-y,the concentration of serum S100βin two groups on 24 h after surgery were significantly decreased (P < 0.05 ).The concentration of serum S100β in group L on the end of surgery and 24 h after surgery were higher than that in group D significantly (P <0.05).Compared with 1 d before surgery, postoperative 1 d MMSE scores in two groups and postoperative 3 d MMSE score in group L de-creased significantly (P <0.01).Compared with postoperative 3 d,postoperative 7 d MMSE score in group L increased significantly (P <0.01).Postoperative 1,3 d MMSE score in group D were signifi-cantly higher than group L (P <0.05).Compared with 1 d before surgery,TMT completion time in two groups on 1 d after surgery were significantly prolonged (P <0.01 ).Compared with 1 d after surgery,TMT completion time in two groups on 3 d after surgery were significantly shortened (P <0.01).Compared with 3 d after surgery,TMT completion time in group L on 7 d after surgery was significantly shortened (P <0.01 ).TMT completion time in group D on 1,3 d postoperative were significantly shorter than group L (P <0.05).POCD incidence of group D on 1 d after surgery was lower than that in group L (P < 0.05).Conclusion Different depth of anesthesia can ensure hemo-dynamic balance in old patients during surgery and after surgery.When BIS value was maintained at 30 to 39,it had lower S100βprotein levels,lower incidence of early POCD and a lesser degree of post-operative cognitive dysfunction.

This paper introduced the concept of humanistic therapy and its connotation and application in the field of surgery, the spiritual essence and the docking and bioethics.The authors also analyzed the perioperative patients need humanistic therapy, including technology, ethics, psychology, the needs of the practice; discusses the humanistic therapy in clinical practice,includes:practice conditions, personnel, measures and problems.

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Objective To investigate the effects of endovascular cooling in different degrees on severe traumatic brain injury in dogs.Methods Eighteen dogs of both sexes,weighing 12-15 kg,were randomly divided into 3 groups ( n =6 each):hypothermia at 31 ℃ group (group A),hypothermia at 35 ℃ group (group B) and normothermia group (group C).The model of severe traumatic brain injury was established according to the improved Feeney's free-fall method.Six hours of endovascular cooling was performed using an endovascular cooling system in A and B groups.The cerebrospinal fluid (CSF) was collected before traumatic brain injury (T0),and at 24,48 and 72 h after traumatic brain injury (T1-3) for measurement of the concentrations of neuron-specific enolase (NSE),S-100β,myelin basic protein (MBP),aspartate (Asp),glutamie acid (Glu),glycine ( G ly) and gammaaminobutyric acid (GABA).Results The concentrations of NSE,S-100β,MBP,Asp,Glu and Gly in CSF were significantly lower at T1-3,while the concentration of GABA in CSF was significantly higher at T1-3 in groups A and B than in group C (P ＜0.05 or 0.01).The concentrations of NSE,Asp,Glu and Gly in CSF were significantly lower at T1-3,while the concentration of GABA in CSF was significantly higher at T1-3 in group B than in group A ( P ＜0.05 or 0.01).Conclusion Endovascular cooling can reduce severe traumatic brain injury in dogs,and the efficacy is better when the temperature is reduced to 35 ℃ than that when reduced to 31 ℃.

Background It is determined that riboflavin/ultraviolet A (UVA)-induced corneal collagen crosslinking is able to increase resistance of cornea against enzymatic digestion and has antimicrobial efficacy for various kinds of bacteria in vitro.However,its in vivo study is less now.Objective This study aimed to evaluate the efficacy of iontophoresis-mediated corneal collagen crosslinking combined with or without drugs for Staphylococcus aureus keratitis.Methods Bacterial keratitis models were induced by the interstromaly injection of Staphylococcus aureus suspension with concentration 2× 109/ml in the right eyes of 40 rabbits,and then the rabbits were randomly classified into the model group,gatifloxacin eye drops group,riboflavin/UVA corneal crosslinking group and drugs+ crosslinking group.The smearing of corneal surface was performed for the identification of bacteria 24 hours after injection.Iontophoresis-mediated riboflavin/UVA crosslinking was applied on the eyes of the riboflavin/UVA corneal crosslinking group and drugs+crosslinking group,and gatifloxacin eye drops was topically used 7 times per day on the eyes of the gatifloxacin eye drops group and drugs+crosslinking group.The corneal inflammation was examined and graded under the slit lamp biomicroscope before and after treatment.Ocular anterior segment optical coherence tomography(AS-OCT),corneal histopathology and ultrastructure were examined 14 days after treatment.The living environment of the experimental animals was maintained at 21 ℃ with a 12-hour light and dark cycle.Animals used in this study were treated in accordance with the Weifang Medical College Animal Experimentation Ethic Committee (AEEC) guidelines.The study protocol was approved by the AEEC.Results Corneal inflammation and ulcer were observed,but no significant difference was found in the inflammatory grade among the 4 groups 24 hours after injection (x2=0.293,P＞0.05).In the 14th day after injection,the corneal ulcer area was smaller and corneal edema was milder in the drugs+crosslinking group compared with the model group,gatifloxacin eye drops group and riboflavin/ UVA corneal crosslinking group,showing a significant difference in the inflammatory grade among them (x2 =38.710,P＜0.001).The cornea thickness values of ulcer zone were (428.1 ± 146.2) μm on the 14th postinjected day in the drugs+crosslinking group,which was evidently higher than those in the model group,gatifloxacin eye drops group and riboflavin/UVA corneal crosslinking group,with a significant difference among the 4 groups (F =8.310,P＜0.001).A lower degree of destruction of cornea collagen and less inflammatory cells were seen in the cornea tissue of the drugs+ crosslinking group by haematoxylin and eosin staining in comparison with other 3 groups,and normal keratocytes were much more in the drugs + crosslinking group than those in other treated groups.Conclusions Iontophoresismediated corneal collagen crosslinking can alleviate Staphylococcus aureus keratitis.The combination of crosslinking with drugs has a better effectiveness than the administration of gatifloxacin eye drops only or riboflavin/UVA corneal crosslinking only.

Objective To investigate the changes of interleukin(IL)-2 and interferon(IFN)-γin serum and synovial fluid of patients with joint injure with Kashin-Beck disease(KBD), and study the roles of IL-2 and IFN-γ in KBD joint injure. Methods In accordance with the "Diagnostic Criteria of Kashin-Beck disease"(GB16003-1995),48 cases of KBD patients and 26 healthy people(control group) from KBD endemic area in Long county Shaanxi province were enrolled in the study. KBD patient were 24 males and 24 females, respectively, aged 40 to 65 years (mean age 51 years). Forty-eight serum specimens and 28 synovial fluid specimens of patients(14 males and 14 females,respectively) were collected. Healthy control group were 13 males and 13 females, respectively. Twenty-six serum specimens of healthy controls were collected. Serum and synovial fluid IL-2 and IFN-γ levels were determined by enzyme-linked immunosorbent assay(ELISA). Results In healthy controls and KBD patients, the midian of serum IL-2 were 46.8 ng/L and 55.7 ng/L, respectively, and IFN-γ were 52.3 ng/L and 48.8 ng/L, respectively. The difference was not statistically significant between healthy controls and KBD patients(t = 0.62, 0.70, all P ＞ 0.05).In synovial fluid of KBD patient, the midian of IL-2 and IFN-γwere 48.3 ng/L and 44.1 ng/L, respectively. The difference was not statistically significant between serum and synovial fluid in KBD patients(t = 0.69, 1.72, all P ＞0.05). Conclusion Serum and synovial fluid IL-2 and IFN-γare not significantly increased in KBD patients with articular damage, indicating that IL-2 and IFN-γare not involved in KBD joint injury.

Ferula sinkiangensis K.M. Shen is a kind of endangered national plant medicine in the northern of Xinjiang,China. It mainly contains sesquiterpene coumarins,sulfides,polysaccharides,aromatic compounds and other effective chemical constitu-tions;Chromatography is used to build the fingerprint and to control the medicine quality in most cases. Both raw plant medicine and specific compounds possess pharmacologic activities such as antibacterial,insecticidal,anti-allergic,and antitumor properties. The present paper summarizes the resource distribution,chemical constituents,fingerprints and pharmacological activities of F. sinkian-gensis,to provide reference for its systematic research,effective quality control and efficient development and utilization.