Proximal tibial fractures, especially high energy ones, can incur unique challenges in clinical treatment. Soft tissue is injured from both fracture and surgical dissection; the fracture often brings with it neurovascular problems; it is difficult to reduce and stabilize proximal fragments. Treatment strategies of dealing with associated injuries, accurate diagnosis, and selection of individualized method for reduction and fixation are emphasized. Soft tissue protection should always be kept in mind during operation.

Complex Pilon fracture is always a challenge to orthopaedic surgeons. Careful assessment of the injury, especially the soft tissue condition, is essential for a proper treatment planning. Classification of the fracture is also important for evaluation of the prognosis. Treatment planning includes: timing of the surgery, selection of the fixation method and postoperative protocols. In this article, on the basis of literature review and personal experience, the author suggests criteria for injury assessment and postoperative treatment. A brief comparison of different kinds of fixation is made and the principle of implant selection is discussed in the text.

To investigate the mechanism of lead biosorption and biotransformation in lead-resistant bacteria in microcosmic scale, synchrotron radiation micro X-ray fluorescence (μ-SRXRF ) and X-ray absorption near edge structure ( XANES) was used to determine the element distribution characteristics and speciation of lead ( Pb) in lead-resistant bacteria strain isolated from farmland soil samples taken from a lead-zinc mine in Lanping county, Yunnan province in China. The isolated species was identified to be Arthrobacter sp. The concentration of Pb biosorpted in lead-resistant bacteria was directly determined byμ-SRXRF, and the results showed that the highest concentration was 5925μg/g and the bioaccumulate factor was 14 . 8 . Speciation of Pb in lead-resistant bacteria B2, LB ( Lysogeny Broth) medium and soil were also presented after using Pb LⅢXANES. Compared with Pb LⅢ XANES peak shape and peak position between standard samples, it was demonstrated that the Pb in lead-resistant bacteria was mainly formed by amorphous forms like PbS (58. 0%), (C17H35COO)2Pb (22. 2%), Pb5(PO4)3Cl (19. 8%) rather than organic Pb speciation which was exist in LB medium. Therefore, the isolated lead-resistant bacteria could biotransform Pb to sulfuric compounds. The biotransformation regular could be of great interest for other investigators as reference in study of bioavailability impact factor of heavy metals.

Objective:To propose the requirement of hospital development quality inspection information management system, develop solution, avoid cost enormous waste problem and realize the system on-line.Methods: Use the UML method to develop hospital equipment management information system, and completed a detailed description of its specific use case diagram, sequence diagram, class diagram.Results: Equipment operation rate increased by 10%, significantly shorten specimens control time of, the fault response time decreased from 10min to 1 min, quality control indexes increased to 16%.Conclusion: The UML-based LIS system improved the work efficiency of the equipment, received the satisfactory effect.

Objective To discuss how to improve the cultivation level of postgraduates majored in general surgery by special training.Methods We retrospectively analysed the work performance of 78 postgraduates in the first year after graduated from the general surgery of our hospital during 2005 to 2009. The employer’s evaluation of the postgraduates was compared between before and after special training.Results 22 postgraduates didn’ t receive special training,and 56 postgraduates receive special training. The clinical skills and clinical thinking ability of the postgraduates received special training were much better than the postgraduates who didn’ t receive special training, there was a significant difference between two groups ( P<0.05 ) . Conclusion The special training can significantly improve the clinical skills and clinical thinking ability of the postgraduates majored in general surgery in our hospital.

Objective To investigate the effect and molecular mechanism of Andrographolide (AD) on matrix metalloproteinase-9 (MMP-9) expression in human colon cancer H 3255 cells. Methods Human lung cancer H3255 cell line weve cultured in vitro, and treated with 1.0, 3.0, 5.0μmol/L AD for 24 h, untreated cells was used as blank control. Cell viability, cell migration and cell invasion were analyzed by MTT assay, scratch healing assay and transwell membrane assay, respectably. Expression of MMP-9 mRNA was analyzed by RT-PCR. Protein expression and phosphorylation of Akt were detected by Western blot. Activity of NF-κB and MMP-9 were analyzed by luciferase reporter assay. Results AD could significantly reduced H 3255 cells invasion and migration without affecting the viability of cells, as demonstrated by scratch healing and transwell membrane assay. Furthermore, Western blot and RT-PCR results showed that AD could markedly inhibited MMP-9 activity and its expression in both protein and mRNA levels. AD could attenuated Akt’s phosphorylation and the activity of NF-κB. Moreover, LY 294002, an inhibitor of PI3 K, could significantly inhibited NF-κB transcriptional activity and MMP-9 expression. In addition, different concentrations of AD could inhibit the promote activity of MMP-9. Conclusion AD was a potential anti-invasive agent by inhibiting MMP-9 involved in PI3 K/NF-κB pathways.

Objective To discuss the value of preoperative C-reactive protein (CRP) and eryth-rocyte sedimentation rate (ESR) in predicting postoperative infections following multiple fractures. Methods A study was conducted in 78 patients with multiple fractures (complicated with pelvic frac-ture, ISS > 18) treated in our department from December 2006 to March 2009. CRP and ESR levels be-fore second damage control operation as well as postoperative infections were recorded. Meanwhile, the optimal cut-off value was determined by receiver operating characteristic curve and analyzed. Results There were 11 patients with postoperative infection. The preoperative optimal cut-off value of CRP was 50 mg/L, with a sensitivity of 0.909 and a specificity of 0.821. The preoperative optimal cut-off value of ESR was 27.5 mm/h, with a sensitivity of 0.818 and a specificity of 0.791. The combination tests showed the sensitivity and specificity of 0.875 and 0.900 respectively. Conclusion CRP (50 mg/L) can be a sensitive predictive index for postoperative infection in the multiple fractures (complicated with pelvic fractures). Combination test of CRP and ESR can benefit diagnosis of postoperative infection.

The incidence rate of erectile dysfunction (ED) is reportedly as high as 30-90% after radical prostatectomy for prostate cancer, which seriously affects the patients' quality of life. Penile rehabilitation is defined as the use of any drug or device at or after radical prostatectomy to maximize erectile function recovery. A variety of treatment options are available for post-prostatectomy ED patients, including oral phosphodiesterase 5 inhibitors (PDE5I) , intracorporal injections, vacuum erection device, and penile prosthesis. This article presents an overview of the currently used methods for the drug treatment and penile rehabilitation of the ED patients after radical prostatectomy. It seems proper to recommend daily use of a vacuum erection device plus oral PDE5I in the early postoperative period. For those who fail to respond to this therapy, intraurethral alprostadil, intracorporal injections, or a penile prosthesis could be considered.
Alprostadil ; administration & dosage ; Combined Modality Therapy ; Erectile Dysfunction ; etiology ; therapy ; Humans ; Male ; Penile Erection ; Penile Prosthesis ; Phosphodiesterase 5 Inhibitors ; administration & dosage ; Prostatectomy ; adverse effects ; Quality of Life ; Recovery of Function ; Vacuum

Complications are always likely to occur in the treatment of fractures. Once fracture-related complications occur,their management will be difficuh,resulting in a long handling process that increases physical and financial pain on the patients.Fea- turing“management of fracture-related complications”,this issue intends to draw attention from orthopaedists to the challenging task of prophylaxis and treatment of such problems in clinic.Not only non-union,malunion,heterotopic ossification,bone necrosis but also such systemic complications as deep vain thrombosis,soft tissue infection and necrosis are discussed.They involve long tubular bones,pelvic,proximal femur,tibial plateau and calcaneum.Authors introduce their experience from their clinical practice which can benefit readers a lot.It is well known that an effective prevention is the best treatment.In treatment of fractures,principles must be strictly followed and preventive measures taken throughout the whole process.Once a complication has been detected,therapy should be individualized 1o gain the best outcome.

Objective To explore the value of morphometric quantitative parameters in differential diagnosis of common thyroid benign and malignant tumors, and establish a data bank as a basis for diagnosing diseases with the help of computer. Methods Using PIPS-2020 image analysis system to make a morphometric analysis in 32 cases of thyroid benign papillary lesion (TBPL), 32 cases of thyroid papillary adenocarcinoma(TPAC), 27 cases of thyroid follicular adenoma(TFA) and 24 cases of thyroid follicular adenocarcinoma(TFAC). Results Among many morphometric quantitative parameters of nuclei, eight including area, circumferential length, diameter,volume,long diameter, short diameter, largest to smallest diameter ratio, and circular rate were selected to analyze. The eight morphometric quantitative parameters between TFA and TFAC had a highly significant difference(P0.01). Conclusion These nuclear parameters have some value in differentiation of common thyroid benign and malignant tumors.