OBJECTIVETo investigate clinical effects of minimally invasive fixation and bone grafting througn medial side for the treatment of Schatzker III tibial plateau fracture.

METHODSFrom April 2009 to August 2011, 18 patients with Schatzker III tibial plateau fracture were treated with minimally invasive fixation and bone grafting through medial side. There were 15 males and 3 females ranging in age from 64 to 73 years, with an average of (69.75 ± 1.22) years. Sixteen patients were caused by falling down, 2 cases were caused by traffic accident. Operative time and length of incision were be recorded. Clinical and radiological follow-up was performed after operation. Hospital for Special Surgery (HSS) score and Kellgren-Lawrence score were used to evaluate clinical effects.

RESULTSThe mean operative time was (45.32 ± 1.58) min, and the mean length of incision was (5.21 ± 0.65) cm. Postoperative X-ray showed excellent reduction. Eighteen patients were followed up for 10 to 13 months with an average of (11.5 ± 1.35) months. The mean HSS score was 86.51 ± 2.71, 12 cases got excellent results,4 good and 2 fair. Three patients were developed mild osteoarthritis according to the Kellgren-Lawrence system.

CONCLUSIONMinimally invasive fixation and bone grafting through medial side, not only could reduce surgical invasive, but also guarantee early function activities. It has advantages of keeping well after reduction. So it has the favorable future in clinic.

Aged ; Bone Transplantation ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; methods ; Retrospective Studies ; Tibial Fractures ; surgery

Objective To discuss the implementation of different nursing modes in different wards,so as to provide comprehensive,full course and consistent nursing for patients.Methods Multiple nursing modessuch as fixed-nurse,inter-group,overall and dailycontractual liability were adopted and combined in wards of neurology,gastroenterology and otorhinolaryngology to assure the consistence of nursing.Qualification rate of first grade nursing,incidence rate of accident events and nursing complications,understanding rate of health education,qualification rate of nursing document and satisfaction rate of patients were compared before and after the implementation.Results After implementation of diversified nursing modes,the qualification rate of first grade nursing,understanding rate of health education,qualification rate of nursing document had all improved to some extent,while the incidence rate of accident events and nursing complications had declined,and the differences were statistically significant (P ＜ 0.05).After implementation of diversified nursing modes,patients' satisfaction rate in departments of neurology,gastroenterology and otorhinolaryngology had also improved,respectively from 91.67％,89.17％,90.00％ to 98.33％,96.67％,97.50％,and the differences were statistically significant (x2 =5.614,5.128,5.760,respectively ; P ＜ 0.05).Conclusions Diversified nursing modes in different wards can improve the quality of nursing,satisfaction of patients and core competency of nursing staff,as well as ensure the implementation of holistic nursing effectively.

Objective To assess the clinical values of MR angiography(MRA)in the detection of deep vein thrombosis of the lower limbs.Methods Two-dimensional time of flight(2D TOF)MRA was performed in thirty patients who were suspected of having deep vein thrombosis in the lower limbs.The findings of MRA were compared to that of digital subtraction angiography(DSA).Results twenty-five cases showed deep vein thrombosis in the lower limbs,the MRA findings included venous filling defect (14 cases),occlusions and interruptions of veins(8 cases),venous recanalizations(3 cases),collateral veins(25 cases).Taking the results of DSA as a golden standard,MRA detected all of the affected cases with only one case as the false positive.Conclusion 2D TOF MRA is a method of choice in the diagnosis of deep vein thrombosis of the lower limbs.

Objective To study the clinical features and prevention means of the infection caused by the highly dathogenic avian influenza A(H_5N_1).Method The clinical data which were confirmed to be an H_5N_1 infected case were analyzed retrospectively.Results The patient,16-year-old male,had no unambi guous history of direct contact with diseased or dead poultry before the onset of the disease.After the onset of the disease,chest X-ray showed flake shadow of the right lower lung quickly spread to the whole lung,associated with mediastinum,subcutaneous emphysema,acute respiratory distress syndrome(ARDS)was occurred on the fifth day.Mechanical ventilation is the primary measure in the comprehensive treatment.On the sixth day,Chinese Center for Disease Control and Prevention detected the pharyngeal specimen of the patient by RT - PCR,Real- time PCR method and suggested positive for the A/H5/N1 virus nucleic acid andis01ated the avian flu(H_5N_1) virus.The disease course was 10 days from onset of illness to death.Conclusions Human infection by the highly pathogenic avian influenza A(H_5N_1)is a deadly infectious disease.If the lesions is widespread and associated with ARDS,prognosis is poor.

OBJECTIVETo observe the clinical significance of nitric oxide (NO) and 8-isoprostane (8-isoPG) changes in exhaled breath condensate ( EBC) of acute respiratory distress syndrome (ARDS) patients after treated by Qingfei Decoction (QD).

METHODSTotally 48 ARDS patients receiving mechanical ventilation were equally assigned to the QD treatment group and the control group by random digit table. EBC specimens were collected by modified Ecoscreen breath condensate collector (German JAEGER Company) on the first day and the fifth day after confirmed diagnosis of ARDS. Concentrations of NO and 8-isoPG in EBC were measured by ELISA. The oxygenation index and APACHE II scores were recorded at the same time.

RESULTS(1) The fatality rate in the QD treatment group was lower than that in the control group (8.3% vs 37.5%, P < 0.05). (2) After treatment NO and 8-isoPG concentrations in EBC were lower in the QD treatment group (34.49 ± 5.67 µmol/L, 30.09 ± 7.89 ng/L) than in the control group (39.78 ± 9.27 µmol/L, 35.65 ± 8.90 ng/L; P < 0.05). (3) After treatment improved oxygenation index value was higher in the QD treatment group than in the control group (120.88 ± 35.16 vs 101.50 ± 37.70, P < 0.05). After treatment APACHEII scores was lower in the QD treatment group than in the control group (6.21 ± 3.51 vs 10. 26 ± 4.33, P < 0.05).

CONCLUSIONTreatment of ARDS patients by QD was favorable in controlling inflammation, alleviating lung injury, and improving clinical efficacy.

Breath Tests ; Dinoprost ; analogs & derivatives ; analysis ; Drugs, Chinese Herbal ; pharmacology ; therapeutic use ; Humans ; Inflammation ; Nitric Oxide ; analysis ; Respiration, Artificial ; Respiratory Distress Syndrome, Adult ; drug therapy

Objective To investigate the value of the Wells score and D-dimer assay in assisting pulmonary perfusion imaging (PPI) for the diagnosis of acute pulmonary embolism (APE). Methods One hundred twenty-one patients with suspected APE were studied from January, 2006 to December, 2008. All patients underwent the Wells score, the quantitative D-dimer assay, chest X-ray photography, and PPI. The diagnostic sensitivity, specificity, positive predictive value and negative predictive value of PPI with the assistance of Wells score and D-dimer assay were calculated. Results Fifty (41.3%) patients were diagnosed with APE. PPI combined with chest X-ray photography (Q/X scan) showed positive results in 49 patients. The sensitivity, specificity, positive predictive value and negative predictive value of the Q/X scan were 86.0% (43/50), 91.5% (65/71), 87.8% (43/49) and 90.3% (65/72), respectively. With assistance of Wells score >4 and D-dimer≥0. 5 mg/L, Q/X scan had a positive predictive value of 100.0% (29/29), for patients with Wells score ≤4 and D-dimer<0.5 mg/L, the negative predictive value for Q/X scan was 100.0% (41/41). Conclusion Combined with Wells score and D-dimer assay, PPI can make accurate diagnosis of APE.

Objective To evaluate the feasibility of 3-(4-~(18)F-fluorobenzyl)-8,9-dimethoxy-1,2,3,4-tetrahydrochromeno [3,4-c]pyridin-5-one ( is F-FDTP) as a potential dopamine D4 receptor PET imaging agent.Methods ~(18)F-FDTP solution in ethanol-physiological saline was incubated with calf serum to test its in vitro stability through the determination of radiochemical purity.Normal rats were injected intravenously with ~(18)F-FDTP and then sacrificed at 2,5,10,15,30,60 and 120 min after anesthesia.Blood,organs and brain tissue samples were collected.All samples were weighed and measured for radioactivity.The uptake of samples was expressed as percentage activity of injection dose per gram of tissue ( % ID/g).Results The stability of ~(18)F-FDTP was satisfactory and its radiochemical purity was above 95% after incubation 120 min at 37℃ in calf serum.The biodistribution showed that ~(18)F-FDTP could penetrate through the blood-brain barrier and selectively accumulate in striatum,hypothalamus,frontal certex,hippocampus,cerebellum,where the D_4 receptor was reportedly located.The radioactivities in hippocampus,hypothalamus,striatum,frontal cortex,cerebellum,pons were (0.42±0.03),(0.46±0.05),(0.54±0.04),(0.39±0.04),(0.45±0.06),(0.35±0.04) %ID/g,respectively,2 min post injection.And there was difference between the normal biodistribution results and the blocking experimental results:(0.36 ±0.05),( 0.33±0.05 ),(0.55±0.05 ),(0.30±0.07 ),(0.34±0.07 ) and (0.32±0.04) % ID/g in hippocampus,hypothalamus,striatum,frontal cortex,cerebellum and pons,respectively.Conclusions ~(18)F-FDTP can penetrate through the blood-brain barrier and selectively accumulate in striatum,hypothalamus,frontal cortex,hippocampus,cerebellum,where the D_4 receptor was known to concentrate.These preliminary results suggest that ~(18)F-FDTP is a potential dopamine D_4 receptor imaging agent and further studies are needed.

Objective To retrospectively analyze the relationship between the atherosclerosis plaques in abdominal aorta and superial mesenterial artery (SMA) and the development of ischemia bowel disease (IBD) in elderly patients. Methods Elderly patients diagnosed as IBD (n=20) and non-IBD elderly patients with coronary heart disease (n=20) were selected in our hospital from January 2010 to December 2015. Data of CT imaging of abdominal aorta and SMA were evaluated by Syngo.Via software in two groups. Results The calcified plaques were dominated by dots in control group, while they were the annular lesions in IBD group, according to the CT imaging data. The mean sum of calcification in SMA was significantly increased in IBD group than that in control group (χ2=5.010,P=0.025). The stenosis of SMA was more significant in IBD group compared to that of control group (Z=3.370,P=0.001). The degree of SMA lesion was positively correlated with its opening stenosis in the IBD group (rs=0.650,P=0.002). Conclusion The basic vascular lesion is dot calcification in elderly patients with coronary heart disease, and the opening stenosis in SMA induced by mass calcification is the main cause of atherosclerosis-induced ischemic intestinal disease in elderly people.

BACKGROUNDThe precise mechanisms responsible for the development and growth of intracranial arteriovenous malformations (AVMs) remain unclear. Osteopontin (OPN) is a phosphorylated glycoprotein with diverse functions. This study aimed to analyze the expression of OPN in human brain AVMs.

METHODSThe AVM nidus was surgically obtained from patients with AVM, whereas control brain artery specimens were surgically obtained from patients with epilepsy. Reverse transcription-polymerase chain reaction (RT-PCR) was used to examine the expression of OPN mRNA in biopsy specimens. OPN protein expression was localized by immunohistochemistry. The statistical differences between different groups were assessed by two-way analysis of variance (ANOVA).

RESULTSWe analyzed 36 brain AVM specimens and 8 control brain artery specimens. Eleven patients with brain AVM received embolization treatment, and five underwent gamma knife radiotherapy before resection. Nineteen patients with brain AVM had a history of hemorrhage from AVMs. The expression of OPN mRNA was significantly higher in AVMs than that in the control specimens (25.76 ± 2.71 vs. 21.46 ± 2.01, P < 0.01). There was no statistically significant difference in the extent of OPN mRNA expression between the AVM group with and that without history of hemorrhage (26.13 ± 2.45 vs. 25.34 ± 2.99) or gamma knife radiotherapy (24.39 ± 2.10 vs. 24.53 ± 1.85). However, the difference between the AVM group with and that without embolization treatment history was statistically significant (24.39 ± 2.10 vs. 28.80 ± 1.13, P < 0.01). In the group with gamma knife radiotherapy history, OPN expression was found in arteries with early-stage radio-effect.

CONCLUSIONSOPN may contribute to the vascular instability of brain AVMs. It may play an important role in the pathophysiological process related to embolization treatment.

Analysis of Variance ; Brain ; metabolism ; pathology ; Immunohistochemistry ; Intracranial Arteriovenous Malformations ; genetics ; metabolism ; pathology ; Osteopontin ; genetics ; metabolism ; Reverse Transcriptase Polymerase Chain Reaction

OBJECTIVETo investigate the effect of propofol at doses for different anesthesia depths on γ-aminobutyric acid (GABA) in different cerebral regions at propofol uptake equilibrium in dogs.

METHODSTwelve 12-18-month-old healthy hybrid dogs weighing 10-12 kg were randomly divided into light anesthesia group (n=6) and deep anesthesia group (n=6) with a single bolus dose of propofol (5.5 and 7.0 mg/kg, respectively) completed in 15 s followed by intravenous propofol infusion at a constant rate (55 and 70 mg·kg(-1)·h(-1), respectively). Blood samples (2 ml) were taken from the internal carotid artery and jugular vein to measure plasma propofol concentrations 50 min after the start of the infusion. The dogs were then sacrificed and tissues were taken from different brain regions and the cervical cord to measure GABA concentrations using high-pressure liquid chromatography (HPLC).

RESULTSThe plasma propofol concentrations in internal carotid artery and jugular vein were similar in both light anesthesia group (3.00 ± 0.31 and 3.10 ± 0.51 µg/ml, respectively, P>0.05) and deep anesthesia group (6.41 ± 0.05 and 6.40 ± 0.11 µg/ml, respectively, P>0.05). GABA concentrations in the brain regions were significantly higher in deep anesthesia group than in light anesthesia group (P<0.05). The dorsal thalamus and hypothalamus showed greater GABA variations [(83.83 ± 2.230%) and (85.83 ± 1.72)%] compared to other brain regions at different anesthesia depths (P<0.05).

CONCLUSIONSIn both groups, plasma propofol concentrations in the internal carotid artery and internal jugular vein reach equilibrium at 50 min of propofol infusion. The variation of GABA is associated with the anesthesia depth of propofol, and GABA variation in the dorsal thalamus and hypothalamus plays an important role in propofol anesthesia.

Anesthetics, Intravenous ; pharmacokinetics ; Animals ; Brain ; metabolism ; Dogs ; Female ; Male ; Propofol ; blood ; pharmacokinetics ; gamma-Aminobutyric Acid ; metabolism