OBJECTIVETo study clinical effects of the over-articular external fixator combined with limited internal fixation for the treatment of Pilon fractures caused by high energy.

METHODSFrom September 2003 to April 2011, 36 patients with Pilon fractures caused by high energy were treated with the over-articular external fixator combined with limited internal fixator. There were 25 males and 11 females, ranging in age from 16 to 72 years old,with an average of 38 years old. The diagnoses of all patients were determined by conventional X-ray examination or three-dimensional spiral CT examination. The AOFAS scoring criteria was used to evaluate the therapeutic effects. The patients with comminuted fractures were treated with screw or Kirschner wire fixation without uncovering periost so as to enhance stability between fracture end and bone blocks,followed by the fixation with over-articular external fixators.

RESULTSAll the patients were followed up, and the duration ranged from 4 to 27 months, with an average of 13 months. Thirty-two patients got wound healing at the first stage. And the bone union duration ranged from 2 to 6 months, with a mean of 3 months. According to the AOFAS ankle-hindfoot subjective scoring standard, 13 patients got an excellent result, 20 good and 3 fair, with an score of 88.2 +/- 3.6. Twelve patients had infections at pinhole, 5 patients had pinhole pain. One patient had the fixator broken induced by over loading, who was cured after treatment. There were no complications such as nerve or vascular injuries, or osteomyelitis.

CONCLUSIONThe over-articular external fixation combined with limited internal fixation for the treatment of Pilon fractures caused by high energy is an ideal method, which has such advantages as reliable fixation, simple operation, coincidence with principles of biomechanical fixation, and benefit for fracture healing.

Adolescent ; Adult ; Aged ; Ankle Injuries ; diagnostic imaging ; surgery ; Ankle Joint ; diagnostic imaging ; surgery ; External Fixators ; Female ; Fracture Fixation ; Fracture Fixation, Internal ; Humans ; Internal Fixators ; Male ; Middle Aged ; Radiography ; Treatment Outcome ; Young Adult

OBJECTIVETo observe the protection effect of Ligustrazine Hydrochloride (LH) on coagulation reaction and inflammation reaction in single valve replacement patients with rheumatic heart disease undergoing cardiopulmonary bypass (CPB).

METHODSTotally 40 patients undergoing single valve replacement were recruited in the study and randomly assigned to the two groups, the treatment group and the control group, 20 in each group. In treatment group LH (3 mg/kg) was intravenously infused from the jugular vein. LH (3 mg/kg) was also added in the CPB priming. In the control group LH was replaced by equal amount of normal saline. Endothelial micro-particles (EMP) count was detected before CPB, 30 min after CPB, 1 h and 24 h after CPB finished. The coagulation reaction time (R), coagulation time (K), clotting formation velocity (alpha angle), maximum amplitude (MA), coagulation index (CI), platelet (PLT), hypersensitive C reactive protein (hs-CRP), IL-6, and IL-10 were detected before CPB, 1 h and 24 h after CPB finished.

RESULTSThere was no statistical difference in aorta arresting time, period of CPB, post-operative drainage volume, plasma transfusion volume, post-operative respirator assistant time, and hospitalization time between the two groups (P >0.05). Compared with pre-CPB in the same group, the count of EMP was much higher at 30 min after CPB and 1 h after CPB finished (P < 0.01). R and K, hs-CRP, IL-6, and IL-10 increased at 1 h and 24 h after CPB finished (P <0.01,P < 0.05). The alpha angle,.MA, CI, and PLT decreased 1 h after CPB finished (P <0.01). The a angle increased, while CI and PLT decreased 24 h after CPB finished (P <0.05). Compared with the control group in the same period, the count of EMP was lower in the treatment group 30 min after CPB and 1 h after CPB finished (P <0. 05, P <0. 01). R and K values obviously decreased in treatment group 1 hour after CPB finished (P <0. 05), while a angle, MA, CI, and PLT increased (P <0. 05, P <0. 01). hs-CRP and IL-6 decreased in the treatment group 1 h and 24 h after CPB finished (P <0.05), while IL-10 increased (P <0.05). The count of PLT increased 24 h after CPB finished in the treatment group (P <0. 05).

CONCLUSIONLH had certain protection effect on the vascular endothelium undergoing CPB, and lower excessive activation of coagulation reaction and inflammation reaction in patients undergoing CPB.

Blood Coagulation ; drug effects ; C-Reactive Protein ; metabolism ; Cardiopulmonary Bypass ; methods ; Humans ; Inflammation ; Interleukin-10 ; blood ; Interleukin-6 ; blood ; Pyrazines ; pharmacology ; therapeutic use ; Rheumatic Heart Disease ; drug therapy

OBJECTIVETo analyse the preoperative conditions and intraoperative anesthetic managements of parturients who underwent Caesarean section and explore possible relationship between perianesthetic managements and prognosis of parturients and fetuses.

METHODSA group of 30 parturients who underwent Caesarean sections under general anesthesia were analysed retrospectively.

RESULTSAll the 30 Caesarean sections were smooth in terms of both procedure and anesthesia.

CONCLUSIONSGeneral anesthesia is still indicated in Caesarean section, although multiple risks may still exist. Considerate perinatal planning, careful preoperative preparations, and delicate intraoperative managements positively contribute to the good prognosis of parturient and fetus.

Adult ; Anesthesia, General ; Anesthesia, Obstetrical ; Apgar Score ; Cesarean Section ; Female ; Humans ; Pregnancy ; Retrospective Studies

OBJECTIVETo observe the effect of obesity on pharmacokinetics and pharmacodynamics of isoflurane.

METHODSTwenty-six patients undergoing cholecystectomy were divided into obese group (Group A, BMI > or = 27, n = 13) and normal body weight group (Group N, BMI < or = 24, n = 13) according to body mass index (BMI). All patients were given to the same isoflurane anesthesia. Inspired and end-expired concentrations of isoflurane were monitored and uptake fraction of isoflurane were calculated.

RESULTSIsoflurane concentrations of vaporizer in Group A [(1.8 +/- 0.3)%] were evidently higher than those in Group N [(1.5 +/- 0.1)%] at all observed points (P < 0.05 or P < 0.01). Uptake fraction of isoflurane in Group A were higher than those in Group N at observed points (P < 0.05, P < 0.01 or P < 0.001), but there were no differences in the time when isoflurane concentration was lowered to 50% and awake time between the two groups after discontinuing inhaling isoflurane.

CONCLUSIONSObese patients demand higher inspired concentration and uptake of isoflurane than those in normal weight patients but discharge of isoflurane was influenced by obesity within the observed period of (66 +/- 33) min.

Adult ; Aged ; Anesthesia, Inhalation ; Anesthetics, Inhalation ; administration & dosage ; pharmacokinetics ; Body Mass Index ; Cholecystectomy, Laparoscopic ; Dose-Response Relationship, Drug ; Female ; Humans ; Isoflurane ; administration & dosage ; pharmacokinetics ; Male ; Middle Aged ; Obesity ; complications ; metabolism

OBJECTIVETo evaluate the efficiency of navigation system for orbital wall reconstruction in unilateral orbital fractures.

METHODSFifteen patients (7 male and 8 female) with unilateral orbital fracture underwent orbital reconstruction with the help of intraoperative navigation system. The average age was 34.3 ± 9.5 years. All patients underwent spiral CT scanning preoperatively, and the CT data was imported to the BrainLab navigation system (Germany, BrainLab company). The orbit of the intact side was mirrored to the opposite side as the reference for pre-operative planning. The titanium mesh was mounted on the resin template made by rapid prototyping machine based on the mirrored CT data. When the injury was limited, the hydroxyapatite sheet was used for the orbital wall reconstruction. During the operation, the real-time navigation helped to ensure precise placement. The re-establishing result was assessed based on the postoperative CT data with the following four variables: the volumetric difference between the bilateral orbit, the volume of the herniated soft tissue, the global projection and the discrepancy between the simulated and the achieved position of the reconstructed orbital wall. The reconstructive discrepancy was measured only in the titanium plate grafting cases.

RESULTSThere were no serious complications such as infection, graft rejection and optic nerve injury in any case. Preoperatively, the average degree of enophthalmos was (3.5 ± 1.6) mm, the average volumetric difference between the injured and the unaffected orbit was (4.5 ± 1.8) ml, and the average volume of the herniated orbital soft tissue was (2.1 ± 0.7) ml. Postoperatively, the three values were respectively reduced to (1.3 ± 0.6) mm, (1.8 ± 0.9) ml and (0.7 ± 0.3) ml. The discrepancy of the medial and inferior wall were (2.5 ± 0.6) mm and (2.1 ± 0.4) mm.

CONCLUSIONSThe intraoperative use of navigation system for the orbital wall reconstruction in unilateral orbital fractures can provide reliable accuracy and achieve satisfactory results.

Adult ; Computer Simulation ; Enophthalmos ; diagnostic imaging ; etiology ; surgery ; Female ; Humans ; Male ; Orbit ; diagnostic imaging ; surgery ; Orbital Fractures ; complications ; diagnostic imaging ; surgery ; Reconstructive Surgical Procedures ; methods ; Surgery, Computer-Assisted ; Surgical Mesh ; Titanium ; Tomography, X-Ray Computed

OBJECTIVELamiophlomis rotata is a common wild herb in Tibetan traditional medicine with important medicinal and economic value. The paper examines the wild distributions, exploitation regime, and situations.

METHODA variety of research methods, such as literature survey, specimens inspection, market information collection in major Chinese herbal markets, questionnaire of herbalists and employers of local governments and institutions, and field quadrat survey and AcrGIS as well, have been used for this work.

RESULTTotal stock of wild resources of L. rotata is ranging from 3 713.49 tons to 6 896.56 tons (2 519-3 314 t in Qinghai, 490-1 414 t in Gansu, 641-1 167 t in Sichuan, and 422-999 t in Tibet, respectively), acceptable harvest quantity of the herb is ranging from 908-1 675 t per year, and actual harvest quantity is 2 520 t annually far beyond the acceptable harvest quantity.

CONCLUSIONHarvesting quantity of L. rotata is far more than that of acceptable, suggesting that utilization pattern of this wild resource plant is unsustainable. L. rotata seems to act as an indicating plant of degraded ecosystem of high-altitude grassland, shrub grassland, and wetland, and distributes in those degraded and degrading plateau ecosystems, and the plant is facing with pressure of ecological protection and wild resource population degradation. Wild population monitoring and standard cultivation are of importance for although they are far from implementation due to shortage of related basic studies.

China ; Conservation of Natural Resources ; Ecosystem ; Lamiaceae ; growth & development ; Plants, Medicinal ; growth & development

Objective： This study was designed to investigate the three-dimensional quantitative structure-activity relationship (3D-QSAR) and the active sites of podophyllotoxin derivatives. Methods： Twenty-three podophyllotoxin derivatives had been designed to investigate 3D-QSAR against L1210 cells by comparative molecular field analysis (CoMFA), then they were studied by Austin model 1 (AM1) method of quantum chemical calculation. The 3D-QSAR and the active sites were discussed according to their stereo structure and electronic structure. Results： A CoMFA model with considerable predictive ability was established. The results showed that the C4 position was an effective modified point. The steric effect and the electrostatic effect of 4-substituted group were the dominant factor for the activity. The replacement of the “ -NH-” bridge at C4 with the “ -O-” bridge resulted in lowering of the anticancer activity. The results revealed that there was a large electropositive region around the B ring moiety and it could easily combine with an acceptor of the drug. The B ring was essential for the activity. The E ring and its C4′ hydroxyl group also have strong influence on the activity and is an important center of negative electricity within the molecule. Conclusions： The inhibitory activities of the compounds can be predicated by the CoMFA mode. The B ring and E ring are important active sites of the molecule.

OBJECTIVETo evaluate the clinical efficacy of domestic sevoflurane by comparing the pharmacokinetic and pharmacodynamic characteristics of domestic sevoflurane and an imported product.

METHODSEighty patients undergoing general anesthesia for transabdominal hysterectomy were equally randomized into domestic sevoflurane group and imported sevoflurane group. The following data were recorded and compared: vital signs; change of sevoflurane concentrations in the induction period and recovery period; the time when inhaled sevoflurane concentration reached half of the pre-set concentration of the vaporizer; the time when the end-tidal sevoflurane concentration reached half of the pre-set concentration of the vaporizer; the time when the end-tidal sevoflurane concentration reached half of inhaled sevoflurane concentration; the time of the end-tidal sevoflurane concentration reached 0. 8 MAC in the induction period; the recovery time; the extubation time; and time to recovery of consciousness.

RESULTSThe general conditions of the two groups were not significantly different. The pharmacokinetic and pharmacodynamic parameters at the intra-operative time points as well as the minimal alveolar concentration, the inspired and end-tidal sevoflurane concentrations, and the time to recovery of consciousness also showed no significant differences between the two groups.

CONCLUSIONThe domestic sevoflurane has similar pharmacokinetic and pharmacodynamic characteristics as the imported products. It can serve as a cost-effective product for transabdominal hysterectomy.

Adolescent ; Adult ; Aged ; Anesthesia, Inhalation ; Anesthetics, Inhalation ; pharmacokinetics ; Double-Blind Method ; Female ; Humans ; Hysterectomy ; Methyl Ethers ; pharmacokinetics ; Middle Aged ; Young Adult

OBJECTIVETo evaluate the safety and efficacy between endoscopic papillary balloon dilatation (EPBD) and endoscopic sphincteropapillotomy ( EST) for common bile duct stones using meta-analysis method.

METHODSRandomizd controlled trials comparing EPBD with EST for common bile duct stones and published from January 1990 to July 2012 were recruited. This meta-analysis was conducted to estimate short-term and long-term complications. Fixed random effect model or random effect model was established to analyze the data.

RESULTSTwelve randomizd controlled trials were included in this analysis. These studies included 1865 patients, 925 of them were treated with EPBD and 940 were treated with EST. The analysis of basic characteristics of these included studies showed that: compared to EST, patients in the EPBD group were younger (OR = -1.16, 95% CI: -1.49 to -0.84, P = 0.00), while in two groups, there were no significant difference (P > 0.05) in gender proportion, average size of stones, number of gallstones, previous cholecystectomy, the number of merged duodenal diverticulum, common bile duct diameter, the total follow-up time. Also, compared to EST, the overall stone clearance in the EPBD group was lower (OR = 0.64, 95% CI: 0.42 to 0.96, P = 0.03), pancreatitis incidence was higher (OR = 2.67, 95% CI: 1.61 to 4.43, P = 0.00), incidence of bleeding (OR = 0.12, 95% CI: 0.04 to 0.34, P = 0.00), acute cholecystitis (OR= 0.39, 95% CI: 0.18 to 0.84, P = 0.02), total long-term complication rate (OR = 0.53, 95% CI: 0.36 to 0.77, P = 0.01), stone recurrence rate more than a year were lower (OR= 0.48, 95% CI: 0.26 to 0.90, P = 0.02). While in two groups, there were no significant difference (P > 0.05) in the stone removal on 1 '' attempt, the total near-term complications and acute cholangitis.

CONCLUSIONSOn the basis of lower rates of bleeding, EPBD seems to be preferred strategy over EST for endoscopic remove of common bile duct stones in patients who have coagulopathy. Although stone recurrence rate more than a year of EPBD is lower, but the overall stone clearance rate is lower and the risk of pancreatitis is higher than that of EST.

Dilatation ; Gallstones ; surgery ; Humans ; Postoperative Complications ; epidemiology ; Randomized Controlled Trials as Topic ; Sphincterotomy, Endoscopic ; Treatment Outcome

OBJECTIVETo summarize the clinical experience of hyperbaric oxygen therapy in the patients with groupment acute carbon monoxide poisoning.

METHOD172 patients with acute carbon monoxide poisoning were received hyperbaric oxygen therapy besides some other regular therapies from january 2007 to december 2011. The clinical effect were analyzed retrospectively.

RESULTS160 patients were cured (93%), 12 cases improved (7%), the total effective rate was 100%. The cure rate of the patients with hyperbaric oxygen therapy within 6 hours after the poisoning for 100% (115/115), It was significantly higher than that of patients treated for more than 6 hours [The cure rate was 78.9% (45/57)], The difference was statistically significant (P < 0.05).

CONCLUSIONTreated by hyperbaric oxygen therapy early enough in the patients with acute carbon monoxide poisoning, can prevent or reduce the occurrence of delayed encephalopathy, decreasing disability and mortality.

Acute Disease ; Adolescent ; Adult ; Carbon Monoxide Poisoning ; therapy ; Humans ; Hyperbaric Oxygenation ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Young Adult