Objective To investigate the reliability of the Three-Column classification for fracture of tibial plateau and compared with the conventional Schatzker classification.Methods From December 2004 to March 2007,304 patients with tibial plateau fracture were treated in our department.The CT scans and 3D reconstruction were performed in all patients before operation.All the patients were classified by the Three-Column classification and then treated with open reduction and internal fixation via the corresponding approaches based on the Three-Column classification.To validate the Three-Column classification,four doctors classified 50 patients which were chosen randomly from 323 consecutive fracture cases.Schatzker classification was also classified at the same time.Inter-observer reliabilities of the Three-Column classification and the Schatzker classification were figured out respectively in the form of Kappa value.Results According to the Three-Column classification,there were 4 pure compression fractures (1.2％),181 one-column fractures(56.0％),108 two-column fractures(33.4％) and 30 three-column fractures (9.3％) in all 323 cases.In one-column fracture cases,the numbers of lateral,medial,and posterior column fractures were 114 (63.0％),53 (29.3％),and 14 (7.7％),respectively.Among two-column fracture cases,the lateral-medial column fractures (33.3％) were 36.While the number of medial-posterior column fractures and lateral-posterior column fractures were 34 (31.5％) and 38 (35.2％),respectively.There was a moderate inter-observer reliability when using Schatzker classification (Kappa=0.567; range,0.513-0.589).There was a substantial interobserver reliability when using the Three-Column classification (Kappa=0.766; range,0.706-0.890).Conclusion The Three-Column classification based on CT and 3D reconstruction is simple and more reliable for fracture of tibial plateau.It is suggested that the new classification system,the Three-Column classification,can be used and popularized in the orthopaedic surgery.

OBJECTIVETo evaluate the lumber plexus blockade as anesthesia technique for hip fracture repair in elderly patients.

METHODSWe retrospectively analyzed the peri-operative data of 87 hip fracture patients, aged 70 years or older, who underwent surgical repair at our hospital between 2003 and 2006. Patients were divided into three groups according the anesthesia techniques applied: general anesthesia (GA) group (n=21), epidural anesthesia (EA) group (n=37), and lumber plexus blockade (LPB) group (n=29).

RESULTSThe peri-operative data were comparable among three groups, except that intra-operative the dosage of fentanyl was significantly lower in LPB group compared with in GA group(P0.05), and the blood urea nitrogen 1 day after surgery was significantly increased in GA group(P0.05).

CONCLUSIONLumber plexus blockade combined with small-dose intravenous anesthesia is an optional anesthetic technique for elderly patients undergoing hip fracture repair.

Aged ; Aged, 80 and over ; Female ; Hip Fractures ; surgery ; Hip Joint ; surgery ; Humans ; Lumbosacral Plexus ; Male ; Nerve Block ; Retrospective Studies

BACKGROUNDSeveral million subclavian-vein catheters are placed in patients each year to enable caregivers to administer chemotherapy, total parenteral nutrition, or long-term antibiotics or to manage preoperative fluids. Subclavian venipuncture requires the position of a deep vein to be identified with only surface landmarks. But the traditional right subclavian vein (RSV) catheterization (primitive procedures) is not the answer for all patients. The precise location of the vein is not known, and it is important to select the most appropriate method to achieve central venous access safely in any given patient. To modify the primitive procedures of the RSV catheterization for greater success and reduce the complications, anatomic studies and ultrasonography were conducted and clinical applications were validated.

METHODSAnatomical observation and measurement of the RSV and its adjacent structures were performed on 20 adult cadavers according to modified procedures. The RSV catheterization of 2900 cases was carried out by the modified procedure, 500 of these cases were observed by ultrasonography after the operation.

RESULTSThe anatomical studies and clinical application showed that the insertion point differs from the bodily form of fatness or leptosome. The clinical data revealed that in the 2900 cases which were performed with the modified approach, the success rate was 98.90% (2868 cases), the failure rate was 1.10% (32 cases), and the complication rate is 0.79% (23 cases), and the catheterization time is (31.2 +/- 10.5) minutes. Five hundred and sixty cases of the RSV catheterization were carried out by the recommended insertion procedure; the results were compared with the modified approach and the traditional approach. The successful rate of the traditional approach was 73.0%, of which the complication rate was 6.1%; the two approaches were significantly different (successful rate: chi(2) = 626.642, P < 0.01; complication rate: chi(2) = 80.708, P< 0.01).

CONCLUSIONSThe modified RSV catheterization is characterized with a higher success rate and less complications, and the insertion procedure differs from the bodily form of fatness or leptosome.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents ; pharmacology ; Catheterization, Central Venous ; adverse effects ; methods ; Catheters, Indwelling ; Child ; Humans ; Middle Aged ; Subclavian Vein ; anatomy & histology

OBJECTIVETo explore whether daunorubicin (DNR) combined with cytosine arabinoside (Ara-C) and DNR alone have similar effect on acute promyelocytic leukemia (APL) cell line NB4 and acute myeloblastic leukemia cell line HL-60 in vitro.

METHODSCell morphology, cells viability, and cell apoptosis (Annexin-V by flow cytometry assay) were analysed.

RESULTSAfter incubation with DNR plus Ara-C for 24 hours,NB4 cell viability [(36.75 +/- 3.82)%] (n = 6) and cell apoptosis rate [(21.24 +/- 5.82)%] (n = 3) did not change significantly compared to that treated with DNR alone for 24 hours [(35.73 + 6.28 )%, (22.55 +/- 3.26)%, respectively] (P > 0.05). However, HL-60 cell viability [(67.17 +/- 2.07)%] and cell apoptosis rate [(48.05 +/- 0.92)%] changed significantly in DNR plus Ara-C group compared with DNR alone [(63.31 +/- 1.80)% ,(41.51 +/- 0.89)%, respectively] (P < 0.01 and < 0.05, respectively).

CONCLUSIONDNR plus Ara-C and DNR alone have similar effect on NB4 cells, but have different effect on HL-60 cells.

Apoptosis ; drug effects ; Cytarabine ; pharmacology ; Daunorubicin ; pharmacology ; HL-60 Cells ; drug effects ; Humans ; Leukemia, Promyelocytic, Acute ; pathology

OBJECTIVETo investigate the combined treatment with areola approach for capsular contracture after breast augmentation with implants.

METHODSFrom Feb. 2005 to Jun. 2011, 94 cases (168 sides) with Baker III and IV capsular contracture after breast augmentation with implants were treated with areola approach. The implants cavity was recreated, with or without removal of capsule. The implants were reimplanted behind pectoralis major or breast at the second stage in some patients.

RESULTS46 cases were followed up by clinic visit and the others were followed up by telephone for 6-37 months, with an average of 9.9 months. The capsular contracture was relapsed in 2 cases as Baker III and 1 case as Baker IV. All the other breasts got a good appearance with good soft texture and feeling. No hematoma, infection, implants rupture, breast ptosis or implant displacement happened.

CONCLUSIONSCombined treatment with areola approach has a good therapeutic effect for capsular contracture after breast augmentation with implants. The breast appearance is satisfactory with low occurrence of capsular contracture.

Adult ; Breast Implantation ; adverse effects ; Contracture ; etiology ; surgery ; Female ; Humans ; Mammaplasty ; methods ; Postoperative Complications ; surgery

OBJECTIVETo investigate the telomerase activity of human adipose derived stem cells (ADSCs) during proliferation and differentiation in vitro.

METHODSADSCs were highly purified and cultured in vitro. The morphology, phenotype and biological properties of the cultured ADSCs were observed by flow cytometer. Then ADSCs were induced to differentiate into adipocytes and osteoblast. The telomerase activity was detected by TRAP.

RESULTSADSCs had the ability of multi-directed differentiation, like adipocytes and osteoblast. It could also express the stem cell-related surface markers. The telomerase activity was negative or lowly expressed in ADSCs in vitro within 12 generations. The telomerase activity was up-regulated when ADSCs was adipogenic differentiated, but deceased 3-6 days later.

CONCLUSIONSThe telomerase activity of ADSCs is not changed during culture in vitro. It is up-regulated when ADSCs are induced to adipogenic differentiation, but decreased later.

Adipocytes ; cytology ; metabolism ; Adult ; Cell Differentiation ; Cell Proliferation ; Cells, Cultured ; Female ; Humans ; Mesenchymal Stromal Cells ; cytology ; metabolism ; Stem Cells ; cytology ; metabolism ; Telomerase ; metabolism ; Young Adult

OBJECTIVETo explore the effect of immune-enhanced enteral nutrition (IEN) together with recombined human growth hormone (rhGH) on patients after total gastrectomy.

METHODSForty-eight patients after total gastrectomy were randomly divided into EN group (n=16), IEN group (n=16) and IEN+ rhGH(n=16) group. Nitrogen balance, nutritional status, immune function and lassitude degree were compared among 3 groups.

RESULTSIEN+rhGH group had better efficacy as compared to EN and IEN group in improving postoperative nutritional status, immune function, nitrogen balance and lassitude degree, and recovered to normal level after 7 days. All the indexes of IEN+rhGH group except CD8 were improved significantly on the 10th day after operation as compared to those of EN group[total protein(66.8 +/- 2.0)g/L vs (65.8 +/- 0.9)g/L, CD3(66.1 +/- 6.3)% vs (60.5 +/- 5.6)%, Christensen score (4.6 +/- 0.9) vs (6.3 +/- 0.9), all P<0.05].

CONCLUSIONEarly application of IEN combined with rhGH plays an effective role in improving protein metabolism and immune function for patients after total gastrectomy in short period.

Aged ; Enteral Nutrition ; methods ; Fat Emulsions, Intravenous ; Female ; Gastrectomy ; Human Growth Hormone ; immunology ; therapeutic use ; Humans ; Male ; Middle Aged ; Postoperative Period ; Prospective Studies ; Recombinant Proteins ; immunology ; therapeutic use ; Stomach Neoplasms ; therapy

OBJECTIVETo explore the clinical efficacy of electroacupuncture intervention on severe acute pancreatitis (SAP) at early stage complicated with intestinal paralysis.

METHODSSixty-eight cases of SAP were randomly divided into observation group (48 cases) and control group (20 cases). In observation group, according to the course of sickness, the early-stage subgroup (30 cases, hospitalized in 3 d) and late-stage subgroup (18 cases, hospitalized in 3-7 d) were subdivided. In control group, the conventional treatment was applied. In observation group, based on the same treatment as control group, electroacupuncture was supplemented at Zhongwan (CV 12), Zusanli (ST 36), Neiguan (PC 6), Hegu (LI 4), etc. Acute physiology and chronic health evaluation (APACHE) II scores, the recovery time of intestinal paralysis and laboratory indices, complications, operation transfer rate, death rate and the admission time were compared among groups after treatment.

RESULTSThe total effective rate was 83.3% (25/30) in early-stage subgroup, which was superior to 72.2% (13/18) in late-stage subgroup and 65.0% (13/20) in control group (P < 0.05, P < 0.01). In early-stage subgroup, the remission time of abdominal pain, the remission time of abdominal distention, the recovery time of borborygums, the recovery time of gas discharge, and the recovery time of defecation were all shorter significantly than those in late-stage subgroup and control group (P < 0.05, P < 0.01). In early-stage subgroup, APACHE II scores, the recovery time of WBC and blood/uric amylase, complications, operation transfer rate, death rate and admission time were all lower remarkably than those in late-stage subgroup and control group (P < 0.05, P < 0.01); but, there were no statistical significant differences in comparison between late-stage subgroup and control group (all P > 0.05).

CONCLUSIONThe clinical efficacy of electroacupuncture intervention on SAP complicated with intestinal paralysis is superior remarkably to that of conventional treatment, and the efficacy of electroacupuncture intervention at early stage is better than that at late stage.

Acute Disease ; Adult ; Aged ; Electroacupuncture ; Female ; Humans ; Intestinal Pseudo-Obstruction ; etiology ; therapy ; Male ; Middle Aged ; Pancreatitis ; complications ; therapy

OBJECTIVETo explore the application of caffeine-halothane contracture test (CHCT) in the confirmation of malignant hyperthermia (MH).

METHODSOne patient who underwent radical gastrectomy presented with clinical manifestations of MH during routine intravenous-inhalation anesthesia process. Isoflurane inhalation and the operation were ceased immediately and emergency management approaches such as physical cooling therapy were taken. Meanwhile, the levels of serum creatine kinase (CK), serum myoglobin, and urinary myoglobin were examined and rectus abdominis was taken and then CHCT was performed to confirm the clinical diagnosis. Total genome was extracted from the patient and then exons 2-18, 39-46, and 90-104 of ryanodine receptor 1 (RYR1) gene were screened to detect mutations using DNA sequencing technique.

RESULTSThe patient was diagnosed as MH episode by clinical characteristics and postoperatively continuous elevation of the levels of CK, serum myoglobin, and urinary myoglobin (30 times higher than normal level). Despite halothane test was negative, the diagnosis of MH was verified by the positive result of caffeine test. DNA sequencing of RYR1 gene of the patient revealed c. 6724C > T (p. T 2 206M).

CONCLUSIONCHCT can be used to confirm the diagnosis of MH.

Anesthetics, Inhalation ; therapeutic use ; Caffeine ; Creatine Kinase ; blood ; Enzyme-Linked Immunosorbent Assay ; Halothane ; Humans ; Isoflurane ; therapeutic use ; Malignant Hyperthermia ; blood ; diagnosis ; genetics ; Muscle, Skeletal ; drug effects ; physiopathology ; Myoglobin ; blood ; Ryanodine Receptor Calcium Release Channel ; genetics

This study was purposed to investigate the serum levels of soluble intracellular adhesion molecule (sVCAM-1), interleukin 18 (IL-18) and vascular endothelial growth factor (VEGF) in patients with aplastic anemia (AA) and their clinical significance. Enzyme linked immunosorbent assay (ELISA) was used to detect sVCAM-1, IL-18 and VEGF in serums of 30 patients with AA and 25 normal controls. The results showed that the serum levels of sVCAM-1 and IL-18 in patients with AA [(839.08 +/- 173.97) ng/ml, (380.35 +/- 47.76) pg/ml] were significantly higher than those in normal controls [(538.16 +/- 91.21) ng/ml, (256.39 +/- 59.52) pg/ml] (p < 0.01; p < 0.01). The levels of sVCAM-1 and IL-18 in severe AA patients [(969.94 +/- 182.54) ng/ml, (388.96 +/- 46.06) pg/ml] were higher than those in chronic AA patients [(709.26 +/- 165.32) ng/ml, IL-18 (352.21 +/- 47.08) pg/ml] (p < 0.01; p < 0.05), but the level of VEGF in AA patients [(69.63 +/- 27.42) pg/ml] was lower than that in the normal controls [(125.62 +/- 32.15) pg/ml] (p < 0.01)]. The level of VEGF in severe AA patients [(51.30 +/- 29.86) pg/ml] was significantly lower than that in chronic AA patients [(80.02 +/- 25.14) pg/ml] (p < 0.01). The levels of sVCAM-1 and IL-18 in AA patients after treatment were lower than those before treatment (p < 0.01; p < 0.05), but the level of VEGF after treatment was significantly higher than that before treatment (p < 0.05). It is concluded that the high levels of sVCAM-1, IL-18 and low level of VEGF in serum may be involved in the pathogenesis and progress of AA.
Adolescent ; Adult ; Aged ; Anemia, Aplastic ; blood ; Case-Control Studies ; Female ; Humans ; Interleukin-18 ; blood ; Male ; Middle Aged ; Vascular Cell Adhesion Molecule-1 ; blood ; Vascular Endothelial Growth Factor A ; blood ; Young Adult