Objective:To investigate the epidemiological characteristics, diagnosis, treat-ment and prognosis of gallbladder cancer in China from 2010 to 2017.Methods:The single disease retrospective registration cohort study was conducted. Based on the concept of the real world study, the clinicopathological data, from multicenter retrospective clinical data database of gallbladder cancer of Chinese Research Group of Gallbladder Cancer (CRGGC), of 6 159 patients with gallbladder cancer who were admitted to 42 hospitals from January 2010 to December 2017 were collected. Observation indicators: (1) case resources; (2) age and sex distribution; (3) diagnosis; (4) surgical treatment and prognosis; (5) multimodality therapy and prognosis. The follow-up data of the 42 hospitals were collected and analyzed by the CRGGC. The main outcome indicator was the overall survival time from date of operation for surgical patients or date of diagnosis for non-surgical patients to the end of outcome event or the last follow-up. Measurement data with normal distribu-tion were represented as Mean±SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M( Q1, Q3) or M(range), and com-parison between groups was conducted using the U test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. Univariate analysis was performed using the Logistic forced regression model, and variables with P<0.1 in the univariate analysis were included for multivariate analysis. Multivariate analysis was performed using the Logistic stepwise regression model. The life table method was used to calculate survival rates and the Kaplan-Meier method was used to draw survival curves. Log-rank test was used for survival analysis. Results:(1) Case resources: of the 42 hospitals, there were 35 class A of tertiary hospitals and 7 class B of tertiary hospitals, 16 hospitals with high admission of gallbladder cancer and 26 hospitals with low admission of gallbladder cancer, respectively. Geographical distribution of the 42 hospitals: there were 9 hospitals in central China, 5 hospitals in northeast China, 22 hospitals in eastern China and 6 hospitals in western China. Geographical distribution of the 6 159 patients: there were 2 154 cases(34.973%) from central China, 705 cases(11.447%) from northeast China, 1 969 cases(31.969%) from eastern China and 1 331 cases(21.611%) from western China. The total average number of cases undergoing diagnosis and treatment in hospitals of the 6 159 patients was 18.3±4.5 per year, in which the average number of cases undergoing diagnosis and treatment in hospitals of 4 974 patients(80.760%) from hospitals with high admission of gallbladder cancer was 38.8±8.9 per year and the average number of cases undergoing diagnosis and treatment in hospitals of 1 185 patients(19.240%) from hospitals with low admission of gallbladder cancer was 5.7±1.9 per year. (2) Age and sex distribution: the age of 6 159 patients diagnosed as gallbladder cancer was 64(56,71) years, in which the age of 2 247 male patients(36.483%) diagnosed as gallbladder cancer was 64(58,71)years and the age of 3 912 female patients(63.517%) diagnosed as gallbladder cancer was 63(55,71)years. The sex ratio of female to male was 1.74:1. Of 6 159 patients, 3 886 cases(63.095%) were diagnosed as gallbladder cancer at 56 to 75 years old. There was a significant difference on age at diagnosis between male and female patients ( Z=-3.99, P<0.001). (3) Diagnosis: of 6 159 patients, 2 503 cases(40.640%) were initially diagnosed as gallbladder cancer and 3 656 cases(59.360%) were initially diagnosed as non-gallbladder cancer. There were 2 110 patients(34.259%) not undergoing surgical treatment, of which 200 cases(9.479%) were initially diagnosed as gallbladder cancer and 1 910 cases(90.521%) were initially diagnosed as non-gallbladder cancer. There were 4 049 patients(65.741%) undergoing surgical treatment, of which 2 303 cases(56.878%) were initially diagnosed as gallbladder cancer and 1 746 cases(43.122%) were initial diagnosed as non-gallbladder cancer. Of the 1 746 patients who were initially diagnosed as non-gallbladder cancer, there were 774 cases(19.116%) diagnosed as gallbladder cancer during operation and 972 cases(24.006%) diagnosed as gallbladder cancer after operation. Of 6 159 patients, there were 2 521 cases(40.932%), 2 335 cases(37.912%) and 1 114 cases(18.087%) undergoing ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) examination before initial diagnosis, respec-tively, and there were 3 259 cases(52.914%), 3 172 cases(51.502%) and 4 016 cases(65.205%) undergoing serum carcinoembryonic antigen, CA19-9 or CA125 examination before initially diagnosis, respectively. One patient may underwent multiple examinations. Results of univariate analysis showed that geographical distribution of hospitals (eastern China or western China), age ≥72 years, gallbladder cancer annual admission of hospitals, whether undergoing ultrasound, CT, MRI, serum carcinoembryonic antigen, CA19-9 or CA125 examination before initially diagnosis were related factors influencing initial diagnosis of gallbladder cancer patients ( odds ratio=1.45, 1.98, 0.69, 0.68, 2.43, 0.41, 1.63, 0.41, 0.39, 0.42, 95% confidence interval as 1.21-1.74, 1.64-2.40, 0.59-0.80, 0.60-0.78, 2.19-2.70, 0.37-0.45, 1.43-1.86, 0.37-0.45, 0.35-0.43, 0.38-0.47, P<0.05). Results of multivariate analysis showed that geographical distribution of hospitals (eastern China or western China), sex, age ≥72 years, gallbladder cancer annual admission of hospitals and cases undergoing ultrasound, CT, serum CA19-9 examination before initially diagnosis were indepen-dent influencing factors influencing initial diagnosis of gallbladder cancer patients ( odds ratio=1.36, 1.42, 0.89, 0.67, 1.85, 1.56, 1.57, 0.39, 95% confidence interval as 1.13-1.64, 1.16-1.73, 0.79-0.99, 0.57-0.78, 1.60-2.14, 1.38-1.77, 1.38-1.79, 0.35-0.43, P<0.05). (4) Surgical treatment and prognosis. Of the 4 049 patients undergoing surgical treatment, there were 2 447 cases(60.435%) with complete pathological staging data and follow-up data. Cases with pathological staging as stage 0, stage Ⅰ, stage Ⅱ, stage Ⅲa, stage Ⅲb, stage Ⅳa and stage Ⅳb were 85(3.474%), 201(8.214%), 71(2.902%), 890(36.371%), 382(15.611%), 33(1.348%) and 785(32.080%), respectively. The median follow-up time and median postoperative overall survival time of the 2 447 cases were 55.75 months (95% confidence interval as 52.78-58.35) and 23.46 months (95% confidence interval as 21.23-25.71), respectively. There was a significant difference in the overall survival between cases with pathological staging as stage 0, stage Ⅰ, stage Ⅱ, stage Ⅲa, stage Ⅲb, stage Ⅳa and stage Ⅳb ( χ2=512.47, P<0.001). Of the 4 049 patients undergoing surgical treatment, there were 2 988 cases(73.796%) with resectable tumor, 177 cases(4.371%) with unresectable tumor and 884 cases(21.833%) with tumor unassessable for resectabi-lity. Of the 2 988 cases with resectable tumor, there were 2 036 cases(68.139%) undergoing radical resection, 504 cases(16.867%) undergoing non-radical resection and 448 cases(14.994%) with operation unassessable for curative effect. Of the 2 447 cases with complete pathological staging data and follow-up data who underwent surgical treatment, there were 53 cases(2.166%) with unresectable tumor, 300 cases(12.260%) with resectable tumor and receiving non-radical resection, 1 441 cases(58.888%) with resectable tumor and receiving radical resection, 653 cases(26.686%) with resectable tumor and receiving operation unassessable for curative effect. There were 733 cases not undergoing surgical treatment with complete pathological staging data and follow-up data. There was a significant difference in the overall survival between cases not undergoing surgical treatment, cases undergoing surgical treatment for unresectable tumor, cases undergoing non-radical resection for resectable tumor and cases undergoing radical resection for resectable tumor ( χ2=121.04, P<0.001). (5) Multimodality therapy and prognosis: of 6 159 patients, there were 541 cases(8.784%) under-going postoperative adjuvant chemotherapy and advanced chemotherapy, 76 cases(1.234%) under-going radiotherapy. There were 1 170 advanced gallbladder cancer (pathological staging ≥stage Ⅲa) patients undergoing radical resection, including 126 cases(10.769%) with post-operative adjuvant chemotherapy and 1 044 cases(89.231%) without postoperative adjuvant chemo-therapy. There was no significant difference in the overall survival between cases with post-operative adjuvant chemotherapy and cases without postoperative adjuvant chemotherapy ( χ2=0.23, P=0.629). There were 658 patients with pathological staging as stage Ⅲa who underwent radical resection, including 66 cases(10.030%) with postoperative adjuvant chemotherapy and 592 cases(89.970%) without postoperative adjuvant chemotherapy. There was no significant difference in the overall survival between cases with postoperative adjuvant chemotherapy and cases without postoperative adjuvant chemotherapy ( χ2=0.05, P=0.817). There were 512 patients with pathological staging ≥stage Ⅲb who underwent radical resection, including 60 cases(11.719%) with postoperative adjuvant chemotherapy and 452 cases(88.281%) without postoperative adjuvant chemotherapy. There was no significant difference in the overall survival between cases with postoperative adjuvant chemo-therapy and cases without post-operative adjuvant chemo-therapy ( χ2=1.50, P=0.220). Conclusions:There are more women than men with gallbladder cancer in China and more than half of patients are diagnosed at the age of 56 to 75 years. Cases undergoing ultrasound, CT, serum CA19-9 examination before initial diagnosis are independent influencing factors influencing initial diagnosis of gallbladder cancer patients. Preoperative resectability evaluation can improve the therapy strategy and patient prognosis. Adjuvant chemotherapy for gallbladder cancer is not standardized and in low proportion in China.

Objective:To investigate the effects of naturally occurring mild hypothermia and artificial mild hypothermia on the expression of high mobility group box 1(HMGB1) in lung tissues of septic mice.Methods:One hundred and twenty BALB/C mice (SPF level) were randomly numbered.Twelve mice with integer multiples of 10 were used as the normal control (NC) group, and the remaining 108 mice were chosen as the septic group.The septic mouse model was established by intra abdominal injection of lipopolysaccharide (LPS) 10 mg/kg.The NC group was given the same dose of normal saline.Anal temperature of the septic mice were measured 1 hour after the model was established successfully, and then were divided into naturally occurring mild hypothermia group and non-mild hypothermia group according to T≤36℃ and T>36℃.In the naturally occurring mild hypothermia group, the mice with T<34℃ were eliminated, and the remaining septic mice were randomly divided into the naturally occurring mild hypothermia(NOMH) observation group and the keep normothermia (KN) group.NOMH group was not given preheating intervention, while KN group was placed in an incubator to maintain the anal temperature between 36.0℃ and 37.5℃.Septic mice in the non-mild hypothermia group were randomly divided into the nonhypothermia (NH) observation group and the artificial mild hypothermia (ATMH) group.The NH group was not treated with hypothermia, while the ATMH group was treated with physical hypothermia, so that the anal temperature of the mice were maintained at 34℃-36℃.Four mice in each group were randomly selected at 6 and 12 hours after modeling, and the concentrations of tumor necrosis factor-α(TNF-α), interleukin-6(IL-6) and HMGB1 in serum were detected by enzyme-linked immunosorbent assay(ELISA). At 12 hours, the survival rate of each group of mice was observed.Then 4 mice of each group were sacrificed and lung tissues were taken.The pathological changes of lung tissues were observed by hematoxylin-eosin (HE) staining, and the expression of HMGB1 in lung tissues was observed by immunohistochemical staining.Real time fluorescence quantitative PCR and Western blot were used to detect the relative expression of HMGB1 at mRNA and protein levels.Results:(1)Twelve hours after modeling, the survival number of NOMH group, ATMH group, KN group and NH group were 36(40), 6(11), 27(40), 4(11), respectively, and there were differences between the four groups (χ 2=32.286, P=0.002). Compared with the other three groups of septic mice, the survival rate was highest in the NOMH group (compared with ATMH group: χ 2=5.222, P=0.022; compared with the KN group: χ 2=6.050, P=0.013; and the NH group: χ 2=11.672, P=0.001), but the differences between the other two groups were not statistically significant (all P>0.05). (2)Compared with the NC group, the concentrations of serum TNF-α, IL-6 and HMGB1 of septic mice in each group were significantly increased at 6 h and 12 h (all P<0.05). Compared with NOMH group, the concentrations of TNF-α, IL-6 and HMGB1 in ATMH group, KN group and NH group were significantly increased at 6 h and 12 h(all P<0.05), and the concentrations of TNF-α, IL-6 and HMGB1 in NH group were the highest at all time points (all P<0.05). The concentrations of TNF-α at 12 h decreased compared with 6 h (all P<0.05), while the concentrations of IL-6 and HMGB1 at 12 h increased compared with 6 h (all P<0.05). (3)HE staining showed that the lung tissue damage were minimal in NOMH group, followed by ATMH group.(4)Immunohistochemical staining showed that the expression of HMGB1 protein was in order of NOMH group, ATMH group, KN group and NH group; (5)The relative expressions of HMGB1 protein in lung tissues of septic mice in NOMH group, ATMH group, KN group, and NH group was 0.280±0.013, 0.320±0.016, 0.340±0.018, and 0.380±0.014, respectively, and the relative expression level of HMGB1 mRNA was 4.86±0.22, 6.02±0.18, 6.26±0.20, and 7.98±0.28, respectively, compared with NC group (HMGB1 protein content was 0.240±0.013, and the relative expression level of HMGB1 mRNA was 2.21±0.12) significantly increased (all P<0.05). Cmpared with NOMH group, the relative expression levels of HMGB1 protein and HMGB1 mRNA in the lung tissues of the ATMH group, KN group and NH group were significantly increased(all P<0.05), with the highest expression level in the NH group(all P<0.05). Conclusion:Mild hypothermia may reduce lung tissue damage by down-regulating the expression of HMGB1 in lung tissues of septic mice, and the improvement of spontaneous mild hypothermia was more significant.

Objective: To evaluate our replantation and functional reconstruction of amputated lower extremities. Methods: From February 2013 to October 2017, 13 patients with an amputated lower extremity were treated at Orthopaedic Department, The 960th Hospital of the PLA Joint Logistics Support Force. They were 10 males and 3 females, aged from 15 to 63 years (average, 39 years). In all the patients, large segmental shortening and extremity replantation was conducted at the first stage and Ilizarov extremity lengthening at the secondary stage. After desired extension was achieved, the frame of Ilizarov external fixator was removed and replaced by external fixation with a locking plate under closed reduction. Postoperatively, functions of the knee and ankle joints, sensory recovery of the foot sole, length and appearance of the extremity were observed. Results: All the 13 patients were followed up for 12 to 24 months (average, 16 months). All the limb replants survived well. Of them, 12 were satisfied with their weight-bearing walking and therapeutic outcomes. Conclusions For an amputated lower extremity, the first-stage shortening and replantation can result in fine extremity salvage and the secondary Ilizarov extremity lengthening can lead to fine therapeutic outcomes.

Objective To study the anatomic relationship between the thoracic transverse process and adjacent bony structures and its clinical significance for thoracic screw fixation.Methods The present anatomic measurement used 45 dry cadaveric specimens of the normal adult thoracic vertebrae.We measured the distances from the horizontal midline of the transverse process to the superior,middle and inferior margius of the pedicle,the height of the anterolateral transverse process sheltered by ribs,and the position at the horizontal midline of the transverse process corresponding to the vertebral body.Results The horizontal midlines margius of the transverse processes of T1 to T10 are localized in the plane ranging from the superior to the inferior margins of the pedicle.The midlines of the transverse process are closer at T6 and T7 while more apart at T9 and T10.From T1 to T8,the anterolateral transverse process is totally or mostly sheltered by ribs,but the shelter is much less at T9 and T10.The horizontal midline of the transverse process corresponds to the upper 1/3 or middle 1/3 of the vertebral body.Conclusion Thoracic screw fixation across the transverse process to the vertebral body is safe,reliable and feasible in clinic.

Objective To observe the effects of lung protective ventilation strategy (LPVS) on inflammatory mediators in bronchial alveolar lavage fluid (BALF) in pulmonary and extrapulmonary acute respiratory distress syndrome(ARDS).Methods All of 62 extrapulmonary ARDS(ARDSexp) cases and 60 pulmonary ARDS (ARDSp) cases were divided into observation group and control group by table of random digit.ARDSexp and ARDSp observation group were received LPVS treatment [tidal volume 6-8 ml/kg,positive end expiratory pressure (PEEP) 5-15 cm H2O (1 cm H2O =0.098 kPa)],and ARDSexp and ARDSp control group were received the routine ventilation strategy (tidal volume 10-12 ml/kg,PEEP 4-8 cm H2O).All groups were treated with the same conventional therapy of ARDS,same model and parameter of mechanical ventilation.The level of tumor necrosis factor (TNF)-α,interleukin (IL)-6,IL-8 in BALF were tested by enzyme linked immunosorbent assay on the 1st,4th,7th day in each group.The oxygenation index was tested at 8 o'clock each morning.Results There were 4 ARDSexp cases and 6 ARDSp cases who were expelled,because of death within 7 days.ARDSexp observation group was in 28 cases,ARDSexp control group was in 30 cases,ARDSp observation group was in 28 cases,ARDSp control group was in 26 cases.The oxygenation index had no significant difference between ARDSexp and ARDSp observation group and corresponding ARDSexp and ARDSp control group on the 1st and 2nd day (P ＞ 0.05).But the oxygenation index in ARDSexp and ARDSp observation group were significantly higher than that in ARDSexp and ARDSp control group from 3rd to 7th day (P ＜ 0.05).The oxygenation index in ARDSexp observation group was significantly higher than that in ARDSp observation group except 1st day (P ＜0.05).The oxygenation index in ARDSexp and ARDSp observation group were significantly better with the time passing (P ＜ 0.05).The BALF levels of TNF-α,IL-6 and IL-8 in ARDSexp and ARDSp observation group were significantly lower than those in corresponding ARDSexp and ARDSp control group on the 4th and 7th day (P＜ 0.05).The BALF levels of TNF-α,IL-6 and IL-8 in ARDSexp observation group and ARDSexp control group were significantly lower than those in corresponding ARDSp observation group and ARDSp control group (P＜ 0.05).The BALF levels of TNF-α,IL-6 and IL-8 in ARDSexp and ARDSp observation group were decreased significantly with the time passing (P ＜0.05).Conclusion It is more reasonable to decrease the BALF levels of inflammatory mediators,increase oxygenation index for ARDS patients to with LPVS treatment,then for ARDSexp patients obviously.

Objective To study the application of 3％ hypertonic saline (HS) in patients with severe craniocerebral injury after operation.Methods Sixty-eight cases with severe craniocerebral injury after operation were divided by random digits table method into HS group and control group with 34 cases each.The patients in control group were treated with 125 ml 20％ mannitol every 6 hours or 8 hours.The patients in HS group were given conventional mannitol and added with 130 ml 3％ HS every 12 hours or 8 hours through fast intravenous drip altemated with mannitol.The levels of intracranial pressure (ICP),mean arterial pressure (MAP),central venous pressure (CVP) were recorded within 6 hours,12 hours,24 hours of the 1st day,24 hours of the 2nd day,24 hours of the 3rd day,24 hours of the 5th day.The Na+ level of blood serum and the plasma osmotic pressure were recorded and calculated within 12 hours,24 hours of the 1st day,24 hours of the 2nd day,24 hours of the 3rd day,24 hours of the 5th day.The Glasgow coma scale( CCS) score was accounted within 24 hours of the 1 st day,24 hours of the 3rd day,24 hours of the 5th day.Results Compared with control group,the level of ICP in HS group decreased at every time point (P ＜ 0.05).The tendency of ICP in two groups was not significant on the 1st and 2rid day (P ＞ 0.05 ),but the level of ICP within 24 hours of the 3rd and 5th day obviously increased compared with those of the 1st and 2nd day (P＜0.05).The levels of MAP and CVP in HS group were significantly higher than those in control group within 6 hours,12 hours and 24 hours of the 1 st day and 24 hours of the 2nd day [ ( 87.98 ± 5.03 ),(88.56 ± 5.36),(87.04 ±6.90),(90.03 ±5.19) mm Hg (1 mm Hg =0.133 kPa) vs.(77.98 ±5.09),(79.98 ±6.09),(80.98 ± 5.27),(81.98 ± 4.32) mm Hg and (9.23 ± 1.24),(9.67 ± 1.35),( 10.21 ± 1.38 ),( 10.56 ± 1.96)mm Hg vs.(7.15 ± 2.01 ),(8.32 ± 1.53),(8.67 ± 1.89),(9.22 ± 2.03) mm Hg] (P ＜ 0.05),but the values within 24 hours of the 3rd and 5th day between two groups had no significant differences (P＞ 0.05 ).The Na+ level of blood serum and the plasma osmotic pressure in HS group at every time point was obviously higher than that in control group (P＜ 0.05).The GCS scores within 24 hours of the 1st,3rd and 5th day in HS group were (4.21 ± 2.31 ),(5.44 ± 2.46 ),(7.23 ± 1.64 ) scores,respectively,while the scores in control group were (4.14 ± 2.10),(5.15 ± 2.31 ),(7.31 ± 2.12) scores,respectively ;the score within 24 hours of the 5th day in two groups was obviously higher than that of the 1st day respectively (P＜ 0.05 ),but the scores between two groups had no statistical significance (P＞ 0.05 ).Conclusions Adding 3％ HS is more effective to decrease ICP,improve the brain perfusion and reduce the adverse reactions.3％ HS can be used as the first-line therapy for patients with severe craniocerebral injury after operation.

Objective To study clinical outcomes of cross-leg fibula flap for difficult reconstruction of an extensive injury in the lower extremity,which included large soft-tissue defects and long infected bone and tibia defects combined with vascular injury.Methods From September 2004 to September 2008,8 cases with an extensive injury in the lower extremity,which included large soft-tissue defects and long infected bone and tibia defects with vascular injury,were retrospectively analyzed,including 6 males and 2 females with an average age of 36 years (range,19-55 years).The course of disease ranged from 2 weeks to 3 months (average,2 months).The bone defect length ranged from 8 to 20 cm (average,13 cm),and the skin defect area varied from 10 cm×7 cm to 22 cm×12 cm.After thorough debridement,cross-leg fibula flap was used to repair the tibial defect and concomitant soft tissue defect.The pedicles were divided at 4-6 weeks after the initial surgery.The important technical considerations were outlined.Results All 8 patients were followed up for 6 to 36 months (average,24 months).The flaps survived in all 8 patients,and no infection and osteomyelitis happened.The flap transplantations healed at two weeks after operation with good shape.The fractures healed in all of patients with an average period of 11 months (range,6-15 months).All of patients recovered to walk without aid.According to Edwards classification of tibial fractures,4 cases were classified as good,2 as acceptable,and 2 as poor.Conclusion The cross-leg fibula flap is relatively simple,liable for the treatment of an extensive injury in the lower extremity.

Objective To observe the resection of the scapholunate interosseous ligament (SLIL)and its subregions on the three-dimensional(3-D)movement of the scaphoid and lunate so as to discuss the role of SLIL in the 3D flexion-extension motion of the scaphoid and lunate.Methods Twelve upper extremities(six left extremities and six right extremities)from adult cadaver were used in this study and divided into five groups:normal group,proximal subregion resection group,proximal subregion plus dorsal subregion resection group,proximal subregion plus palmar subregion resection group and whole SLIL resection group.The 3-D laser scan and reconstruction technique were used for meusure ment of the 3-D flexion-extension motion of the scaphoid and lunate.Results In the normal group,the scaphoid and lunate flexed and the radial deviated at the same direction during wrist flexion-extension motion.At the same time,there was minimal scaphoid and lunate pronation-supination during wrist flexionextension.After resection of the proximal and palmar(or dorsal)subregions of the SLIL,some different movements were found compared with the normal specimen.Whole SLIL resection resulted in increase of the flexion motion of the scaphoid but decrease of the palmar flexion of the lunate.Conclusions 3-D laser scanning and image reconstruction techniques can accurately measure the 3D motion of the scaphoid and lunate.Partial or whole resection of SLIL may exert significant effect on the flexion-extension motion of the scaphoid and lunate.However,the proximal subregion of SLIL has no prominent effect on the motion of the scaphoid and lunate.

Objective To discuss the effect of different methods of dropping the high temperature of the tubercular meningitis patients. Methods 35 cases with tubercular meningitis with high fever were divided into research group(11 cases) and control group(24 cases) ,24 patients in control group were treated by traditional cooling method, 11 patients in research group were rteated by mild hypothermia therapy, The self signs, the intracranial pressure,Glasgow scores, complications and the death rates of patients were assessed and compared. Results The effective rates of the research and control cooling method were 81.8% and 41.7% respectively. The difference between the two groups was significant;After the intervention,compared with the control group, the self scale is superior in research group,and the intracranial pressure and the death rates of patients were lower,and patients'Glasgow scores were higher,but the complications between the two groups had no significant differences. Conclusion Mild hypothermia can effectively control patients'temperature,at the same time, which can improve the patients conscious state and reduce the mortality.

BACKGROUND: There is lack of effective method for treating humerus nonunion, lilac plate can maintain the compact contact between fracture end and bone graft, accelerate bone union, as well as provide stability for bone union. OBJECTIVE: To evaluate the clinical effects of treating humerus nonunion by using lilac bone graft as plate combined with the external fixation.METHODS: Thirteen patients with nonunion of the humorous at Department of Orthopedic Trauma Surgery, Jinan Command General Hospital of Chinese PLA were selected, including 11 males and 2 females, aged 20 51 years, mean aged 35.5 years. All the patients were treated with Uiac bone graft and screws combined with the mono lateral external fixation. The bone healing was observed by X-ray film. Shoulder function and complications were measured by Neer score.RESULTS AND CONCLUSION: All patients were followed up for 7-64 months, mean 38 months. Bony union was achieved in all patients within 6-10 months (mean 8.1 months). The activity function of shoulder and elbow was normal; and Neer scores were 71-96 (mean 87 scores). No infection, pain, prevalent fracture or nonunion occurred. The results demonstrated that using lilac bone graft as plate combined with the mono lateral external fixation is a good salvage operation for nonunion of the humerus.