Surgical Management of Giant Scalp Neurofibroma After Ultra-Selective Embolization of Nutrient Artery.

OBJECTIVES: Neurofibroma, a common benign tumor in soft tissue, continues to grow, so it often appears to be giant. Surgical management of giant neurofibroma is a challenge due to the risk of excessive bleeding. Embolization of tumor's nutrient artery may reduce the blood loss in operation. This study introduces the surgical management of giant scalp neurofibroma with preoperative ultra-selective embolization of nutrient artery. METHODS: From January 2006 to December 2013, 9 patients with giant scalp neurofibroma were enrolled into the study. Digital subtraction angiography (DSA) showed tumor's nutrient artery. Ultra-catheter was inserted into the nutrient artery and its branches as close as possible to the tumor. Then ultra-selective embolization was performed with gelatin sponge particles. Surgical removal of tumor was performed in 3 days after embolization. The wound was repaired by skin graft. RESULTS: All of the 9 patients underwent successful DSA and ultra-selective embolization. Among them, occipital artery was embolized in 3 patients (left side in 1 patient and right side in 2 patients). Both occipital artery and superficial temporal artery were embolized in 6 patients (left side in 2 patients, right side in 3 patients, and both side in 1 patient). No complications, such as ectopic embolism, occurred in the patients. All of the tumors were resected completely without blood transfusion. The skin graft survived very well on the wounds. CONCLUSIONS: Preoperative ultra-selective embolization of nutrient artery is a feasible, safe, and effective method to reduce the blood loss in operation and facilitate the surgical management of giant scalp neurofibroma.

The optimal blood glucose is significantly associated with lower mortality in critically ill patients with cardiogenic shock: an analysis revealed with time series blood glucose records.

BACKGROUND: The optimal blood glucose (BG) level for patients with cardiogenic shock in the intensive care unit (ICU) remains unclear. Studies have found that both excessively high and low BG levels contribute to adverse cardiovascular events. Our study aims to investigate the optimal BG level for critically ill patients with cardiogenic shock and evaluate the effects of optimal BG on the prognosis of patients. METHODS: A total of 2013 patients with cardiogenic shock obtained from the Medical Information Mart for Intensive Care (MIMIC) IV database were included in the final cohort for our retrospective observational study for data analysis. The exposure was time-weighted average BG (TWA-BG), which was calculated by the time-series BG records and corresponding time stamps of patients with cardiogenic shock during their stay in the ICU. The cut-off value of TWA-BG was identified by the restricted cubic spline curve and included patients were categorized into three groups: low TWA-BG group (TWA-BG ≤ 104 mg/dl), optimal TWA-BG group (104 < TWA-BG ≤ 138 mg/dl), and high TWA-BG group (TWA-BG > 138 mg/dl). The primary outcome was 28-day mortality, and the secondary outcomes were ICU and in-hospital mortality. We performed the log-rank test to detect whether there is a difference in mortality among different groups in the original cohort. Multiple distinct models were employed to validate the robustness of the results. RESULTS: Our study revealed that the optimal BG level for critically ill patients with cardiogenic shock is 104-138 mg/dl. Compared to the optimal TWA-BG group, the low TWA-BG group (hazard ratio (HR): 1.67, 95% confidence interval (CI): 1.19-2.33, p = 0.002) and high TWA-BG group (HR: 1.72, 95% CI: 1.46-2.03, p < 0.001) exhibited higher 28-day mortality. Similarly, the low TWA-BG group and high TWA-BG group demonstrated higher risks in terms of ICU mortality (low TWA-BG group: HR: 2.30, 95% CI: 1.40-3.79, p < 0.001; high TWA-BG group: HR: 1.77, 95% CI: 1.45-2.17, p < 0.001) and in-hospital mortality (low TWA-BG group: HR: 1.73, 95% CI: 1.19-2.51, p = 0.001; high TWA-BG group: HR: 1.64, 95% CI: 1.38-1.95, p < 0.001). Sensitivity analysis conducted through propensity score matching and the subgroup analysis further substantiated the robustness of the results. CONCLUSION: The optimal BG level for patients with cardiogenic shock is 104-138 mg/dl. BG levels below 104 mg/dl and above 138 mg/dl were associated with a less favorable prognosis.

[Risk factors of mortality in severe chest trauma patients].

OBJECTIVE: To investigate the risk factors of mortality in patients with severe chest trauma (SCT). METHODS: The clinical data of 777 SCT [abbreviated injury scale (AIS) ≥3] patients who were treated in the Chongqing Emergency Medical Center from January 2006 to April 2009 were retrospectively reviewed. Stepwise logistic regression analysis was used to explore 15 possible mortality-related risk factors. RESULTS: Seven factors were found to be correlated with the mortality of SCT: age, hemorrhagic shock, multiple organ dysfunction syndrome (MODS), pulmonary infection, abdominal organ injury, Glasgow coma scale (GCS) score, and thorax AIS score. Among them five factors were the independent factors that might increase the mortality of SCT: hemorrhagic shock (B=1.710, OR=1.291, P=0.001), MODS (B=3.453, OR=1.028, P<0.001), pulmonary infection (B=2.396, OR=10.941, P<0.001), abdominal organ injury (B=1.542, OR=1.210, P=0.005), and thorax AIS score ≥4 (B=0.487, OR=1.622, P<0.001). Two factors showed protective effects: age ≤60 years (B=-0.035, OR=0.962, P=0.01) and GCS score ≥12 (B=-0.635, OR=0.320, P<0.001). CONCLUSIONS: Age, disease severity, and complications (hemorrhagic shock, MODS, and pulmonary infection) are independent risk factors of the mortality of SCT. Effective treatment programs targeting these risk factors may improve the outcomes of SCT patients.

Treatment of unstable posterior pelvic ring fracture with percutaneous reconstruction plate and percutaneous sacroiliac screws: a comparative study.

OBJECTIVE: The aim of this study is to compare the clinical effects of percutaneous reconstruction plate and percutaneous sacroiliac screws in treatment of unstable posterior pelvic ring fracture. METHODS: Fifty-eight patients with unstable posterior pelvic ring fracture treated with two methods from March 2002 to October 2007 were enrolled in the study and divided into two groups according to two kinds of internal fixation: percutaneous reconstruction plate (20 males and 9 females, at mean age 37.3 ± 11.3 years) and percutaneous sacroiliac screws (21 males and 8 females, at mean age 39.3 ± 10.4 years). Causes of injury included traffic accident in 38 patients, fall from height in 17, and crush in 3. The correlative data of operation duration, number of X-ray exposures, intraoperative bleeding volume, length of incision, Majeed postoperative functional evaluation, and postoperative complications were analyzed statistically. RESULTS: All 58 patients were followed up for 12-36 months (mean duration 21.3 months). There was statistical difference for operation duration, number of X-ray exposures, size of incision, and intraoperative bleeding volume between the two groups. Majeed postoperative functional evaluation indicated excellent and good rates of 86.1% for percutaneous reconstruction plate and 88.2% for percutaneous sacroiliac screws. CONCLUSIONS: The clinical effect of the two methods is similar in treatment of Tile C pattern posterior pelvic ring fracture. However, the percutaneous reconstruction plate has lower risk of damaging nerves and blood vessels than the percutaneous sacroiliac screws. Moreover, intraoperative fluoroscopy is rarely performed.

Comparative analysis of characteristics and risk factors of traffic injury in aged people from urban and rural areas in Chongqing.

OBJECTIVE: To study the epidemiologic characteristics of traffic injuries among people over 60 years old in the Nan'an district (urban) and Jiangjin district (rural) of Chongqing, and to discuss the corresponding strategies for its prevention and cure. METHODS: Records of traffic injuries in people over 60 years old registered by the traffic police between 2000 and 2006 in Nan'an district and Jiangjin district were collected in the Database of Road Traffic Accidents and Traffic Injuries. Epidemiologic characteristics of traffic injuries among the aged people were analyzed and compared. RESULTS: Between the year 2000 and 2006, the average annual incidence of traffic injuries and mortality rate in the aged people in Nan'an district were 124.62/100 000 and 13.85/ 100 000 respectively, higher than that in Jiangjin district (27.49/ 100 000, 7.13/100 000, P less than 0.01). However, the mortality rate for the aged people who were involved in traffic injuries in Jiangjin district was 20.60%, higher than that in Nan'an district (10.00%, P less than 0.01). Head injury was the primary cause of death. Totally 76.58% of casualties were pede-strians. Over 90% of the traffic accidents occurred in the areas with no traffic signal or traffic control system. CONCLUSIONS: The traffic environment is unfavorable to the aged people. It is important to enhance traffic safety consciousness of drivers and the elderly and to strengthen traffic safety system and traffic law, so as to provide a safe road traffic environment for the aged people.

[Prevalence and mortality of severe chest trauma in Three Gorges Area of China].

OBJECTIVE: To analyze the epidemiological features of severe chest trauma (SCT) and investigate the risk factor of its mortality in the Three Gorges Area of China. METHODS: The clinical data of 1834 SCT patients who were admitted in three hospitals in this area from January 1990 to December 2009 were retrospectively reviewed. Th epidemiological features of SCT were analyzed using a database. Stepwise logistic regression analysis was used to analyze 15 possible risk factors affecting mortality. RESULTS: The morbidity rates of blunt trauma (68.5% vs. 74.7%,p=0.006) and sharp instrument injury (12.2% vs. 15.9%,p=0.039) showed significant differences before and after 2000. The pre-hospital time [(3.45±2.38)h vs. (2.20±4.39)h,p<0.01] and transfer rate (32.39% vs. 36.80%,p=0.01) significantly improved. The thoracic Abbreviated Injury Scale (AIS)(3.56±0.71vs. 3.43±0.58,p<0.01)score and Revised Trauma Score (RTS)(7.14±2.18 vs. 6.93±1.07,p<0.01) significantly increased. Treatment for pulmonary infection (12.63±4.79 vs. 17.16±6.41,p=0.019) and hemorrhagic shock (2.4±0.75 vs. 3.4±1.34,p=0.008 )was significantly improved. The leading cause of death was hypovolemic shock (59.41%). The independent rik factors of death among these SCT patients included: hemorrhagic shock (B=1.710,OR=1.291,p=0.001), multiple organ dysfunction syndrome (B=3.453,OR=1.028,p<0.001), pulmonary infection(B=2.396,OR=10.941,p<0.001), abdominal organ injury(B=1.542,OR=1.210,p=0.005), and thorax AIS(B=0.487,OR=1.622,p<0.001). CONCLUSIONS: The prevalence of SCT shows an increasing trend in the Three Gorges Area in recent years, but with a decreased rate of complications and improved treatment. Age, complications, thorax AIS, and GCS are useful prognostic indicators.

Clinical features and direct medical cost of splenic injury in China: a cross-sectional study.

OBJECTIVES: This study analyses the clinical features and direct medical cost (DMC) of splenic injury during 2000-2013 in China. DESIGN: This was a cross-sectional study. METHODS: We used 'The No. 1 Military Medical Project' information system to conduct a retrospective study. Patients' information from 2000 to 2013 were identified. Demographic data, treatment, clinical data and DMC were collected. We performed a generalised linear method (GLM) using gamma distribution to assess the drivers of DMCs. RESULTS: We included 8083 patients with splenic injury who met the study criteria. Over the 14-year study period, 2782 (34.4%) patients were treated with non-operative management (NOM), 5301 (65.6%) with OM. From 2000 to 2013, the rate of NOM increased from 34.7% to 55.9%, while OM decreased from 65.3% to 44.1%. Mean per-patient DMC in both NOM and OM increased from 2000 to 2013. In GLM analysis, male, old age, length of stay, severe splenic injury grade, OM, intensive care unit, blood transfusion and tertiary hospitals were associated with higher DMC, while female and NOM was associated with lower DMC. CONCLUSIONS: In China, management of splenic injury was the most important factor impacting the total DMC. Proper management and public policy could curtail the burden of splenic injury.

[Comparative study of protein markers in serum and bronchoalveolar lavage fluid from patients with lung cancer by surface-enhanced laser desorption ionization time of flight mass spectrometry].

OBJECTIVE: To detect the protein markers in serum and bronchoalveolar lavage fluid (BALF) of the patients with lung cancer by surface-enhanced laser desorption ionization time of flight mass spectrometry (SELDI-TOF-MS) technology, and to explore if they can be used as markers for the diagnosis of lung cancer. METHODS: SELDI-TOF-MS technology and protein chips weak cation exchange (WCX-2 chip) were used to detect the protein mass spectrum in serum and BALF of 35 patients with lung cancer and 18 cases of benign pulmonary diseases. The different protein markers were analyzed by Biomarker Pattern Software and the initial diagnosis models were set up. The diagnosis models were verified further by blind screen to confirm the efficacy of diagnosis. RESULTS: Five protein peaks in the sera of the patients with lung cancer were significantly higher (P < 0.05). The protein peak with a mass/charge ratio (M/Z) of 5639 was selected to establish the classification tree model. The sensitivity of diagnosis was 80% (28/35) and the specificity was 78% (14/18). The results verified by blind screen showed a sensitivity of 85% (17/20), a specificity of 90% (9/10), a crude accuracy (CA) of 87% (26/30) and Youden's index (γ) of 0.7. Eight protein peaks in the BALF of the patients with lung cancer were significantly higher (P < 0.05). The different protein peaks with M/Z of 7976 and 11 809 respectively were selected to establish the classification tree model. The sensitivity of diagnosis was 86% (30/35) and the specificity was 72% (13/18). The results verified by blind screen showed a sensitivity of 90% (18/20), a specificity of 90% (9/10), a CA of 90% (27/30) and γ of 0.8. There was a complementary role in combination of differential proteins in serum and BALF and the sensitivity, specificity and accuracy of diagnosis for lung cancer were 100% by parallel test. CONCLUSIONS: The SELDI-TOF-MS technology can screen out the differential protein markers in serum and BALF of the patients with lung cancer, which show high sensitivity and specificity as tumor markers. The differential proteins in the BALF may be more promising for clinical application.

[The study of differential proteins in patients with peripheral lung cancer by surface-enhanced laser desorption/ionization time of flight mass technology].

OBJECTIVE: To scan the protein mass spectra in the sera and bronchoalveolar lavage fluid (BALF) from patients with peripheral lung cancer, screen out the differential proteins, and explore the clinical significance of the differential proteins. METHODS: SELDI-TOF-MS was used to detect the protein mass spectra and to screen out the differential proteins in the sera and BALF collected before and after lung biopsy in 20 patients with peripheral lung cancer and 20 patients with benign pulmonary diseases. The differential proteins were analyzed and the initial diagnostic models were set up. RESULTS: (1) There were 6 differential protein peaks in the sera of the 2 groups (P < 0.05). The protein with a mass/charge ratio (M/Z) of 6637 was selected to establish the diagnostic model. The sensitivity of diagnosing peripheral lung cancer was 70% (14/20), the specificity 90% (18/20), the accuracy 80% (32/40), the positive predictive value (PV+) 88% (14/16), the negative predictive value (PV-) 75% (18/24), and the area under the ROC curve (AUC) was 0.73. (2) There were 11 differential protein peaks in the BALF collected before lung cancer biopsy of the 2 groups (P < 0.05). The protein with a M/Z of 7982 was selected to establish the diagnostic model. The sensitivity of diagnosing peripheral lung cancer was 85% (17/20), the specificity 90% (18/20), the accuracy 88% (35/40), the PV+ 89% (17/19), the PV- 86% (18/21), and the AUC was 0.94. (3) There were 14 differential protein peaks in the BALF collected after lung cancer biopsy of the 2 groups (P < 0.05). The protein with a M/Z of 7671 was selected to establish the diagnostic model. The sensitivity of diagnosing peripheral lung cancer was 85% (17/20), the specificity 100% (20/20), the accuracy 93% (37/40), the PV+ 100% (17/17), the PV- 87% (20/23), and the AUC was 0.93. CONCLUSIONS: There were more differential proteins in BALF as compared with sera. There were more differential proteins in the BALF collected after lung biopsy as compared to that before lung biopsy. The AUC of the diagnostic models set up by proteins in BALF collected before and after lung biopsy were all above 0.9 and showed higher efficiency for the diagnosis of peripheral lung cancer as compared to proteins in sera. These differential proteins may be better tumor markers for the diagnosis of peripheral lung cancer at the early stage.

[The variation trend of fluorescence characteristics of DOM in the acetophenone degradation process by electro-Fenton].

In the acetophenone degradation process by electro-Fenton, the variation trend of fluorescence characteristics of dissolved organic matter (DOM) in acetophenone synthetic wastewater was detected by excitation-emission matrix (EEM) fluorescence spectra. The fluorescence spectra characteristics of acetophenone were studied, and the fitting line of fluorescence intensity and acetophenone removal efficiency was discussed in detail. The results show that the locations of the two fluorescence centers of acetophenone synthetic wastewater are at lambda(Ex/Em) = 270/305 nm (Peak A) and lambda(Ex/Em) = 215/305 nm (Peak B), respectively, and the ratio of Peak A/Peak B is 1.22. In the electro-Fenton treatment process, firstly, acetophenone was decomposed into unsaturated fatty acid which had stronger fluorescence intensity, further, it was degraded into short-chain small molecular compounds which have weaker fluorescence intensity. Therefore, the fluorescence intensity of synthetic wastewater was increased at first and decreased afterwards in the entire 180 min electro-Fenton treatment process. The two-dimensional fluorescence peak at 285-375 nm of emission wavelength (at lambda(Ex) = 250 nm) had a good linear relationship with the removal efficiency of acetophenone, therefore, it could reflect effectively the removal efficiency of acetophenone in the whole electro-Fenton treatment process.

MicroRNA-506 has a suppressive effect on the tumorigenesis of nonsmall-cell lung cancer by regulating tubby-like protein 3.

MicroRNA-506 (miR-506), a miRNA, has been proven to act as a tumor suppressor gene in nonsmall-cell lung cancer (NSCLC); Tubby-like protein 3 (TULP3) is a potential target gene of miR-506. This study investigates whether miR-506 can prevent NSCLC progression by mediating TULP3. In vivo and in vitro experiments were performed to explore the function and potential regulatory relationship of miR-506 and TULP3 in NSCLC. Our results revealed that miR-506 is high expression in NSCLC cell lines, and the overexpression of miR-506 could inhibit cell viability and enhance cell apoptosis in H1299 and A549 cells. Pro-apoptotic related protein (cytochrome C, Bax, and cleaved caspase-9) expression increased while anti-apoptotic related protein (BCL-2 and BCL-XL) expression decreased after miR-506 was overexpression. Meanwhile, the overexpression of miR-506 could notably downregulate TULP3. Additionally, silence of TULP3 inhibited cell viability and promoted cell apoptosis. At the same time, pro-apoptotic related protein expression was promoted while anti-apoptotic related protein expression was inhibited. Furthermore, TULP3 overexpression could markedly reverse the inhibitory effect of miR-506 on the proliferation and induction of mitochondrial apoptosis in H1299 and A549 cells. In vivo tumor formation experiments also exhibited consistent results indicating that the functions of TULP3 might be correlated with the promotion of tumorigenesis. In conclusion, we firstly found that miR-506 can be involved in the processes of NSCLC and exert a suppressive effect on tumorigenesis by regulating TULP3 expression.

X-ray observation on how axial compression stimulates tibial fracture healing.

OBJECTIVE: To validate the hypothesis that there exists an optimal axial compression stress range to enhance tibial fracture healing. METHODS: Rabbits with a surgically induced V-shaped tibial fracture were separated into 2 main groups: the control group (C Group, n equal to 6) without application of any axial compression stress stimulation postoperatively and the stimulation group (S Group, n equal to 90). The S Group was further divided into 20 subgroups (S11 to S54) in terms of 5 axial compression stress stimulation levels (112.8 kPa, 289.8 kPa, 396.5 kPa, 472.7 kPa, and 602.3 kPa) and 4 experimental endpoints (1, 3, 5 and 8 weeks after operation). A custom made circular external fixator was used to provide the axial compression stress of the fracture sites. Based on X-ray observation, a fracture healing scoring system was created to evaluate the fracture healing process. RESULTS: At 8 weeks after operation, there existed a "arch shape" relationship between healing score and axial compression stress stimulation level of fracture site. The optimal axial compression stress stimulation ranged from 289.8 kPa to 472.7 kPa, accompanying the best fracture healing, i.e. the fracture line became indistinct or almost disappeared, and a lot of callus jointed the two fracture ends. Meanwhile, at 5 weeks after operation, corresponding to the relatively low healing scores, there was a fracture healing performance similar to that at 8 weeks. Besides, at 1 or 3 weeks after operation, for all the axial compression stress levels (0-602.3 kPa), no obvious healing effect was found. CONCLUSIONS: It is implied from the stated X-ray observation results in this study that the potential optimal axial compression stress stimulation and optimal fracture healing time are available. The axial compression stress level of 289.8-472.7 kPa and fracture healing time of more than 8 weeks jointly comprise the optimal axial compression stress stimulation conditions to enhance tibial fracture healing.

Analysis of injuries and treatment of 3,401 inpatients in 2008 Wenchuan earthquake--based on Chinese Trauma Databank.

OBJECTIVE: A catastrophic earthquake struck Wenchuan region of West China on May 12, 2008 and caused more than 69 225 deaths. This study was to analyze injury characteristics and treatment of the seismic patients based on Chinese Trauma Databank, which will be helpful for improvement of future medical rescue in potential disasters. METHODS: Based on inpatients'medical records of seismic patients admitted into 11 hospitals, data were registered with Trauma Database System Version 3.0. Patients'general information, causes, clinical characteristics and treatment of injuries were studied. RESULTS: Main causes for seismic injuries were blunt strike (68.2%), crush/burying (18.7%) and slip/falling (11.5%). Slip/falling was the main cause for spinal injuries and accounted for 19.1%, which was higher than the percentage for other body part. Extremity injuries accounted for 54.8% of all injuries. Fractures accounted for 53.1%. Lower extremity fracture accounted for 70.1% of lower extremity injury and spinal fracture accounted for 85.9% of spinal injury. The proportion of spinal injuries with AIS larger than or equal to 4 was higher than that of other injured locations except for the abdomen. Debridement and suturation for single injury and multiple injury patients accounted for 64.7% and 42.9% of their operations respectively. CONCLUSIONS: Blunt strike, crush/burying and slip/falling are the main causes for seismic injuries. The most frequently injured site is extremity. The main injury type is fracture, especially for the lower extremities and the spine. Multiple injury patients were mainly treated by operation, including debridement and suturation, closed reduction and external fixation, etc.

Theophylline and dexamethasone in combination reduce inflammation and prevent the decrease in HDAC2 expression seen in monocytes exposed to cigarette smoke extract.

Lung and systemic inflammation are associated with impaired lung function and increased mortality in patients with chronic obstructive pulmonary disease (COPD). Theophylline and glucocorticoids have been shown to have an anti-inflammatory effect in some respiratory diseases. However, corticosteroid insensitivity is a major barrier to the anti-inflammatory management of COPD. This study aimed to explore whether a combined treatment of theophylline and dexamethasone (Dex) could decrease cigarette smoke extract (CSE)-induced inflammation via prevention of a reduction in histone deacetylase 2 (HDAC2) expression and through inhibition of the PI3K/Akt pathway, which may be related to corticosteroid sensitivity. The half-maximal inhibitory concentration (IC50) of Dex (IC50-Dex) was used to as a marker of corticosteroid sensitivity. IC50-Dex was determined through observation of Dex inhibition of tumor necrosis factor-α (TNF-α)-induced interleukin (IL)-8 release. Using reverse transcription quantitative PCR and western blotting, U937 cells treated with CSE were assessed for HDAC2 expression levels and phosphorylation levels of Akt. Theophylline and Dex pre-treatment was shown to significantly reduce the CSE-induced release of IL-8 and TNF-α. The combination of theophylline and Dex pretreatment also reversed corticosteroid insensitivity in CSE-induced U937 cells and inhibited the PI3K/AKT pathway to a greater extent than theophylline treatment alone. CSE-treated U937 cells showed a reduction in HDAC2 mRNA and protein expression compared with the control group. However, this effect was reduced after pre-incubation with the combined therapy or theophylline alone. In conclusion, pretreatment with theophylline and Dex decreased CSE-induced inflammation via inhibition of the PI3K/Akt pathway and increase in HDAC2 protein expression.

Influence of distal tibiofibular synostosis on ankle function.

OBJECTIVE: To study the influence of distal tibiofibular synostosis on ankle function. METHODS: From October 1998 to October 2004, a total of 281 consecutive patients underwent operations because of ankle fractures or distal fractures of the tibia and fibula. Distal tibiofibular synostosis occurred after operation in 8 patients. The duration of follow-up averaged 20.6 months (14-44 months). The ankle function was assessed on the basis of functional rating system described by Mazur.(1) RESULTS: According to Mazur's ankle evaluation system, 4 patients achieved an excellent result, 2 a good result and 2 a fair result. The dorsiflexion of the synostosis ankle reduced by 8.26 degrees as compared with that of the contralateral ankle, and there was little influence on the plantar flexion. All the patients had a normal gait. CONCLUSION: The distal tibiofibular synostosis after the operation of ankle fractures or distal fractures of the tibia and fibula usually gives rise to few symptoms and needs no specific treatment.

Road crash in China from 2003 to 2005.

OBJECTIVE: To analyze characteristics and causes of road crash and injuries in China from 2003 to 2005. METHODS: The data of road crash in 2003-2005 were collected to study the characteristics including total vehicle number, occurrence rates of traffic accidents and serious traffic accidents so as to discuss the causes and characteristics of road crash in China. RESULTS: From 2003 to 2005, the numbers of traffic accidents, injuries and deaths as well as the mortality rates per 100,000 persons and per 10,000 vehicles declined in China. Until 2005, the total number of traffic accidents decreased to 450,000 and deaths to 99,000, with the mortality rate per 10,000 vehicles being 7.6 persons. While the drivers and passengers accounted for 33.2% and 26.6% of death casualties respectively in 2005. Most traffic accidents were caused by drivers, especially those with driving experience less than 3 years. Traffic accidents occurred on suburban roads accounted for 60%. The mortality rate of the traffic accidents per 100 km on the first grade road ranked the highest. The mortality rate of the traffic accidents on expressways ranked the highest, with continual increase of death and injury. CONCLUSIONS: At present, the increase trend of traffic accidents and casualties in China has been slowed down to some extent and shows a declining tendency, but the situation is far away from being optimistic. In order to cut down the number of traffic accidents and casualties, we should pay more attention to training and managing drivers with less than three driving years and those driving buses. Strict prevention measures should be laid on traffic accidents on first grade roads, expressways and suburban roads as well as the enhancement on improving first-aid system.

Motorcycle accidents in China.

OBJECTIVE: To analyze the characteristics and causes of motorcycle accidents in China from 2000 to 2005. METHODS: We collected data on possession of motorcycles and automobiles, number of traffic crashes, casualty and economic loss from 2000-2005 Statistic Annual Report of Traffic Management Bureau, Ministry of Public Security of China. The data was processed statistically by SPSS 11.0 software package. RESULTS: During 6 years, the number of motorcycle accidents were up to 122,300 in 2003, which was the highest, and then gradually decreased. However, the casualty had the tendency of consistent increase, for example, the motorcycle accidents resulted in 26,200 deaths and 157,500 injuries in 2005. The mortality per 10, 000 motorcycles and the ratio of deaths to injuries were lower than those of automobiles, but the mortality per 100 motorcycle accidents was significantly higher than that of automobiles (P less than 0.01). CONCLUSIONS: China has attached great importance to the management of traffic safety, which is beneficial to control and reduce traffic accidents in recent years. However, the casualty keeps increasing annually. Therefore, it is urgent to strengthen the management of motorcycles, promote the education of motorcyclists, take effective traffic measures and improve the first-aid system of traffic injuries.

[Molecular mechanism of anti-apoptotic action of survivin in NCI-H446 lung cancer cells].

OBJECTIVE: To investigate cell apoptosis induced by survivin ASODN and clarify the precise mechanism of anti-apoptotic action of survivin. METHODS: Cells of lung cancer cell line NCI-H446 were treated with survivin ASODN at different concentrations. The changes of survivin mRNA and protein expression were assessed by RT-PCR and Western blot assay. The apoptosis index (AI) and proliferation index (PI) were determined by flow cytometry (FCM). After 500 mmol/L survivin ASODN treatment, cells were stained with Rh123 to detect changes of mitochondrial membrane potential (deltapsim) by FCM. The concentration of cytoplasmic cytochrome c (cyt-c) was continuously determined by ELISA. Relative activities of caspase-9 and caspase-3 were assessed by colorimetric assay. The expression of caspase-8 protein was measured by Western blot assay. The apoptotic rates of lung cancer cells induced by survivin ASODN with or without mitochondrial permeability transition pole (MPTP) inhibitor CsA treatment were assessed by FCM. RESULTS: Down-regulated survivin mRNA was shown to be in dose-dependent and time-dependent manners. Its maximal effect was achieved at a concentration of 500 nmol/L for 72 h, at which mRNA was down-regulated by 62.7%, the expression of survivin protein in NCI-H446 cells was also obviously decreased. After treatment with survivin ASODN at concentration of 500 mmol/L for 72 h, AI was 48.35%, higher than that of control, lipofectin, NSODN, survivin ASODN 100 mmol/L and 300 mmol/L groups (3.75%, 3.41%, 4.69%, 19.85% and 34.39%, respectively). PI was 24.38%, lower than that of control, lipofectin, NSODN, survivin ASODN100 and 300 mmol/L groups (75.74%, 73.12%, 71.76%, 51.03% and 38.94%, respectively). Deltapsim was decreased in 9.54% of NCI-H446 cells treated with survivin ASODN for 3 h and 97.06% for 24 h. Following it, release of cyt-c from mitochondria to cytosol and activation of caspase-9 and caspase-3 increased significantly. The above mentioned indicators changed with a time-dependent and time diversity relationship. In the presence of CsA, the apoptotic rate of lung cancer cells induced by survivin ASODN was decreased significantly. No up-regrulation and activation in caspase-8 protein was observed. CONCLUSION: Survivin inhibits apoptosis via regulation of mitochondrial-dependent pathway. survivin ASODN can not only induce apoptosis but also inhibit cell proliferation through blocking the expression of survivin mRNA and protein.

Treatment of displaced radial head fractures by internal fixation with absorbable pins.

OBJECTIVE: To study the effect of internal fixation with absorbable pins on treatment of displaced radial head fractures. METHODS: From May 1999 to May 2004, 16 patients with displaced radial head fractures (Mason types II and III) were treated with internal fixation by absorbable pins. The duration of follow-up averaged 22.6 months (12-58 months). The outcome was assessed on the basis of elbow motion, radiographic findings and the functional rating score delineated by Broberg and Morrey. RESULTS: All fractures healed within 10 months without avascular necrosis of radial head. The mean elbow flexion loss was 15 degrees (0 degrees-35 degrees), and pronation and supination decreased by 10 degrees (0 degrees-30 degrees) on average compared with those of the contralateral elbow. Five patients had an excellent result, 6 a good result, and 3 a fair result according to the criteria of Borberg and Morrey. CONCLUSIONS: Internal fixation with absorbable pins is an effective method in treating displaced radial head fractures. It can maintain the biomechanical stability of forearm, improve the elbow function and avoid second operation.

Comparative observation of protective effects of earplug and barrel on auditory organs of guinea pigs exposed to experimental blast underpressure.

OBJECTIVE: To explore the protective effects of earplug and barrel on auditory organs of guinea pigs exposed to experimental blast underpressure (BUP). METHODS: The hearing thresholds of the guinea pigs were assessed with auditory brainstem responses (ABR). The traumatic levels of tympanic membrane and ossicular chain were observed under stereo-microscope. The rate of outer hair cells (OHCs) loss was analyzed using a light microscope. The changes of guinea pigs protected with barrel and earplug were compared with those of the control group without any protection. RESULTS: An important ABR threshold shift of the guinea pigs without any protection was detected from 8h to 14d after being exposed to BUP with a peak ranging from -64.5 kPa to -69.3 kPa ( P<0.01). The rate of perforation of tympanic membrane reached 87.5% and that of total OHCs loss was 19.46% +/- 5.38% at 14d after exposure. The guinea pigs protected with barrel and earplug had lower ABR threshold and total OHCs loss rate compared with the animals without any protection (P<0.01). All of the tympanic membrane and ossicular chain of the protected animals maintained their integrities. Meanwhile, the guinea pigs protected with the barrel had lower ABR threshold and total OHCs loss rate than those with earplug (P<0.01). CONCLUSIONS: The earplug and barrel have protective effects against BUP-induced trauma on auditory organs of the guinea pigs and the protective effects of barrel are better than those of earplug.