Classification and treatment of syndesmotic injury / 中国骨伤

The distal tibiofibular syndesmosis is a critical structure in maintaining the ankle stability. Syndesmotic injuries are usually associated with ankle fractures and high fibula fractures. Non-isolated and partially isolated syndesmotic injuries are involved in unstable injuries, which need to operative treatment. Partially isolated syndesmotic injuries belong to stable injuries, which should be treated with non-operative management. It is becoming clear that early fixation and stabilization for unstable injuries are probably better than non-treatment or delayed treatment. It still remains without consensus of accurately defining stable from unstable injuries and sufficiently differentiating between acute and chronic injuries. Because of stability, fixation type, and duration, the clinical efficacy is different. Screw fixation is a gold standard treatment of syndesmotic injury. However, it remains controversial that whether removal of the syndesmotic screw is required and effect of the level of syndesmotic screw insertion, limited micro-movement is one of disadvantages of screw fixation. Micro-movement of the distal tibiofibular syndesmosis has been paid more and more attention. Dynamic fixation is a viable alternative to the static fixation device, with lower re-operation rates and less complications, which has obtained a great short-term clinical efficacy. However, further long-term studies should be carried out to confirm this clinical efficacy. Optimized treatment strategies considering stability of syndesmotic injury, duration, and fixation type can help to improve clinical efficacy.

Surgical intervention and radiotherapy outcome of solitary plasmacytoma of cervical spine / 中华外科杂志

<p><b>OBJECTIVE</b>To study the clinical features, treatment methods and outcome of solitary plasmacytoma of cervical spine.</p><p><b>METHODS</b>From January 1995 to December 2007, the data of 23 cases with solitary plasmacytoma of cervical spine was analyzed. There were 16 males and 7 females (mean age 56 years, range: 32 - 76 years). Two cases underwent radiotherapy alone and 21 patients received surgery. According to WBB staging system, surgical procedures were defined as total or subtotal resection (6 cases), appendix resection (4 cases), sagittal resection (3 cases) and total spondylectomy (8 cases). All surgical cases were managed using an anterior approach, posterior approach or combined anterior and posterior approach. The cervical spinal reconstruction was achieved through anterior cervical titanium plate and titanium mesh cage filled with auto iliac graft or bone cement, or anterior and posterior combined instrumented fusion. All patients received radiotherapy as adjunctive therapy.</p><p><b>RESULTS</b>Follow-up of the 23 cases lasted 24.0 - 143.0 months (mean: 64.7 months). Neck pains obviously improved, and nerve compression symptoms disappeared or improved after surgery. Neurological function improved by 1 - 2 grades based on Frankel grading system. All the internal fixations were fused well and stability of the cervical spine was fine and no spine instability could be seen in our series. The bone graft fusion rate was 100%. During the follow-up period, 6 surgical cases had local recurrence and finally progressed to multiple myeloma (MM) and 3 died. Two cases without surgical treatment progressed to MM in 1 year and 1.5 years after confirmed diagnosis. They were given systemic chemotherapy. The other 15 patients had disease-free survival and after surgery and adjunctive radiotherapy. Obvious abnormity were not found in such examinations as M protein, bone marrow aspiration and emission computed tomography or PET-CT examinations.</p><p><b>CONCLUSIONS</b>Solitary plasmacytoma of cervical spine is rarely seen clinically. Surgery is recommended as the primary management for patients with overt bone destruction and spinal instability or neurological dysfunction. Tumor excision with adjunctive radiotherapy can obviously reduce local recurrences and lower the possibility of progression to MM. The patients with progression to MM should receive chemotherapy according to chemotherapy protocol while the prognosis is comparatively worse.</p>

Evaluation of efficacy and safety on steroid withdraw at the seventh day after liver transplantation / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate efficacy and safety on steroid withdrawal at the seventh day after liver transplantation.</p><p><b>METHODS</b>Seventy-six adult patients undergoing first cadaveric liver transplantation from October 2005 to October 2007 were randomly divided into 7 day (n = 40) and 3 month (n = 36) steroid withdrawal groups. All patients received FK506 3 mg and intravenous methylprednisolone 1000 mg during intra-operation and FK506 thereafter was adjusted to predefined 8 - 12 microg/L from day 1 to month 6. Patients in 7 day steroid withdrawal group received 500, 240, 200, 160, 80, 40 and 20 mg intravenous methylprednisolone tapered daily from postoperative day 1 to day 7. In 3 month steroid withdrawal group, patients received the same protocol as 7 day steroid withdrawal group for intravenous methylprednisolone tapered daily from postoperative day 1 to day 7 and thereafter received oral prednisone 48, 40, 32, 24, 16, 8, 4 mg tapered every 3 days and maintained 4 mg to the 3(rd) month. All patients were followed up for 6 months. The incidence of treated acute rejection and side effects were evaluated between two groups.</p><p><b>RESULTS</b>A total of 69 cases were fully followed up, and 7 cases were discontinued including death (n = 2), server infection (n = 2), protocol violation (n = 2) and retransplantation (n = 1). There were no statistical difference between 2 groups concerning the incidence of acute rejection, hypertension, hyperlipemia and other adverse events (P > 0.05), but significant difference in incidence of diabetes (17.5% vs. 38.9%, P = 0.047).</p><p><b>CONCLUSION</b>Steroid withdrawal strategy at day 7 is same safety and efficacy as steroid withdrawal at 3 month.</p>

Effects of Huoxiang Zhengqi liquid on enteric mucosal immune responses in mice with Bacillus dysenteriae and Salmonella typhimurium induced diarrhea / 中国中药杂志

<p><b>OBJECTIVE</b>To explore the effects of Huoxiang Zhengqi liquid (HXZQ) on enteric mucosal immune responses in mice with Bacillus dysenteriae and Salmonella typhimurium induced diarrhea (BSD).</p><p><b>METHOD</b>Mice were randomly divided into four groups with 10 mice in each group: control group (control), BSD group, Huoxiang Zhengqi liquid treated BSD groups at high dosage and low dosage (HXZQ high, HXZQ low). HXZQ was administrated from the day of diarrhea induction at dosage of 5.21 g kg(-1) and 0.52 g kg (-1) respectively. Peyer's patch and periphery lymphocytes were prepared for flow cytometry, and level of TNF-alpha in periphery and enteric tissue homogenate were determined with ELISA. Student's t-test was used for statistics.</p><p><b>RESULT</b>Mice in BSD group started showing continuous diarrhea at the day of induction till the fourth day when the mice were sacrificed. Diarrhea in the mice of HXZQ high and low groups lasted for 36 and 54 h respectively. There were more CD4+ and CD8+ cells in periphery, less CD4+ cells in peyer's patch in BSD mice comparing to normal mice. In peyer's patch, there were more CD8+ cells in mice in HXZQ high and low groups and more CD4+ in mice in HXZQ high group. Higher level TNF-alpha in periphery and intestinal tissue homogenate in BSD group were observed. Mice in HXZQ high group showed the decreased level TNF-alpha in periphery and enteric tissue homogenate.</p><p><b>CONCLUSION</b>The immune regulation on peyer's patch CD4+ and CD8+ cells and suppression on TNF-alpha level in enteric homogenate might partially explain the effect of HXZQ on improvement of BSD.</p>