Research progress on chemical constituents and pharmacological effects of Ajania plants / 中国中药杂志

Ajania belonging to the subtribe Artemisiinae of Anthemideae(Asteraceae) is a genus of semi-shrubs closely related to Chrysanthemum. There are 24 species of Ajania in northwestern China, most of which are folk herbal medicines with strong stress tolerance. Modern medical studies have demonstrated that the chemical constituents of Ajania mainly include terpenoids, flavonoids, phenylpropanoids, alkynes, and essential oils. These compounds endow the plants with antimicrobial, anti-inflammatory, antitumor, antimalarial, antioxidant, and insecticide effects. In this study, we reviewed the research progress in the chemical constituents and pharmacological activities of Ajania, aiming to provide reference for the further research and development of Ajania.

Long Noncoding RNA PVT1 Promotes Stemness and Temozolomide Resistance through miR-365/ELF4/SOX2 Axis in Glioma

Long non-coding RNA (lncRNA) are a class of non-coding RNAs demonstrated to play pivotal roles in regulating tumor progression. Therefore, deciphering the regulatory role of lncRNA in the development of glioma may offer a promising therapeutic target for treatment of glioma. We performed RT-qPCR analysis on the expression of lncRNA plasmacytoma variant translocation 1 (PVT1) and miR-365 in glioma tissues and cell lines. Cell proliferation and viability was assessed with CCK8 assay. Cell migration was assessed by wound healing assay. Transwell assay was used to assess cell invasion capacity. Expression of CD133+ cells was detected by flow cytometry. Western blot assay was used to detection the expression of ELF4 and stemness-related protein SOX2, Oct4 and Nanog. Bioinformatics and dual-luciferase assay were used to predict and validate the interaction between PVT1 and miR-365. Elevated PVT1 expression was observed in glioma tissues and cells. Knockdown of PVT1 and overexpression of miR-365 inhibited proliferation, migration, invasion and promoted stemness and Temozolomide (TMZ) resistance of glioma cells. PVT1 regulated ELF4 expression by competitively binds to miR-365. PVT1 regulated the stemness and sensitivity of TMZ of glioma cells through miR-365/ELF4/ SOX2 axis. This study identified that PVT1 promoted glioma stemness through miR-365/ELF4/SOX2 axis.

Comparison of active ingredients and protective effects of Dendrobium huoshanense of different growth years on acute liver injury / 中国中药杂志

The differences of the active ingredients in Dendrobium huoshanense of different growth years and their protective effects on acute liver injury were studied to provide evidence for optimizing harvest time. The contents of polysaccharides, total flavonoids and total alkaloids in D. huoshanense of different growth years were determined by UV spectrophotometry, and the contents of gigantol in D. huoshanense were determined by HPLC. C57 BL/6 mice were randomly divided into blank control group(saline), modeling group(saline), high-dose(7.5 g·kg~(-1)) and low-dose(1.25 g·kg~(-1)) groups of D. huoshanense of different growth years. Each group was intragastrically administered every day for 2 weeks. 500 mg·kg~(-1) paracetamol was injected intraperitoneally 2 h after last treatment except the control group. After 12 hours, the serum and liver tissues were collected to detect the activities of ALT and AST, and the levels of SOD and MDA. The hepatic histopathological examination was performed. The results showed that the chemical constituents of D. huo-shanense of different growth years were significantly different(P<0.05). The contents of polysaccharide and gigantol of D. huoshanense of 2 growth years were the highest. The contents of flavonoids and alkaloids of D. huoshanense of 3 growth years were the hig-hest, followed by the D. huoshanense of 2 growth years, and the lowest were that of 1 growth year. Compared with the modeling group, D. huoshanense of different growth years could decrease the activities of ALT and AST in serum. Meanwhile, the levels of MDA reduced significantly, while those of SOD increased markedly. Histopathological results suggested that all D. huoshanense samples were effective in the reduction of the necrosis of hepatocytes in different degrees. The results of the multi-component SPSS paired tests showed that polysaccharide and gigantol probably played a leading role in the liver protection effects, while D. huoshanense of 2 growth years showed the best efficacy. The optimal harvesting time of D. huoshanense is 2 growth years.

Long Noncoding RNA PVT1 Promotes Stemness and Temozolomide Resistance through miR-365/ELF4/SOX2 Axis in Glioma

Long non-coding RNA (lncRNA) are a class of non-coding RNAs demonstrated to play pivotal roles in regulating tumor progression. Therefore, deciphering the regulatory role of lncRNA in the development of glioma may offer a promising therapeutic target for treatment of glioma. We performed RT-qPCR analysis on the expression of lncRNA plasmacytoma variant translocation 1 (PVT1) and miR-365 in glioma tissues and cell lines. Cell proliferation and viability was assessed with CCK8 assay. Cell migration was assessed by wound healing assay. Transwell assay was used to assess cell invasion capacity. Expression of CD133+ cells was detected by flow cytometry. Western blot assay was used to detection the expression of ELF4 and stemness-related protein SOX2, Oct4 and Nanog. Bioinformatics and dual-luciferase assay were used to predict and validate the interaction between PVT1 and miR-365. Elevated PVT1 expression was observed in glioma tissues and cells. Knockdown of PVT1 and overexpression of miR-365 inhibited proliferation, migration, invasion and promoted stemness and Temozolomide (TMZ) resistance of glioma cells. PVT1 regulated ELF4 expression by competitively binds to miR-365. PVT1 regulated the stemness and sensitivity of TMZ of glioma cells through miR-365/ELF4/ SOX2 axis. This study identified that PVT1 promoted glioma stemness through miR-365/ELF4/SOX2 axis.

Clinical Efficacy of Shensuyin in Treating Adult Viral Myocarditis with Syndrome of Insufficiency of Lung-Qi / 中国实验方剂学杂志

Objective: To investigate the efficacy of Shensuyin in treating viralmyocarditis (VMC) with syndrome of insufficiency of lung-qi and the effect on levels of Th17 and Treg cells and relevant factors. Method: One hundred-four VMC cases were regaded as object of study and randomly divided into control group and observation group, with 52 cases in each group. Control group was treated with routine therapy by reference to ‘Chinese Guidelines for Diagnosis and Treatment of Heart Failure 2014’. In addition to the therapy of control group, observation group on the basis of treatment in the control group with Shensuyin, 1 dose/d, bid. One course of treatment was 8 weeks for both groups. Scores of Shensuyin, serum levels of Troponin I (cTnI) and cardiac free fatty acid binding protein (H-FABP), heart function and total efficacy were compared for both groups. Flow cytometry was used to detect peripheral blood levels of Th17 and Treg cells for the two groups. Serum levels of interleukin (IL) -17, IL-21, IL-10 were detected in both groups. Result: After treatment, scores of syndrome of Yin and Yang deficiency (shortness of breath, fatigue, dull chest pain, bad breath, cough) of observation group were obviously lower than those of control group (PPPPPConclusion: In addition to the routine therapy of VMC, the efficacy of Shensuyin has a significant effect in treating VMC with syndrome of lung qi deficiency, and the regulatory effect on levels of Th17 and Treg cells and relevant factors may be one of the effective ways.

Establishment of Antibody-induced Immune Hemolytic Disease Model in SD Rats and Their Pathotogical Changes / 中国实验血液学杂志

OBJECTIVE@#To establish the model of antibody-induced immune hemolytic disease in SD rats so as to provide an experimental platform for the exploration of its pathogenesis, course of disease and evaluation of drug efficacy.@*METHODS@#The red blood cells(RBC) of SD rats were isolated and intraperitoneally injected into BALB/c mice to induce production of the antiserum to SD rat RBC. Twenty SD rats were randomly divided into 2 groups. The rats in the model group were injected with 0.1 ml antiserum via tail vein; the rats in the control group were injected with 0.1 ml saline via tail vein.The symptoms of rats, hemolysis-related indexes and histopathological changes of the main organs were observed in both groups after injection.@*RESULTS@#After the injection of antiserum, the SD rats in the model group displayed nasal flaring, laziness, decrease of ingestion and water intake, skin and mucosal jaundice, and gross hemoglobinuria. At the 4th day after the injection, the body weight of SD rats in the model group was significantly lower than that in the control group (P＜0.01), and the coefficiens of liver and spleen increased significantly (P＜0.01); The levels of WBC, MCV, MCH, DBIL, DBIL/TBIL and FHb all increased statistically significantly, and RBC, Hb, HCT, MCHC and Plt levels decreased significantly in comparison with the control group (P＜0.01). In the SD rats of model group, the hemolytic pathological changes were observed in liver, spleen, kidney, lung and small intestine, and erythroid proliferation was observed in bone marrow smears.@*CONCLUSION@#The immune hemolytic disease model of SD rats can be successfully established by injecting the serum aginst SD rat red blood cells into the tail vein of SD rats, showing the high success rate, good reproducibility and low cost.

Direct and Indirect Methods of High-frequency Ultrasound in Imaging Distal Biceps Brachii Tendon / 中国医学科学院学报

Objective To explore convenient and effective ultrasound scanning methods and skills for imaging the distal biceps tendon.Methods Totally 80 distal biceps tendons of 40 healthy volunteers were scanned and evaluated with high-frequency ultrasound using the direct and the indirect methods. The scanning time and the subjective comfort scores of each subject were recorded. The imaging clarity of the tendon and its insertion onto the radial tuberosity was evaluated.Results The scanning time of the indirect method was shorter than that of the direct method in all volunteers,male volunteers,and female volunteers,although the differences were not statistically significant(all P> 0.05). The mean scanning time was longer on the left side than on the right side regardless of the scanning method (all P> 0.05). The scanning time in women was significantly shorter than in men when the scan was performed by using indirect method on the left side (t=-2.33,P=0.025),direct method on the right side (t=-3.35,P=0.002),or indirect method on the right side (t=-2.67,P=0.011). However,the scanning time was not significantly different between women and men when using the direct method on the left side (t=-1.27,P=0.213). The subjective comfort score was not significantly different between direct and indirect methods in each group (all P>0.05). However,the subjective comfort score was higher on the right side than on the left side regardless of the methods used. In particular,the subjective comfort scores showed significant difference when using the direct method in all subjects (t=2.32,P=0.026),the indirect method in all subjects (t=3.08,P=0.004),and indirect method in females (t=2.52,P=0.021). The overall subjective comfort score of females was higher than that of males,and the difference was statistically significant when the direct method was used on the right side (t=2.33,P=0.025),although no significant difference was observed for the indirect method on the right side (t=2.00,P=0.053),direct method on the left side (t=0.34,P=0.739),and indirect method on the left side (t=-0.15,P=0.884). The clarity rates of the indirect method for the insertions were 100.0% and 95.0%,which were significantly higher than those of the direct method(right side:100.0% vs. 85.0%,P=0.026;left side:95.0% vs.60.0%,P=0.000). The clarity rates of the main trunk of the tendon showed no significant difference between direct and indirect methods on both sides (right side:100.0% vs.95.0%,P=0.494;left side:92.5% vs.87.5%,P=0.712).Conclusions When high-frequency ultrasound is applied for scanning the distal biceps tendon,the scanning time and the subjective comfort are similar when either the direct method or the indirect method is used. The indirect method has higher clarity in imaging the insertion and may be used as the preferred scanning method,whereas the direct method may serve as a supplementary method.

Jiangtang Xiaozhi Recipe () prevents diabetic retinopathy in streptozotocin-induced diabetic rats / 中国结合医学杂志

<p><b>OBJECTIVE</b>To evaluate the prevention effect of diabetic retinopathy of Jiangtang Xiaozhi Recipe (, JXR) in streptozotocin (STZ)-induced diabetic rats.</p><p><b>METHODS</b>Sprague-Dawley rats were randomly divided into normal control group and diabetic group. Rats in the diabetic group were induced by intraperitoneal administration of STZ (50 mg/kg), and subdivided into 5 groups. Rats in the diabetic control group were given saline; four treatment groups were given metformin (300 mg/kg), JXR (2, 4 and 8 g/kg) respectively for 8 weeks, while rats in the normal control group were injected with citrate buffer and given the same volume of vehicle. Body weight and food intake were measured every week. The hypoglycaemic effects were determined by testing fasting blood glucose (FBG) every other week, and hemoglobin A1c (HbA1c), insulin, and glucagon at the end of the treatment. The preventive effects of JXR on STZ-induced diabetic rats were determined by histopathological examination with hematoxylin and eosin staining, and periodic acid-schiff staining. The effects were further evaluated by serum superoxide dismutase (SOD) activity and malondialdehyde (MDA).</p><p><b>RESULTS</b>High-dose JXR significantly reduced FBG and HbA1c level at the 8th week of administration (P<0.01, P<0.05). JXR significantly increased insulin level (P<0.05), and decreased glucagon level (P<0.05). JXR showed the antioxidant defense with increased SOD activity and decreased MDA contents in diabetic rats. Histopathological studies revealed that there were no basement membrane thickening and mild destruction in the treated groups. Morphometric measurements of retina microvascular showed that acellular capillary and capillary density decreased in treated rats while pericyte and endothelial cell increasing after the treatment.</p><p><b>CONCLUSION</b>JXR have protective effect of diabetic retinopathy and its mechanism may be associated with the obvious hypoglycemic and antioxidant effect.</p>

Numerical analysis on longitudinal flexibility of a NiTi coronary stent / 医用生物力学

Objective To analyze the relationship between structure characteristics and longitudinal flexibility of the self-designed NiTi coronary stents by using finite element method. Methods A new type of stent geometric model was designed with the CAD software Soildworks, and then the finite element stent model was established with Hypermesh, MATLAB and ABAQUS software. In ABAQUS, the angular displacement loads were applied on the stent in 9 bending directions within one structural cycle to maintain the stent in a pure bending state. Results The stent flexibility appeared no significant difference before the self-contact occurred, while it showed obvious anisotropy after the self-contact occurred. In addition, the bending deformation occurred under in-plane pure bending loads, accompanied with the out-of-plane deflection and torsion deformation around the axis. Conclusions The bending behavior of the stent is determined by its structural characteristics, and the stent always shows anisotropic flexibility due to its spiral arrangement of the connecting body and self-contact, which will provide a scientific guidance for clinical application of the stent.

Finite element modeling of proximal femur and element size analysis based on CT images / 医用生物力学

Objective To establish 5 different finite element models of the proximal femur based on CT images, and analyze the influences of element size on materials distribution and biomechanical behavior of the proximal femur model. Methods The proximal femur was scanned by spiral CT. The images, stored as DICOM format, were extracted by Mimics to obtain 3D geometric data, and then meshed separately by Mimics, 3-Matic and ICEM software to establa voxel element model, a tetrahedral element model and 3 hexahedral element model (with element size of 2, 1, 0.5 mm). These meshed models were assigned materials by Mimics, and their mechanical behavior was analyzed by Abaqus eventually. Results For the proximal femur model with material assignment based on CT images, the influence of element size on the total mass of all the 5 models was not significant. The nodal Mises stress and nodal displacement along the same path in 5 models showed a similar tendency, while the Mises stress at each node displayed an obvious deviation. The nodal Mises stress in the hexahedral element model with the element size of 0.5 mm showed accordance with the voxel element model. Conclusions The element size has a small influence on the total mass and nodal displacement when the material assignment is attributed to the model based on CT gray values, while decrease in the element size will affect the materials distributions and stress distributions of the model. When the element size of the proximal femur model is close to its voxel size, the mass distributions and mechanical behavior of the femur can be preferably reflected.

Finite element analysis on anterior and posterior internal fixation for treating type ⅡHangman’s fracture / 医用生物力学

Objective To evaluate biomechanical differences between anterior titanium plate internal fixation and posterior pedicle screw internal fixation for treating type Ⅱ unstable Hangman’s fracture by finite element analysis. Methods An intact finite element model of the upper cervical spine (C0-3) was established and validated, and an unstable model was also established. Two different internal fixation models, i.e. anterior titanium plate+Cage with bone graft (Plate+Cage) and C2 pedicle screws+C3 lateral mass screws (C2PS+C3LMS) were established, respectively, based on the unstable model. The vertical load of 40 N was applied on the occiput to simulate head weight and 1.5 N•m torque was applied on the occiput to simulate loading conditions of flexion, extension, lateral bending and rotation. Range of motion (ROM) of C2-3, force pathway and strain at the fractured line were calculated and analyzed. ResultsCompared with the unstable model, the Plate+Cage model could decrease the ROM by 92.4%, 97.1%, 96.5% and 90.0%, while the C2PS+C3LMS model could decrease the ROM by 88.6%, 90.2%, 95.7% and 90.3%, in flexion, extension, lateral bending and axial rotation, respectively. The maximum stress of the Plate+Cage model was smaller than that of the C2PS+C3LMS model under 4 loading conditions. Conclusions The anterior Plate+Cage fixation possesses better stability than the posterior C2PS+C3LMS fixation in flexion and extension, while both fixation methods show similar stability in lateral bending and axial rotation. The anterior Plate+Cage fixation is more reasonable in structure and stress distributions, and can achieve reduction, decompression, fixation and fusion in one step, thus it is an effective operative procedure for treating typeⅡ Hangman’s fracture.

Immunization of BALB/c mice with Brucella abortus 2308DeltawbkA confers protection against wild-type infection

Brucellosis is a zoonotic disease that causes animal and human diseases. Vaccination is a major measure for prevention of brucellosis, but it is currently not possible to distinguish vaccinated animals from those that have been naturally infected. Therefore, in this study, we constructed the Brucella (B.) abortus 2380 wbkA mutant (2308DeltawbkA) and evaluated its virulence. The survival of 2308DeltawbkA was attenuated in murine macrophage (RAW 264.7) and BALB/c mice, and it induced high protective immunity in mice. The wbkA mutant elicited an anti-Brucella-specific immunoglobulin G response and induced the secretion of gamma interferon. Antibodies to 2308DeltawbkA could be detected in sera from mice, implying the potential for use of this protein as a diagnostic antigen. The WbkA antigen would allow serological differentiation between infected and vaccinated animals. These results suggest that 2308DeltawbkA is a potential attenuated vaccine against 16M. This vaccine will be further evaluated in sheep.

Case-control study on close manipulative reduction combined with minimally invasive percutaneous plate fixation for the treatment of proximal humeral fractures / 中国骨伤

<p><b>OBJECTIVE</b>To compare the clinical effects of close manipulative reduction combined with minimally invasive percutaneous plate fixation(MIPPO) and conventional open reduction and internal fixation (ORIF) for the treatment of proximal humerus fractures.</p><p><b>METHODS</b>From April 2008 to March 2013, among the 75 patients with fractures of proximal humerus, 26 patients were male and 49 patients were female, ranging in age from 22 to 80 years; 18 patients had injuries caused by traffic accident and 57 patients had injuries caused by falling down. According to Neer classification, there were 49 cases of two-part fractures and 26 cases of three-part fractures. All the patients were divided into two groups: MIPPO group and ORIF group. There were 12 males and 21 females in the MIPPO group,including 22 cases of Neer two parts and 11 cases of Neer three parts, who were treated with close manipulative reduction combined with MIPPO. While the other 42 patients were in the ORIF group,including 16 males and 26 females. Among those patients,27 cases belonged to Neer two parts and 15 cases of Neer three parts, who were treated with ORIF. Length of the incision, blood loss, operating time, early postoperative pain(recorded by VAS), neck-shaft angle of proximal humerus and postoperative function of shoulder(recorded by Constant-Murley score, including pain, function, ROM and muscle length) were compared.</p><p><b>RESULTS</b>The mean lengths of incision were (6.74 +/- 0.38) cm in MIPPO group and (16.82 +/- 1.74) cm in ORIF group;blood losses were (110.15 +/- 29.49) ml in MIPPO group and (326.19 +/- 59.71) ml in ORIF group; operation times were (48.60 +/- 10.18) min in MIPPO group and (68.84-16.22) min in ORIF group. VAS of patients in MIPPO group on the 1st and 3rd days postoperatively were lower than those of patients in the ORIF group. The postoperative radiographs verified good position of all screws and satisfactory reduction of bone fracture reduction in both groups. All the patients were followed up,and the durig ranged from 8 to 24 months (mean 14.2 months). In the MIPPO group, there was no humeral head necrosis and all patients gained bone union; while in the ORIF group, 3 patients sustained nonunion and received reoperation for bone grafting, and 2 patients sustained humeral head necrosis. The mean Constant-Murley scores of shoulder were 88.94 +/- 2.57 in the MIPPO group and 86.00 +/- 3.36 in the ORIF group.</p><p><b>CONCLUSION</b>The close manipulative reduction combined with MIPPO is a better choice for fixation of proximal humerus fractures, compared with conventional plate. This method possesses such advantages as a shorter incision, less disturbance of the blood supply and stable fixation of the fracture, allowing early exercise so that the function of shoulder recovers rapidly.</p>

Sonographic features of focal Hashimoto's thyroiditis / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the diagnostic values of gray-scale and color Doppler ultrasound in the diagnosis of focal Hashimoto's thyroiditis (FHT).</p><p><b>METHODS</b>The gray-scale and colour Doppler ultrasound data of 120 patients with histopathologically confirmed FHT were retrospectively studied. The background of thyroid parenchyma was subjectively evaluated as absence or presence of diffuse Hashimoto's thyroiditis. The vascular types of thyroid nodules were determined as follows: hypovascularity, marked internal flow, marked peripheral flow, and focal thyroid inferno.</p><p><b>RESULTS</b>Among all 120 nodules, 71 (59.2%) were located in normal thyroid parenchyma, 49 (40.8%) in the background of diffuse Hashimoto's thyroiditis. In the normal thyroid background, hypoechoic nodules accounted for 85.9% (61/71), and only 14.1% (10/71)nodules were isoechoic or hyperechoic. However, in the background of diffuse Hashimoto's thyroiditis, 40.8% were hypoechoic and 59.2% were isoechoic or hyperechoic. The difference was statistically significant (P<0.001). In terms of the vascular types, the hypovascularity, marked internal flow, marked peripheral flow, and focal thyroid inferno accounted for 45 %, 25.9%, 20.8%, and 8.3%, respectively.</p><p><b>CONCLUSION</b>The "focal inferno" is a relative specific color Doppler feature of FHT.</p>

Clinical diagnosis and surgical treatment of diaphragmatic paralysis in infants with congenital heart disease after cardiac surgery / 中华实用儿科临床杂志

Objective To investigate the clinical manifestations,diagnosis and treatment of diagrammatic paralysis in infants with congenital heart disease (CHD) after cardiac surgery.Methods Thirty-one cases of diaphragmatic paralysis after cardiac surgery were selected from Jan.2006 to Jun.2012,including 23 cases were male and 8 cases were female.The age at operation was 20 days to 25 months,(8.0 ± 5.5) months on the average.The body weight at operation was 3.1-12.2 kg,(6.8 ± 2.3) kg on the average.All children received machine auxiliary breathing,and they had breathing difficulty without the machine.Diaphragmatic plication via 6-8 intercostal was performed under general anesthesia and endotracheal intubation.Lateral position,with uninjured side downward,was taken to perform chest posterolateral incision or chest lateral incision.Relaxing and weak diaphragm muscles were resected or directly sutured after folding.The clinical manifestations and diagnosis of children were summarized,and the effectiveness of diaphragmatic plication was evaluated.Results In 31 cases with diaphragmatic paralysis,there were 15 cases with left diaphragmatic paralysis,12 cases with right diaphragmatic paralysis,and 4 cases with bilateral diaphragmatic paralysis.Thirty-one cases had dyspnea after weaning of ventilator,and 28 cases received reintubation,23 cases with ventilator-as-sociated pneumonia,and 10 cases with tracheotomy.Diaphragmatic plication was performed in 28 cases,and all of them were weaned off ventilator successfully after the placation.The time of preoperative mechanical ventilation lasted 119-827 hours [(447 ± 225) hours],postoperative ventilator assistance time was 12-206 hours [(71 ± 52) hours],which showed significant difference in time of ventilation(P ＜0.05).Conservative treatment was given to the remaining 3 cases,and they were weaned off ventilation successfully with a better recovery.Conclusions Diaphragmatic paralysis in infants after CHD surgery affects their recovery.Diaphragm plication is a safe and effective method to treat the diaphragm paralysis.

Close reduction combined with minimally invasive percutaneous plate osteosynthesis for proximal and distal tibial fractures: a report of 56 patients / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the clinical effects of close reduction combined with minimally invasive percutanous plate osteosynthesis (MIPPO) for proximal and distal tibial fractures.</p><p><b>METHODS</b>From March 2007 to December 2010, 56 patients with proximal and distal tibial fractures were treated with close reduction combined with MIPPO technique. There were 39 males and 17 females,aged from 22 to 67 years with an average of 41.3 years. Left fracture was in 25 cases and right fracture was in 31 cases; proximal tibial fracture was in 15 cases and distal tibial fractures was in 41 cases; 34 cases caused by fall down and 22 cases caused by road accident. The mean time from injury to operation was 1.7 d. Clinical manifestation included pain, swelling of leg with limitation of activity. According to the standard of Johner-Wruhs, clinical effects were evaluated.</p><p><b>RESULTS</b>The mean operative time was 46 min in 56 patients. All fractures obtained satisfactory reduction and the location of plate was good. Incisions healed with one-stage and no superficial or deep infection was found. All the patients were followed up from 8 to 23 months with an average of 14.2 months. Only one fracture complication with delayed union,and after auto grafting with ilium bone,the fracture got union. Other 55 cases obtained bone healing in 15 to 20 weeks after operation and no internal fixation failure was found. The time of walking was 4-6 months after operation,without limping at 7 months after operation. Both lower extremities were symmetrical and the function of knee and ankle got complete recovery. According to the criteria of Johner-Wruhs score,46 cases obtained excellent results,9 good and 2 fair.</p><p><b>CONCLUSION</b>Treatment of proximal and distal tibial fractures with close reduction and MIPPO technique can not only preserve soft tissue,simplify operative procedure and decrease wound, but also can obtain rigid internal fixation and guarantee early function exercises of knee and ankle joints. The method has the advantages of less soft tissue injury, less blood loss, reliable fixation, which is effective method in treating proximal and distal tibial fractures and corresponds with the standpoint of biological fixation.</p>

Clinical results of combined palliative procedures for cyanotic congenital heart defects with intractable hypoplasia of pulmonary arteries / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Congenital heart defects with intractable hypoplasia of the pulmonary arteries without intercourse or with intercourse stenosis is unsuitable for surgical correction or regular palliative procedures. We reported our experience with combined palliative procedures for congenital heart defects with intractable hypoplasia pulmonary arteries.</p><p><b>METHODS</b>From 2001 to 2012, a total of 41 patients with cyanotic congenital heart defects and intractable hypoplasia of the pulmonary arteries underwent surgical procedures. From among them, 31 patients had pulmonary atresia with ventricular septal defect (VSD) and the other 10 cases had complicated congenital heart defects with pulmonary stenosis. Different kinds of palliative procedures were performed according to the morphology of the right and left pulmonary arteries in every patient. If the pulmonary artery was well developed, a Glenn procedure was performed. A modified Blalock-Taussig shunt or modified Waterston shunt was performed if pulmonary arteries were hypoplastic. If the pulmonary arteries were severely hypoplastic, a Melbourne shunt was performed. Systemic pulmonary artery shunts were performed bilaterally in 25 cases. A systemic-pulmonary shunt was performed on one side and a Glenn procedure was performed contralaterally in 16 cases. Major aortopulmonary collateral arteries were unifocalized in six cases, ligated in two cases and interventionally embolized in two cases. There was one early death because of cardiac arrest and the hospital mortality was 2.4%.</p><p><b>RESULTS</b>Five patients suffered from postoperative low cardiac output syndrome, three had perfusion of the lungs, and two pulmonary infections. Systemic pulmonary shunts were repeated after the original operation in three cases due to the occlusion of conduits. The mean follow-up time was 25 months. The pre- and the post-operation left pulmonary indices were (8.13 ± 3.68) vs. (14.9 ± 6.21) mm(2)/m(2). The pre- and post-operation right pulmonary indices were (12.7 ± 8.13) vs. (17.7 ± 7.78) mm(2)/m(2). The pre- and post-operational pulmonary indices were (20.87 ± 9.43) vs. (32.6 ± 11.7) mm(2)/m(2). They were all significantly increased (P < 0.001). The diameter of the pulmonary artery increased after the modified Blalock-Taussig shunt ((5.51 ± 0.94) mm(2)/m(2) pre-operation vs. (7.01 ± 1.97) mm(2)/m(2) post-operation), the modified Waterston shunt ((5.70 ± 3.96) mm(2)/m(2) pre-operation vs. (9.17 ± 3.62) mm(2)/m(2) post-operation) and the Melbourne shunt ((2.17 ± 0.41) mm(2)/m(2) pre-operation vs. (7.35 ± 2.49) mm(2)/m(2) post-operation) (all P < 0.05). Bilateral pulmonary arteries developed well as compared to their pre-operation development. Hemoglobin decreased from (194 ± 27) to (174 ± 24) g/L (P < 0.05) and peripheral oxygen saturation increased from (65 ± 11)% to (84 ± 6)% (P < 0.001). During the follow-up of 27 to 49 months, ultimate complete repair was performed in four cases and one patient underwent a Glenn procedure.</p><p><b>CONCLUSIONS</b>The procedures should be considered on a case to case basis in patients having hypoplasia of the pulmonary arteries with cyanotic congenital heart defects. Combined palliative operations could be an adequate strategic treatment.</p>

Implementing surviving sepsis campaign bundles in China: a prospective cohort study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Surviving sepsis campaign (SSC) bundles have been demonstrated to significantly improve survival in sepsis and septic shock patients worldwide. Compliance with these protocols and resultant mortality in sepsis patients was investigated in intensive care units (ICUs) in China.</p><p><b>METHODS</b>Adult patients with severe sepsis or septic shock treated from September 2007 to October 2008 in 11 ICUs of Chinese teaching hospitals were included. The primary outcome was compliance with resuscitation and management bundles. Secondary outcomes included individual bundle protocol impact and the effects of the completed bundle protocol number on 28-day mortality.</p><p><b>RESULTS</b>Overall compliance during 6-hr resuscitation and 24-hour management bundles were 5.5% and 17.4%, respectively, and 28-day mortality was 33.0%. Compliance with protocols for blood cultures before antibiotics (42.2%), central venous pressure ≥ 8 mmHg (65.9%), central venous oxygen saturation ≥ 70% (25.0%), and optimized glucose control (82.1%), were significantly associated with decreased 28-day mortality (P < 0.05). When adjusted for age, acute organ dysfunction, and APACHE II score, compliance with the blood culture before antibiotics protocol produced the most significant decrease in 28-day mortality (OR, 0.33; 95%CI, 0.16 - 0.70; P = 0.004). Compliance with ≥ 5 protocols in the 6-hour resuscitation bundle was also associated with lower 28-day mortality in septic shock patients (OR, 0.17; 95%CI, 0.06 - 0.54; P = 0.001).</p><p><b>CONCLUSIONS</b>Compliance with resuscitation and management bundles is generally poor in China; however, when applied, 6-hour resuscitation bundle are associated with significant reductions in 28-day mortality for sepsis patients.</p>

Comparative analysis of early and middle outcomes of the arterial switch operation in children with complete transposition of the great arteries with ventricular septal defect and severe pulmonary artery hypertension / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The best age for the arterial switch operation (ASO) in complete transposition of great arteries with ventricular septal defect is usually considered to be within six months. This is because of severe pulmonary arterial hypertension and pulmonary arterial obstructive pathological changes. There are few reports on ASO surgery in children older than three years old.</p><p><b>METHODS</b>We studied 41 children, including 24 males and 17 females, from January 2010 to December 2011. They were divided into three groups by operation age; 15 patients were < 1 year old, 13 were 1 - 3 years old, and 13 were > 3 years old. Associated cardiac abnormalities included patent ductus arteriosus in six cases, atrial septal defect in five cases, and mitral regurgitation in two cases. All the patients had echocardiography before the operation. Seventeen patients underwent a coronary computed tomography examination and five patients underwent right heart catheterization. All ASO surgeries were performed under inhalation anesthesia and hypothermic cardiopulmonary bypass.</p><p><b>RESULTS</b>Three operative deaths occurred. Two were in the < 1 year old group, who died from severe postoperative low cardiac output. The other was two years old and died of postoperative multiple organ failure. There was no significant difference in postoperative mortality and the recent mid-term survival rate among the three groups. Thirty-eight cases were followed up for an average of 11.2 months, ranging 6 - 20 months. One seven years old patient died of acute diarrhea and electrolyte disturbance arrhythmia caused by food poisoning. Three patients more than three years old still had residual pulmonary arterial hypertension.</p><p><b>CONCLUSION</b>Children older than three years old can still undergo the ASO procedure, but residual pulmonary hypertension is present.</p>

Effect of oleic acid-induced acute lung injury and conventional mechanical ventilation on renal function in piglets / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Animal models that demonstrate changes of renal function in response to acute lung injury (ALI) and mechanical ventilation (MV) are few. The present study was performed to examine the effect of ALI induced by oleic acid (OA) in combination with conventional MV strategy on renal function in piglets.</p><p><b>METHODS</b>Twelve Chinese mini-piglets were randomly divided into two groups: the OA group (n = 6), animals were ventilated with a conventional MV strategy of 12 ml/kg and suffered an ALI induced by administration of OA, and the control group (n = 6), animals were ventilated with a protective MV strategy of 6 ml/kg and received the same amount of sterile saline.</p><p><b>RESULTS</b>Six hours after OA injection a severe lung injury and a mild-moderate degree of renal histopathological injury were seen, while no apparent histological abnormalities were observed in the control group. Although we observed an increase in the plasma concentrations of creatinine and urea after ALI, there was no significant difference compared with the control group. Plasma concentrations of neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C increased (5.6 ± 1.3) and (7.4 ± 1.5) times in the OA group compared to baseline values, and were significantly higher than the values in the control group. OA injection in combination with conventional MV strategy resulted in a dramatic aggravation of hemodynamic and blood gas exchange parameters, while these parameters remained stable during the experiment in the control group. The plasma expression of TNF-α and IL-6 in the OA group were significantly higher than that in the control group. Compared with high expression in the lung and renal tissue in the OA group, TNF-α and IL-6 were too low to be detected in the lung and renal tissue in the control group.</p><p><b>CONCLUSIONS</b>OA injection in combination with conventional MV strategy not only resulted in a severe lung injury but also an apparent renal injury. The potential mechanisms involved a cytokine response of TNF-α and IL-6 in plasma, lung and renal tissues.</p>