2009年 · 第12卷第04期

Abstract：Objective: To promote stem cells differentiation into neurons and enhance neuromotor function after brain in-jury through brain-derived neurotrophic factor (BDNF) induction.Methods: Recombinant adenovirus vector was ap-plied to the transfection of BDNF into human-derived um-bilical cord mesenchymal stem cells (UCMSCs). Enzyme linked immunosorbent assay (ELISA) was used to deter-mine the secretion phase of BDNF. The brain injury model of athymic mice induced by hydraulic pressure percussion was established for transplantation of stem cells into the edge of injury site. Nerve function scores were obtained, and the expression level of transfected and non-transfected BDNF, proportion of neuron specific enolase (NSE) andglial fibrillary acidic protein (GFAP), and the number of apoptosis cells were compared respectively. Results: The BDNF expression achieved its stabiliza-tion at a high level 72 hours after gene transfection. The mouse obtained a better score of nerve function, and the proportion of the NSE-positive cells increased significantly (P<0.05), but GFAP-positive cells decreased in BDNF-UCMSCs group compared with the other two groups (P<0.05). At the site of high expression of BDNF, the number of apoptosis cells decreased markedly.Conclusion: BDNF gene can promote the differentia-tion of the stem cells into neurons rather than gliai cells, and enhance neuromotor function after brain injury.

Abstract：Objective: To analyze the crash and injury data in forensic medicine for years of 2004-2007. Methods: A sample of over 567 accident cases (9 pedestrians, 116 bicyclists, and 442 motor vehicle occupants) was considered from the Department of Foren-sic Medicine, Shahid Bahonar University of Kerman, in-volving drivers of all ages and covering a four-year period.Results: The male fatality rates were significantly higher than female ones. The groups at 15-30 years old and at 30-55 years old had the first and second highest numbers of deaths (40% and 34%, respectively). There were sub-stantial differences in distribution of injuries in motor ve-hicle occupants and pedestrians and bicyclists. Among motor vehicle occupants, there were more head injuries, such as skull fracture, brain contusion, subdural haemorrhage, and epidural haemorrhage. Nearly 77% of fatalities occurred during 08:00-22:00 in Sirjan. Internal bleeding was also higher in motor vehicle occupants. Pedestrians and bicyclists also had head injuries frequently.Conclusions: In spite of reduction of road traffic fatali-ties in Sirjan in 2007, it is still one of the cities with high road traffic fatality in the world. These results underline the im-portance of preventive strategies in transportation, sug-gesting that different methods are necessary to reduce fa-talities of various traffic participants.

Abstract：Objective: To explore the relationship between dis-seminated intravascular coagulation (DIC) and levels of plasma thrombinogen segment 1+2 (F1+2), D-dimer (D-D), and thrombomodulin (TM) in patients with severe multiple injuries.Methods: In this study, 66 patients (49 males and 17 females, aged 15-74 years, mean=38.4 years) with multiple injuries, who were admitted to our hospital within 24 hours after injury with no personal or family history of hematopathy or coagulopathy, were divided into a minor injury group (ISS<16, n=21) and a major injury group (ISS>≥16, n=45) according to the injury severity. The patients in the major injury group were divided into a subgroup complicated with DIC (DIC subgroup, n=12) and a subgroup compli-cated with no DIC (non-DIC subgroup, n=33). Ten healthy people (7 males and 3 females, aged 22-61 years, mean=36.5 years±9.0 years), who received somatoscopy and diagnosed as healthy, served as the control group. Venous blood samples were collected once in the control group and 1, 3 and 7 days after trauma in the injury groups. The F1+2 and TM concentrations were determined by enzyme linked immunosorbent assay (ELISA), and D-D concentrations were measured by automated latex enhanced immunoassay. Results: F1+2, D-D and TM levels were higher in the minor and major injury groups than in the control group.They were markedly higher in the major injury group than in the minor injury group. In the non-DIC subgroup, F1+2 levels declined gradually while D-D and TM levels declined continuously. In the DIC subgroup, F1+2 and D-D levels remained elevated while TM levels exhibited an early rise and subsequent decrease. Plasma F1+2, D-D and TM levels were higher in the DIC patients than in the non-DIC patients. Injury-induced increases in F1+2, D-D and TM plasma lev-els had significant positive correlation with each other at each time point.Conclusions: Besides being related to trauma severity, F1+2, D-D and TM levels correlate closely with the occur-rence of posttraumatic DIC. Therefore, changes in plasma F1+2, D-D and TM levels may predict the occurrence of DIC.

Abstract：Objective: To distinguish trochlear calcification and intraorbital foreign body after eye injury in order to avoid misdiagnosis as well as mistreatment. Methods: The orbital CT images of 403 patients, who visited the Eye Hospital or the Second Affiliated Hospital of Wenzhou Medical College during May 2005-April 2007, were reviewed. The diagnosis of trochlear calcification and in-traorbital foreign body was made together by a skilled radi-ologist as well as an ophthalmologist. General information and CT characteristics in the patients with trochlear calcifi-cation were collected.Results: Using CT scan images, 27 among 403 pa-tients (6.69%) were identified with trochlear calcification. Three patients (3/27, 11.11%) were misdiagnosed by radi-ologists as intraorbital foreign body. Among the 27 patients with trochlear calcification, 23 (85.19%) were male and 4 (14.81%)were female, with an unilateral calcification in 7 patients (7/27, 25.93%) and bilateral in 20(74.07%). The highest occurrence of trochlear calcification was in 31-40 years old group (13/403, 3.23%) which reached to 12.87% (13/101) after age-correction. There were 3 types of trochlear calcification on the basis of CT images: commas, dot and inverted "U".Conclusions: The trochlear calcification is not an un-common phenomenon and should not be diagnosed as in-traorbital foreign body, especially when it co-exists with eye injury in 31-40 years old group. Injury history and our classification method on the basis of CT images could help to avoid misdiagnosis.

Abstract：Objective: To provide a new method in the fixation of sacral fracture by means of three-dimensional reconstruc-tion and reverse engineering technique.Methods: Pelvis image data were obtained from three-dimensional CT scan in patients with sacral fracture. The data were transferred into a computer workstation. The three-dimensional models of pelvis were reconstructed using Amira 3.1 software and saved in STL format. Then the three-dimensional fracture models were imported into Imageware 9.0 software. Different situations of reduction (total reduction, half reduction and non-reduction) were simulated using Imageware 9.0 software. The best direction and loca-tion of extract iliosacral lag screws were defined using re-verse engineering according to these three situations and navigation templates were designed according to the ana-tomic features of the postero-iliac part and the channel. The exact navigational template was made by rapid prototyping.Drill guides were sterilized and used intraoperatively to as-sist in surgical navigation and the placement of iliosacral lag screws.Results: Accurate screw placement was confirmed with postoperative X-ray and CT scanning. The navigation template was found to be highly accurate. Conclusion: The navigation template may be a useful method in minimal-invasive fixation of sacroiliac joint fracture.

Abstract：Objective: To review the operative technique of tre-phine arthrodesis of subtalar joints and evaluate its clinical effect.Methods: From June 1998 to October 2006, we per-formed subtalar arthrodesis on 38 feet of 34 patients for a variety of painful disorders of hindfoot with trephine technique. Clinical and radiologic follow-up evaluations were performed for 45 months on average (range, 21 to 110 months) after arthrodesis.Results: No severe complications were found in this study except one patient with dropfoot and two with skin necrosis. The average anlde-hindfoot scores of the American Orthopaedic Foot and Ankle Society (AOFAS) was improved from 48.3 preoperatively to 79.2 postoperatively (P<0.05). The pain scores of visual analogue scales (VAS) decreased from 7.2 (range, 3 to 10) preoperatively to 2.6 (range,1 to 6) post-operatively (P<0.05). Subjectively, the patients experienced improvements in pain, function, cosmesis, and shoewearing.Overall, 30 patients were satisfied and all patients would have this procedure again under similar circumstances. Post-operative radiology showed that complete union was found in 35 feet 6 months after operation, with the successful union rate of 92.1%. There was an increase in arthritic scores for 5 ankles, 4 talonavieular joints, 4 calcaneocuboid joints, and 4 midfoot joints. Nonunion occurred in 3 subtalar joints with anterolaterai approach, which required revision arthrodesis.Conclusion: Isolated subtalar arthrodesis with tre-phine method is an effective procedure for painful malalignment of hindfoot.

Abstract：Objective: To investigate the adjuvant effect of intra-operative and postoperative low-dose ketamine administra-tion to remifentanil consumption in patient-controlled anal-gesia (PCA) for lower limb fracture.Methods: A total of 200 patients with lower limb frac-ture receiving the surgery were randomly divided into 4 groups. In Groups A, B and C, patients received 0.5 mg/kgketamine infusion under general anesthesia, and ketamine in a dose of 0.1 mg/kg, 0.05 mg/kg, 0.01 mg/kg per hour continuously for 24 hours after surgery, respectively. The control group (Group D) received an equivalent volume of normal saline only. With 20 μg/ml remifentanil in normal saline, postoperative PCA was administered with a back-ground infusion at 2 ml/h following 2 ml as a loading dose and 1 ml demand dose with a 3-minute lockout period. Remifentanil consumption, 11-point visual analog scale (VAS) scores, global satisfaction score (GSS), and side ef-fects were also recorded by the acute pain service. Results: Cumulative PCA remifentanil consumption in Groups A and B were (1378±377) μg and (1531±402) μg,significantly lower than (1807±510) μg and (1838±523) μg in Groups C and D (P<0.01). VAS scores in Groups A and B were significantly lower than those in Groups C and D (P<0.01). In the first 12 hours after operation, GSS was improved (P<0.01). No respiratory depression was observed. No significant dif-ference in side effects was observed among groups. Conclusion: Low-dose ketamine can relieve postop-erative pain and moderately decrease remifentanil consump-tion for PCA, with no obvious side effects of ketamine.

Skin necrosis from inadvertent extravasation in sur-rounding soft tissues is a rare but not uncommon com-plication of Vinorelbine tartrate, a cytotoxic chemothera-peutic drug widely used intravenously in the treatment of malignant diseases.1,2

B lood loss due to abdominal wall hemorrhage is generally managed conservatively. Further, abdominal wall hemorrhage rarely develops into a life-threatening condition. However, it is difficult to sur-gically achieve hemostasis. We report the case of a liver cirrhosis patient with life-threatening abdominal wall hemorrhage that developed as a result of a minor trauma and was successfully treated with arterial embolization (AE)。

Persistent trigeminal artery (PTA) is a rare abnor-mal vascular anastomosis connecting the internal ca-rotid artery (ICA) with the vertebrobasilar artery. The incidence is 0.1%-0.6% in adult cerebral angiography.1,2 We have recently treated a rare case of post-traumatic PTA-cavemous fistula. In this study, we discussed the mechanisms and treatment of this disease by review-ing literature。

Abstract：Acute respiratory distress syndrome (ARDS) remains a poor prognosis in spite of the recent development of new therapeutic strategies. Cell-based therapy with stem cells has been considered as a promising way for the treatment of vital organ damage. Putative endogenous stem cells have been shown to be located within the adult lung in the basal layer of the upper airways, within or near pulmonary neu-roendocrine cell rests, at the bronchoalveolar junction, as well as within the alveolar epithelium. These stem cells are hypothesized to be the source of lung regeneration and repair. But this mechanism seems to be insufficient after lung injury. There is increasing excitement over the last few years with the suggestion that exogenous stem cells may offer new treatment options for ARDS. Exogenous stem cells have the abihty to differentiate and function as both airway and lung parenchymal epithelial cells in both in vitro and in-creasingly in vivo experiments. However, there is great con-troversy concerning the repair effect of adult stem cells in lung injury. This review evaluates the advances in endog-enous respiratory stem cells, and assesses the evidence for the use of stem cells in the repair of lung injury。

Abstract：Splintage external fixation in Chinese Mongolian oste-opathy is a biological macroscopic model. In this model, the ideas of self-life "unity of mind and body" and vital natural "correspondence of nature and human" combine the physi-ological and psychological self-fixation with supplementary external fixation of fracture using small splints. This model implies macroscopic ideas of uncovering fixation and healing: structural stability integrating geometrical "dy-namic" stability with mechanical "dynamic" equilibrium and the stability of state integrating statics with dynamics, and osteoblasts with osteoclasts, and psychological stability in-tegrating closed and open systems of human and nature. These ideas indicate a trend of development in modem osteopathy。

Abstract：Patients who are diagnosed with acute lung injury/acute respiratory distress syndrome (ALI/ARDS) usually have ventilation-perfusion mismatch, severe decrease in lung capacity, and gas exchange abnormalities. Health care work-ers have implemented various strategies in an attempt to compensate for these pathological alterations. By rotating patients with ALI/ARDS between the supine and prone position, it is possible to achieve a significant improvement in PaO2/FiO2, decrease shunting and therefore improve oxy-genation without use of expensive, invasive and experimen-tal procedures。

Abstract：Chinese surgery journals are of small international im-pact which does not measure up to the state of develop-ment of surgery in China and they can not adequately pub-lish Chinese researches to the world. To improve the visibil-ity of Chinese surgery journals, this article suggests devel-oping more English surgery journals, extending a co-opera-tion with famous publishers, employing overseas experts as editorial committee and making more use of the lnternet。