Objective: To explore the content change of neurofilament (NF) protein subunits in the experimental brain diffuse axonal injury (DAI) by lateral head rotation.Methods: Twenty-four Sprague Dawley (SD) rats were equally divided into three injury groups (2 h, 12 h,and 24 h post injury) and one control group. The models of DAI were made in the injury groups by lateral head rotation. Western blotting technique was used to measure the content of NF68 (a kind of NF protein subunit) in the brainstem tissues among all the injured and control rats.The NF68 immunohistochemical staining was used in another six SD rats in order to observe the morphological changes in DAI.Results: The NF68 content in the brainstem tended to decrease at 2 h post injury, decreased significantly at 12 h and continued its decrease at 24 h. NF56 and NF52, as the breakdown products of NF68, had a tendency to increase at 2-12 h after the injury, and amounted to a significantly higher level at 24 h. Microscopically, there were a lot of swelling neuronal axons in the ventral part of the medullar oblongata at 2 h after the injury. Some axons were disconnected, and axonal retraction balls formed on their proximal end.Conclusions: There is an occurrence of phosphorolysis within the brainstem in DAI by lateral head rotation. These reactions cause the breakdown of NF68,which results in the decrease of NF68 in content. It suggests that the breakdown of neurofilament protein subunits is an important reason for structural destroy of neurofilaments in DAI.

Objective: To elucidate the epidemiological characteristics and to define some preventive strategies for fall injury (FI).Methods: The medical records of patients admitted following a fall from a certain height between August 1996and July 1997 were analyzed retrospectively.Results: A total of 138 patients were assessed, with a mortality of 31.2%. The male-to-female ratio was 3.5: 1.The persons between 20 and 59 years old were the main victims (81.8%), of which 52.2% were related with their work altitude. The remaining adults fall because of,accidents in daily life, suicide attempts, drug abuse,alcohol, or criminal behavior. There were significant differences between the death group and the survival group in the Revised Trauma Score (RTS) and the Injury Severity Score (ISS) value (P ＜0.05 and P ＜0.01, respectively).Six children fall from balconies, open windows or roofs.There were significant differences for the height of fall and RTS value in aged group than those in children,adolescents, and adults (P ＜0.001, 0.005, 0.05; and P ＜0.05, 0.01, 0.05, respectively). The mortality of FI was significantiy correlated to the height of fall (r = 0.897, P ＜0.005).Conclusions: Male adults are the main victims,especially the workers at high altitudes. The mortality of FI is significantly correlated to the height of fall. The preventive strategies developed through analyzing the risk factors of fall in different age groups might reduce the injuries and deaths following fall.

Objective: To assess the relationship between the prognosis of the patients with diffuse traumatic brain swelling (DTBS) and the changes of the ventricles and the cisterns in CT scans.Methods: The outcome of the patients with DTBS and the changes of the ventricles and the cisterns in CT scans were studied and analyzed in a group of 268 cases.We focused on the changes of the third ventricle and the basal cistern, age and Glasgow Coma Scale (GCS).Results: Of 268 cases, there were changes of the third ventricle and/or the basal cistern in 124, 65 died. In 18 cases, the third ventricle and the basal cistern were both absent and 16 died (88.9%). The third ventricle changed significantly in 59 cases, 33 died (55.9%), while the basal cistern changed in 47 cases and 16 died (34%). Of the 124 patients with changes of the third ventricle and/or the basal cistern, 26 were children, 8 died; 98 adults, 57 died.Conclusions: For patients with DTBS, the outcome was in direct correlation with the change of the third ventricle and/or the basal cistern, the change of the third ventricle was much more important in assessment of the outcome than that of basal cisterns. There is no significant difference in, the incidence of DTBS between children and adults while the outcome of children is much better than that of adults. The patients with the changes of the third ventricle and the basal cistern accompanied with lower GCS scores have poor outcome.

Objective: To investigate the morphological characteristics of the bridge tendon grafting in no man’s land to reconstruct the tendon defect and the effect of passive mobilization on it.Methods: A 2 cm defect was made in bilateral flexor digitorum profundus tendons of the middle chicken toes,and was then transplanted to the opposite site to serve as a segmental autograft tendon. Postoperatively, passive mobilization of the left and right middle toes began at 5 and 21 d separately. Specimens were studied by light, scanning and transmission electron microscopy at 5, 10, 21 and 35d.Results: Early repair of the tendon-graft of the left middle toes was made by proliferation and ingrowth of the epitenon cells intermingled with newly-formed collagen fibers. A gliding surface formed at 10 and 21 d. The tendon graft itself played an active role in the repair. In contrast,adhesions obliterated the surface and occupied the space between the tendon graft and surrounding tissues in the right middle toes.Conclusions: It indicates that the use of the segmental bridge tendon graft in no man's land coupled with early passive motion stimulates an intrisic repair process in both the tendon stump and the autogenous tendon graft and results in a functional healing.

Objective: To introduce an operation of subscapularis slide from its origin and anterior release from its insertion for treatment of medial rotation contracture, subluxation and dislocation of the shoulder caused by obstetric brachial plexus palsy (OBPP).Methods: Thirty-six cases with medial rotation contracture of the shoulder were diagnosed by measurement of the inferior glenohumeral angle, passive lateral rotation of the shoulder and plain radiographs. Subscapularis slide was performed in 24 cases with simple medial rotation contracture, and anterior release in 12 cases with complex contracture-medial rotation contracture combined with subluxation, dislocation, or other deformities of the shoulder joint. Systems of Mallet scoring and Gilbert grading for the shoulder were used to evaluate the postoperative shoulder function.Results: With follow up for a minimum of six months, 32 cases got apparent gains from operations,accounting for 88.8% of the total operated on. The younger the child was, the better the result. Of 4 cases with no operative effects, 3 had no flexion of the elbow preoperatively, suggesting a poor recovery of the upper trunk of the brachial plexus; the rest one had no repair of the severed subscapularis tendon.Conclusions: Subscapularis slide and anterior release of the shoulder are effective for treatment of medial rotation contracture as well as its consequence of subluxation and dislocation of the shoulder in OBPP. The operative effect is related to children's age and the recovery extent of the upper trunk of the brachial plexus.

Objective: To study the influence of stress-relaxation plate on disorganization and repair of the cortex beneath the plate.Methods: A washer made of viscoelastic polyethylene was placed between the screw and the screw hole of conventional stainless rigid plate (RP) to produce a stressrelaxation plate (SRP). Both SRP and RP were applied to osteotomized tibia in 48 New Zealand rabbits. Healing process of the fracture with either SRP or RP fixation (control) was comparatively studied with polarized light microscopy, in situ hybridization of collagen mRNA and immunohistochemical technique from 2 to 36 weeks postoperatively.Results: The study of plated bone remodeling showed that the degree of cortex osteoporosis beneath the plate was similar between the SRP and RP group within 12 weeks postoperatively. In comparison, the disorganization of bone structure in SRP group happened later and milder than that of RP group, and the repair process began at 12 weeks after implantation. As a consequence, the absorption cavities became smaller and the structure of collagen fibers became well oriented along with these changes by polarized light microscopy. In addition to these, the in situ hybridization analysis of collagen genes and the immunohistochemical study of type Ⅰ , Ⅲ collagen showed that the osteoblasts lying on the surface of absorption cavities expressed and synthesized type Ⅰ collagen at 8 to 12 weeks after implantation. From this time on, the changes above became more evident significantly before most of cavities were repaired by 36 weeks. In contrast to the changes in the SRP group, no expression and synthesis of any kind of collagen could be observed during 12 to 36 weeks after implantation in RP group.Conclusions: Without removal of the bone plate, the SRP fixation not only reduces the degree of plated bone osteoporosis, but also makes the disorganized bone structure restored to normal in terms of the expression and synthesis of type Ⅰ collagen mRNA of osteoblasts lying on the surface of absorption cavities.

Objective: To evaluate the feasibility of transplanting composite mandibular allografts to repair large mandibular defects.Methods: Three composite mandibular transplantation models were established. The first model consisted of hemimandible with the attached teeth, muscle and skin, and oral mucosa. The second model was transplanted in the same way with the first one excluding oral mucosa and some teeth, and third one excluding the oral mucosa and all dental crowns. Fourteen transplanting operations were performed in canines. Cyclosporine A and methylprednisone were given for immunosuppression.Results: The composite mandibular organs had an effective and closed return circuit. Transplantation of vascularized allograft of mandibular compound organs was feasible. Two longest time survivors of 67 d and 76 d were in the third model group. Cyclosporine A was successful in suppressing rejection of transplanted composite allograft and prolonging survival time of transplantation models.Conclusions: The composite mandibular allografts were available with large block of living composite tissue,and helpful in restoration of appearance and function for severe mandibular defects.

Objective: To evaluate the role of MHC Ⅱ expression in posttrauma immune disturbances and infections.Methods: In experimental study, peritoneal macrophages were harvested from traumatized mice and treated with GM-CSF, Ia molecules were determined by flow cytometry. In 24 trauma patients, monocyte HLA-DR expression was measured by APAAP technique.Results: Marked inhibition of MHC Ⅱ molecule expression was found in both traumatized mice and patients. In traumatic patients with infection, the inhibition was more severe. Treatment with GM-CSF in mice partially restored the Ia expression.Conclusions: Inhibition of MHC Ⅱ molecules plays an important role in postrauma immune disturbances.There is a close relationship between HLA-DR inhibition and clinical infections.

Objective: To elucidate the mechanism of vascular hyporeactivity following severe hemorrhagic shock (HS) by studying the changes of ATP-sensitive potassium channels'(KATP) properties and membrane potential of mesenteric arteriolar smooth muscle cells.Methods: Single channel currents were studied on cell-attached and inside-out patches of enzymatically isolated mesenteric arteriolar smooth muscle cells (ASMCs). Membrane potentials of arteriolar strips and ASMCs were recorded by intracellular membrane potential recording method and confocal microscopy, respectively.Results: KATP channels in ASMCs were activated,which induced smooth muscle hyperpolarization following vsscular hyporeactivity in HS.Conclusions: Hyperpolarizing effect of KATP channel activation plays an important role in low vasoreactivity during severe hemorrhagic shock.

Objective: To analyze the expression of procollagen gene in fracture callus, and to search for the technique of in situ hybridization for undecalcified skeletal tissue.Methods: In situ hybridization of procollagen gene expression was performed on the undecalcified cryosections of rat fracture callus at 7, 14, and 28 d.Results: The hybridization signals achieved were clear and easy to be localized with high specificity. On the 7th day, the expressions of pro α1 ( Ⅲ ) in fibroblasts and some chondrocyte-like cells were dominant; and at the end of second week high expression of type-Ⅱ procollagen mRNA was observed in chondrocytes. At the end of fourth week, the cartilaginous callus was almost all replaced by woven bone tissue, and some type-Ⅰ procollagen mRNA positive osteoblasts and hypertrophic chondrocytes were found scattering in the woven bone and remnants of cartiiaginous callus.Conclusions: The modified method employed in this study is easier, quicker, and more sensitive with high specificity than the conventional technique for in situ hybridization of procollagen gene expression of decalcified rat fracture callus. The phenomenon of shared phenotype expression, which was demonstrated among cells engaged in fracture healing, indicates an important approach to reveal the meehantsm of the origin, differentiation, and orientation of cells.

Objecive: To treat the loss of part of the forearm with a multi-dimension-freedom electronic artificial hand,which is controlled by a reconstructed finger transplanted from the second toe to the forearm stump.Methods: The female patient was 19 years old, whose right hand and wrist were crushed into pieces by machine at work and her forearm was amputated at the level of 8 cm proximal to the wrist. The second toe of her left foot was transplanted to reconstruct the digit onto the stump of her forearm. Two months after the transplantation, the patient was transferred to the rehabilitation center for further rehabilitation training, which consisted of: training for adaptation to weight bearing, testing and training of sensibility to weight. testing and training for stability of the hand, and testing and training for the controlling function of the reconstructed digit.Results: The transplanted toe survived well. After rehabilitation the reconstructed digit functioned well. In testing the performance under control mandate, the accuracy rate of the electronic artificial hand was 100%.Conclusions: A 100% accuracy rate of the electronic artificial hand can be achieved by transplantation of the toe onto the stump of the forearm. It provides a useful pathway and an example for improvement of control accuracy of a multiple-freedom electronic artificial hand and reduction of false action.

Objective: To analyze the principle mechanism of the arcus plantaris and its clinical application.Methods: The states of forces sustained by the arcus plantaris were analyzed and calculated according to the mechanism of the quadratic parabolic arch.Results: The aponeurosis plantaris corresponded to the pull rod of the arcus plantaris. The medial and lateral longitudinal arches formed by the pedal bones were stable with the rod, but unstable without the rod. In the latter condition, on loading, the force sustained by the parabolic arch became a force sustained by a simple beam, and the arcus plantaris tended to disappear and to be flattened.Clinically, 240 feet with talipes equinus were treated with triple arthrodesis. In 34 out of the reexamined 156 feet, the aponeurosis plantaris was cut in addition to the triple arthrodesis and was immobilized with cast for 3 months.One or two years later, their arcus plantaris disappeared,pain developed when walking, and some of them walked with the midtarsai joint against the ground. Then, the triple arthrodesis and shortening of the aponeurosis plantaris were applied on 18 cases, and osteotomy of the calcaneus and reconstruction of the aponeurosis plantaris were made on 10 cases and satisfactory effects were obtained.Conclusions: In order to achieve satisfactory therapeutic effects of the triple arthrodesis, we should reestablish the arcus plantaris and accurately treat the aponeurosis plantaris for the balance of the surrounding muscle force.

Few reports concerning the CT feature of electric shock-induced liver damages have ever been published. This paper presents such a case treated in our Institute.

The failure of using general intramedullary nail or compression plating to treat femoral shaft fracture often causes delayed union or nonunion. Since 1995, we have treated 15 patients with delayed union and nonunion of femoral shaft fracture with interlocked Grosse-Kempf nail. Good results have been obtained.

Steroid-induced femoral head necrosis is claimed to be an ischemic femoral head disease. But there is no discussion on the role of nitric oxide (NO) in the idiopathic disease. The concentration of NO indirectly in serum with steroid induced avascular necrosis of femoral head (ANFH) and in controls are studied in this article.

Bile duct injury caused by abdominal trauma,usually accompanied with injuries of other abdominal organs, is rarely seen. For the reason of its complexity and often delayed diagnosis and treatment, bile duct injury usually leads to severe complications such as abdominal infection. This paper reports a group of 10 cases of bile duct injury treated in our center in the recent decade.