Objective To analyze the features of hidden blood loss in the elderly femoral intertrochanteric fractures treated with extramedullary dynamic hip screw (DHS), intramedullary nails (Gamma 3, PFN) and hip arthroplasty (LBFH). Methods The clinicle records of 193 elderly patients (ages ≥75 year old) with femoral intertrochanteric fractures treat by DHS,Gamma3, PFNA and LBFH in our hospital were retrospectively analyzed. The estimated blood loss were calculated by Gross equation, according to the height,weight and changes of blood routine test reoperative and postoperative,the differences of hidden blood loss among DHS group,Gamma 3 group, PFN group and LBFH group were compared. Results Total blood loss in intramedullary nail groups were significantly higher than DHS group [(766 ± 83) mL],P < 0.05). No significant difference was found between PFN group [(887 ± 75) mL] and Gamma 3 group [(903 ± 91) mL] (P > 0.05), The hidden blood loss were significantly higher in the intramedullary nail groups than those in the LBFH group [(453 ± 98) mL,accounting 54%] and DHS group [(429 ± 59) mL,accounting 56%] (P < 0.05). No significant difference of hidden blood loss was found between Gamma 3 group [(742 ± 137) mL, accounting 82%] and PFN group [(711 ± 153) mL,accounting 80%], (P > 0.05). Conclusion Noteworthy, the hidden blood loss is major part of perioperative total blood loss in the elderly femoral intertrochanteric fractures , intramedullary fixations may result in greater hidden blood loss than extramedullary fixations and hip arthroplasty ,which may cause postoperative anemia.

ObjectiveTo explore the association between air pollutants and hospital outpatient visits in a district of Shanghai. MethodsDaily meteorological data， environmental data， data of outpatient visits to two secondary hospitals and two tertiary hospitals in this district from January 1， 2015 to December 31， 2019 were collected. A Poisson regression generalized linear model was used to analyze the exposure-response relationship between the air pollutants and hospital outpatient visits in this area. ResultsDuring the study period， the total number of outpatient visits in the included hospitals was 17 802 634， with an average daily total of （9 750±4 191） outpatient visits，and an average daily of （761±341） respiratory outpatient visits. In the lag effect of single pollutant model， when the concentration of air pollutant increased by 10 μg·m^-3， PM_2.5， SO₂， NO₂ had the maximum lag effect on the number of outpatient visits in the department of internal medicine for respiratory diseases on lag day 4， day 5 and day 7， respectively. And the RR values and 95%CI were 1.002 0（1.001 3‒1.002 6）， 1.0154（1.012 3‒1.018 5）， and 1.006 1（1.005 3‒1.006 9）， respectively. ConclusionThere is a exposure-response relationship between air pollutants and the number of outpatient visits in each department of the hospitals， and different pollutants have different degrees of lag effects.

OBJECTIVETo explore the effect of postoperative initial neck stem angle on the treatment of proximal humeral fractures with locking plate.

METHODSFrom June 2014 to Septembetr 2016, 62 patients with proximal humeral fractures underwent internal fixation with locking plates were retrospectively analyzed, including 29 males and 33 females with an average age of(55.95±9.48) years old ranging from 34 to 74 years old. According to the difference of the initial neck stem angle, the patients were divided into three groups, 15 patients in the varus group had less than 127° postoperative initial neck-shaft angle, 36 patients in the normal group had 127° to 145° postoperative initial neck-shaft angle, 11 patients in the valgus group had more than 145° postoperative initial neck-shaft angle. The operating time, fracture healing time, complications, the visual analogue scale(VAS) and shoulder functional Neer scores among three groups were compared for analysis.

RESULTSAll 62 patients were followed up for 17.2 months(ranged 12 to 38 months). Operative time, fracture healing time and VAS were(2.37±0.59) hours, (3.99±0.48) months and(3.67±2.02) points in the varus group;(2.60±0.49) hours, (3.78±0.49) months and(3.22±2.06) points in the normal group;(2.75±0.39) hours, (3.82±0.42) months and (4.09±1.58) points in the valgus group. There was no statistical difference in operating time, fracture healing time and VAS among these groups(>0.05). The Neer score(87.14±6.48) in the normal group and(84.31±9.05) in the valgus group was significantly better than(75.93±9.77) in the varus group (<0.05). Among them, 4 cases occurred complications in the varus group;2 cases in the normal group;while no complication occurred in the valgus group.

CONCLUSIONSThe internal fixation with locking plates of the proximal humerus fractures with postoperative initial neck-shaft angle more than 127° can reduce complications, improve shoulder function and allow for better postoperative outcome.

Aged ; Anesthesia ; methods ; Bone Plates ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Tibial Fractures ; surgery

Objective To explore the clinical significance and operational methods during extended radical excision for pancreatic cancer combined with portal vein ( PV )/superior mesentery vein ( SMV ) resection,and to investigate the management of iatrogenic arterial injury. Methods Clinical date of 242 patients with pancreatic cancer undergoing extended radical excision were retrospectively analyzed. All cases were divided into three groups, patients with PV/SMV resection were in group A (n = 51 ), patients with iatrogenic arterial injury during operation were in group B(n =5) ,patients without resection of vessels werein group C (n = 186 ). Operating time、volume of intraoperative blood transfusion, time of vascular interruption、the mean hospitalization,postoperative complications and postoperative survival analysis among three groups were compared with each other. Results Operating time in group A、B and C were (442. 85 ± 102. 32 ) min, ( 348. 62 ± 92. 31 ) min and ( 315.00 ± 83.43 ) min respectively, volume of intraoperative blood transfusion were ( 1430. 83 ± 1092. 43 ) ml、( 1420. 22 ± 794. 41 ) ml and ( 928. 19 ±571.57) ml respectively,operating time and volume of intraoperative blood transfusion were of significantly difference(P <0. 05) among the 3 groups,there was no significant difference in the mean hospitalization and postoperative complications. The postoperative median survival period was 18.4 months for patients of pancreatic adenocarcinoma with PV/SMV resection, the postoperative median survival period was 16. 1 months without PV/SMV resection, there was no significant difference between these by postoperative survival analysis. In the 51 cases with vessel resection,7 cases underwent partial resection of the vascular wall,44 cases underwent segmental resection, reconstruction of the portal vein was performed by end-to-end anastomosis in 38 patients, stent graft in 6 cases, the mean length of the PV/SMV resection was (2. 92 ±1.35 ) cm; latrngenic arterial injury occurred during operation in 5 patients ( 1 in hepatic artery, 1 in superior mesenteric artery, 3 in celiac think), the artery was reconstructed by end-to-end anastomosis in 4 cases,repair in 1 case. Conclusions Active and reasonable operation for pancreatic cancer with PV/SMV resection is important for improving the rate of surgical resection and the quality of life. Because of complex topography,iatrogenic vascular injury may happened frequently.

Objective To explore the composition and distribution of metal and metalloids in fine particulate metter in a certain area of Shanghai through four consecutive years of dynamic monitoring. Methods The sampling point was on the roof of a community health service center in Shanghai, with a height of 12.5 meters.In the four winters of 2014-2017 from Dec. to Feb. next year, samples were continuously collected for 7 days(from 10^th to 16^th) a month and 22 hours for each day.Inductively coupled plasma-mass spectrometry (ICP-MS) was used for the determination of metals and metalloids in collected samples. Results The pairwise comparisons between the total metals, Al, Be, Cr, Hg, Pb, Mn, Ni, Se and Tl in any two years were statistically different through the rank sum test.In the Cochran-Armitage trend test, Al showed an upward trend in the whole periods, while Cr, Pb and Ni was on a downward trend.In factor analysis, factor 1 in each year had relatively stable component elements (As, Cd, Pb, Mn, Se), while the internal components of the remaining factors were relatively unstable. Conclusions There may be relatively stable sources of pollution locally.Al, Cr, Pb and Ni have a significant tendency to increase or decrease.

The ripe dried fruit of citron(Citrus medica) is one of the important sources of Chinese herb Citri Fructus. At the same time, it is also grown for edible and ornamental uses. There are many species and abundant genetic variation. To clarify the intraspecific variation and resource distribution of citron, this study investigated the variation in 11 citron fruits, basically covering the main species in China, including Xiaoguo citron(C. medica var. ethrog), Goucheng(C. medica var. yunnanensis), Muli citron(C.medica var. muliensis), Dehong citron(C.medica×Citrus spp.), Fuzhou citron(C.medica×C.grandis?), Mawu(C.medica×C.grandis?), Cangyuan citron, Binchuan citron, Sweet citron, Big citron, and Small citron. The natural communities of citron were proved to be mainly distributed in the southwestern and western Yunnan and southeastern Tibet of China, with Yunnan, Sichuan, Guangxi, Chongqing, Hubei, and Zhejiang identified as the main production areas. Citron has also been widely grown in India, the Mediterranean region, and the Caribbean coast countries. The field investigation revealed the large-scale intraspecific variation of citron fruits. Most of the fruits are oval-like or sphere-like in shape. The fruits are green when raw and yellow when ripe, with oil cell dots on the skin, stripe-likes running from top to bottom, and bulge at the top. Usually, in the smaller citron fruits, the pulp and juice vesicles are better developed and the central columella is tighter. By contrast, the juice vesicles and central columella in larger fruits became more vacant, with carpels visible, and the apex segregation and development of the carpels is one of the reasons for variation. These variations should be given top priority in the future variety selection and breeding, and the quality differences of different citron species and their mechanisms should be further studied. In particular, variety selection and classification management according to their medicinal or edible purposes will provide scientific and technological supports for the orderly, safe, and effective production of citron products consumed as food and medicine.
China ; Citrus ; Fruit ; Taste ; Tibet

OBJECTIVETo evaluate the efficacy and safety of 100 mg/2 hours recombinant tissue-type plasminogen activator (rt-PA) regimen for treating patients with acute pulmonary thromboembolism (PE) by observing long-term clinical outcome including recurrent pulmonary embolism, chronic thromboembolic pulmonary hypertension (CTEPH) and other complications.

METHODSData of 43 consecutive patients with acute high-risk and intermediate-risk PE treated with intravenous rt-PA (100 mg/2 hours) were prospectively analyzed. Median follow-up post-thrombolysis was (15.6 ± 11.4) months. The endpoints of the study were PE recurrence, death related to PE and onset CTEPH.

RESULTSAfter rt-PA therapy, pulse pressure increased [(46.7 ± 9.5) mm Hg(1 mm Hg = 0.133 kPa)vs. (41.9 ± 11.3) mm Hg, P = 0.007], heart rate and respiratory rate decreased [(84.2 ± 14.7) bpm vs.(93.3 ± 17.7) bpm, P < 0.001; (20.2 ± 2.4) bpm vs. (23.2 ± 4.1) bpm, P < 0.001, respectively], tricuspid annular plane systolic excursion increased [(18.7 ± 3.1) mm vs. (15.9 ± 3.9) mm, P < 0.001] and right ventricle transverse diameter [(34.0 ± 3.6) mm vs. (36.8 ± 4.4) mm, P < 0.001]. PO2, SO2 and P(A-a)O2 improved [ (87.9 ± 17.8) mm Hg vs. (73.4 ± 20.1) mm Hg, P < 0.001; 96.6% ± 2.4% vs. 92.5% ± 6.3%, P < 0.001; 29.9 (12.3, 55.1) mm Hg vs. 52.1(31.5, 76.3) mm Hg, P = 0.014, respectively], D-dimer and NT-proBNP levels significant reduced (P < 0.001). Mortality rate related to PE was 6.9% (4/43) and there was no patient developed CTEPH during follow up.

CONCLUSIONThe 100 mg/2 hours rt-PA regimen is effective to treat acute PE patients and could improve right heart function and outcome in patients with acute PE.

Acute Disease ; Adult ; Aged ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Prospective Studies ; Pulmonary Embolism ; drug therapy ; Recombinant Proteins ; administration & dosage ; Thrombolytic Therapy ; Tissue Plasminogen Activator ; administration & dosage ; Treatment Outcome

Objective To explore the feasibility of anterior cervical decompression assisted with the microscope and mobile microendoscopic discectomy (MMED),and to compare their clinical efficacy.Methods From May 2015 to February 2017,thirty patients with cervical spondylotic myelopathy (CSM) underwent anterior cervical decompression assisted with microscope or MMED.Among them,conventional transverse anterior cervical incisions were used,and intervertebral distractors were placed in order to complete the decompression,then the fusion and fixation procedure were conducted under direct vision,and the operative time and intraoperative blood loss were recorded.Of 30 cases,15 cases were in microscope cohort (anterior cervical discectomy and fusion,ACDF 12 cases;anterior cervical corpectomy and fusion,ACCF 3 cases),including 4 males and 11 females with a mean age of 54.00±11.10 years (range,32-71 years).Another 15 cases were in MMED cohort (ACDF 13 cases,ACCF 2 cases),including 9 males and 6 females with a mean age of 59.60± 11.10 years (range,39-73 years).Neurological and cervical function were evaluated before surgery and at the follow-up according to the Japanese Orthopaedic Association (JOA) and the neck disability index (NDI) scores,and the neurologic improvement grade (NIG) was used to evaluate the neurological function.Results Both the microscope and MMED cohort underwent decompression successfully,and the visual field was clear.No neurological symptoms became worse.For the microscope,its lens and the instrument had to be adjusted separately,whereas MMED lens could move synchronously with the instrument.It was easier for MMED to reveal the posterior edge of the vertebral body and the left and right side of the spinal canal.The operation time of the microscope cohort was 90-180 min,with an average of 124.67±36.42 min;the M MED cohort was operated for 80-130 min with an average of 110.00± 15.12 min,and there was no significant difference between the two cohorts (t=1.440,P=0.161).The intraoperative blood loss for microscope cohort was 20-200 ml,with an average of 66.00±49.11 ml;MMED cohort was 30-150 ml with an average of 60.00±35.25 ml;there was no significant difference between the two cohorts (t=0.384,P=0.704).The JOA score of the microsurgery cohort improved from 8.67±3.20 preoperatively to 15.93± 1.53 at the latest follow-up,and its difference was significant (t=8.687,P=0.000).According to NIG,neurological improvement was excellent in 12 cases and good in 3 cases,giving an excellent to good rate of 100％.NDI was reduced from 18.00％±9.75％ preoperatively to 5.93％±2.58％ at the latest follow-up,with significant difference (t=5.137,P=0.000).The JOA score in MMED cohort improved from 8.87±3.11 preoperatively to 15.53±1.69 at the latest follow-up,and its difference was significant (t=9.413,P=0.000).and Among these 15 patients,11 were excellent and 4 were good,giving an excellent-good rate 100％.NDI decreased from 17.13％± 8.00％ preoperatively to 5.80％±2.43％ at the latest follow-up,and its difference was significant (t=5.592,P=0.000).There was no significant difference in JOA (t=0.680,P=0.502),NIG (P=1.000) and NDI (t=0.146,P=0.885) between the two cohorts at the latest follow-up.Conclusion Both microscope and MMED could provide a clear and magnified field of view,which was beneficial for adequate decompression during the anterior cervical surgery to ensure better clinical results.Compare to the microscope,MMED has relatively narrow indications and steep learning curve,so the surgeon should select cases strictly.

Objective: To investigate the relationship between monokine induced by interferon⁃gamma (MIG) level and coronary slow flow phenomenon ( CSFP) . Methods: 80 patients diagnosed with CSFP and 54 patients with normal CAG were selected as the CSFP group and no⁃CSFP group respectively in this study. Coronary slow flow was determined quantitatively by thrombolysis in myocardial infarction (TIMI) frame count (TFC) method. The clinical characteristics and biochemical indexes , including serum CD40L and Interferon⁃γ (IFN⁃γ) , monokine induced by interferon⁃gamma (MIG) levels were measured , and the relationship between interferon⁃γ induced monocyte level and CSFP were analyzed. Results: The serum levels of CD40L , IFN⁃γand MIG in the CSFP group were higher than those in the no⁃CSFP group ( P = 0. 001) . The MIG levels were positive correlated with mean TFC ( r =0. 879 ,P = 0. 009) . Multivariate logistic regression analysis showed that MIG was an important risk factor for CSFP (β = 0. 874 ,P = 0. 011) . The ROC curve analyses indicated that the MIG levels had diagnostic value in patients with CSFP , the area under the curve ( AUC) was 0. 793 , the sensitivity was 0. 79% and the specificity was 76. 0% , and 95% CI 0. 714 - 0. 872. Conclusion Chemokine CD40L , IFN⁃ γ and MIG may be involved in the process of vascular inflammation and arteriosclerosis. MIG is an important influencing factor of CSFP and participated in the occurrence and development of CSFP.