Objective To analyze the fracture characteristics, operative indicators, complications and treatment results of intertrochanteric fractures of femur in over 80 years old cases. Methods A total of 87 cases (90 hips) of intertrochanteric fractures with mean age over 80 years treated with operative methods from October 1996 to October 2004 were reviewed upon fracture types, preoperative primary diseases, operative methods and postoperative complications. Results The average age was 83.5 years. Of all, 74 cases had different physical diseases included cardiovascular, cerebrovascular, respiratory, digestive system and others (average 2.4 diseases per person). Treatment methods included DHS and intramedullary interlocking nail such as Gamma nail, PFN and reconstructive nails. A follow up for six months in 63 cases showed that excellence rate of functional evaluation was 84%(53/63). Conclusions The full evaluation and treatment of preoperative diseases are the prerequisite for the intertrochanteric fractures in the elderly, for the intertrochanteric fractures in the elderly have high incidence and many preoperative diseases and severe complications.

Objective To investigate the accuracy of 64-detector helical CT in assessing stenoses of coronary arteries. Methods 64-detector helical CT angiography was performed in 128 patients with suspected coronary artery disease,and the results were compared with that of invasive coronary angiography. Results Among 128 patients, 1 724 of 1 920 coronary artery segments were assessable (90%). Overall sensitivity for classifying stenoses was 92%, specificity was 94%, positive predictive value was 82%, and negative predictive value was 96%.Conclusion 64-detector helical CT provides a high diagnostic accuracy in assessing coronary artery stenoses.

Objective: In order to popularize the use of interlocking nail, the authors reviewed 81 femoral shaft fractures in 80 patients who were treated with interlocking nail from July 1988 to October 1997. Material and Method: There are 60 males and 20 females. Forty-one fractures were of left femur and 40 of right. The average age was 33 years(range 15-79 years) . Results: The results showed that 60 cases of fractures that followed up over half a year had bony union. The complications included one bone union failure due to incorrect indication. two fractures during the operation, misinserting the proximal screw in 2, and misinserting the distal screw in 3, lengthening of the extremity in 2, valgus knee in 2, deep infection in 1, delayed infection in 1, nail broken in 3, proximal screw broken in 1, distal screw broken in 1, distal screw loosening in 2. Conclusion: 1) The indication must be correctly chosen. 2) Well-trained operative technique for interlocking nail is necessary to reduce the compli cation. 3 )The patient with old or comminuted fracture fixed with G - K nail should properly delay the time to start weight bearing.

Objective To investigate the change on monoamine neurotransmitter in cerebral cortex motor area of traumatic asphyxia canines and provide scientific basis for its therapy.Methods The model of canine traumatic asphyxia was established,the change on monoamine neurotransmitter in cerebral cortex (motor area) and the products of metabolism during different time were tested with HPLC DC method.Results At 2 h after damage in cerebral cortex 5 hydroxyindolecetic acid (5 HIAA) elevated remarkably; At 8 h after da mage 5 hydroxytryptamine (5 HT), homovanillic acid (HVA) elevated; but there was no obvious change on norepinephrine(NE) and 3,4 dihydroxyphenyl acetic acid (DOPAC).Conclusion The monoamine neurotransmitters might play an important role in the pathological course of secondary brain injury after traumatic asphyxia.The utilization of 5 HT antagonists or compound inhibitor at early stage was a reliable method for treating brain injury after traumatic asphyxia.

Objective To observe the clinical efficacy of relatively proximal humeral locking compression plate( LPHP) with the traditional plate for treatment of proximal humeral fractures .Methods The proximal humeral fractures in patients with 58 cases,the patients were divided into two groups ,the treatment group of 32 cases of locking compression plate in the treatment of T plate ,clover plate in the treatment of 26 patients of the control group received traditional.According to the Neer score compared with two groups of patients with postoperative recovery and compli -cations.Results All the 58 patients for 11 ~15 months of follow-up,the treatment group found no fracture ,fracture nonunion,screw and plate humeral head necrosis ,4 cases of shoulder pain was limited;15 cases of excellent score Neer function,good in 12 cases,5 cases,the excellent and good rate was 84.4%.The control group had 3 cases,2 ca-ses of screw loosening of plate fracture ,3 cases of nonunion ,2 cases of humeral head necrosis ,7 cases of shoulder pain limited.6 cases of excellent score Neer function ,good in 9 cases,3 cases,poor in 8 cases,the excellent and good rate was 57.7%.There was significant differences between the two groups (χ2 =5.113,P <0.05) excellent rate. Conclusion LPHP exact treatment of proximal humeral fractures has fewer complications , which can help patients with early rehabilitation exercises .

Objective To study the expression and significance of monocyte chemotactic protein 1 (MCP-1) in the process of early radiation-induced lung injury in mice.Methods 40 mice were randomly divided into control group (10 cases) and post-irradiation group (30 cases).A large dose (15 Gy) irradiation on chest was performed in post-irradiation group.Every 10 mice in this group were killed on the 1st day (RT1d),the 10th day (RT10d),the 30th day (RT30d),respectively,and the specimens were collected.The expression of MCP-1 mRNA was detected by quantitative real-time PCR (RT-PCR),and MCP-1 and IL-6 proteins in BALF were detected by ELISA.The pathological changes of lung tissue were observed with HE staining.Results Under the microscope,lung tissue began to show inflammation on the 10th day and was more seriousness on the 30th day in post-irradiation group.Immunohistochemistry staining showed that the expression of MCP-1 in lung tissue irradiated was increased.RT-PCR results showed that the relative expressions of MCP-1 mRNA in control group,RT1d group,RT10d group and RT30d group were 7.63±0.77,6.81±0.75,5.75±0.73 and 4.61±0.75,respectively.The differences between RT1d group and control group,RT10d and RT1d group,and RT30d and RT10d were significantly different (all P ＜ 0.05).ELISA results showed that the levels of MCP-1 and IL-6 proteins in post-irradiation group were significantly higher than those in the control group (P ＜ 0.05).Conclusion The expression of MCP-1 in mice after irradiation is abnormal,and MCP-1 may participate in early radiation-induced lung injury.

Objective To report the clinical results of managing distal tibial fractures with a hybrid external skeletal fixator.Methods From January 2006 to June 2013,39 patients with distal tibia fracture were managed with limited-close or limited-open reduction and a hybrid external skeletal fixator.They were 26 men and 13 women,with an average age of 40.1 years (range,from 23 to 65 years).According to AO classification,15 fractures were of type A3,8 of type B2,10 of type B3,2 of type C2 and 4 of type C3.According to Gustilo classification,of the 12 open fractures,8 were of type Ⅱ,3 of type Ⅲ a and one of type Ⅲ b.According to Tscherne classification of soft tissue injury,4 cases were of grade l,24 of grade 2,and 11 of grade 3.Open fractures were managed first with radical debridement.Those complicated with fibular fracture were managed first with open reduction and internal fixation of distal fibula followed by close or limited-open reduction and minimal internal fixation depending on the position of distal tibial fracture.Next,the hybrid external skeletal fixation was applied.Five cases were immobilized with trans-articular fixators.The data were recorded regarding interval from injury to surgery,operation time,perioperative blood loss,hospital stay,time of external fixation,time of bony union,and complications.The ankle function was evaluated clinically with the Maryland Scale system at the final follow-ups.Results The 39 patients were followed up for 12 to 18 months (average,14.5 months).Primary incision healing was achieved in 37 cases,but the other 2 patients with open fracture suffered delayed wound healing which was cured by dressing changes for 4 weeks.Altogether,38 cases achieved normal fracture union and their average time of external fixation was 13.5 weeks.The time for complete infusion of fracture lines on X-rays averaged 19.7 weeks.Delayed union occurred in one case whose fracture united after removal of the external fixator,internal fixation with a locking plate and autogenous bone grafting.One case was complicated with pin track infection which was healed after debridement,drainage for 8 weeks and removal of the external fixator.No neurovascular complications were observed.According to the Maryland Scale system,the ankle function was excellent in 8 cases,good in 24 and fair in 7,with an excellent and good rate of 82.1％.Conclusions The hybrid external skeletal fixator is good for distal tibial fractures,because it can cffectively protect the skin and minimize invasion to the soft tissues,reducing incidences of skin necrosis and wound infection.Moreover,since it is flexible in screwing and structure formulation,it facilitates wound management,eslpecially in the management of open fractures.

Objectives To evaluate the safety and efficacy of endovascular angioplasty for extracranial vertebral artery ( VA ) stenosis caused by atherosclerosis. Methods We analyzed retrospectively data of the 24 patients with extracranial vertebral artery stenosis who had been placed endovascular angioplasty from April 2006 to March 2010. According to Mori classification, there were 21 type A and 3 type B among all cases.The artery stenosis rate was 60％ -95％ , the average was 79％ ± 10％. Results Twenty-four balloon mounted stents were placed, the successful rate was 100％. Postoperatively the stenosis rate decreased to 4％ ± 6％. Patients were followed up from 3 to 36 months, the average was 22 months. Symptomes disappeared in 15 out of 17 patients. Postoperative restenosis on the treatment site with transient brain ischemia occurred in one patient. The symptoms in another patient of multiple cerebral infarction with ataxia and episodic vertigo were not relieved, although the patient didn't suffer from apoplectic seizure after the intervention. Postoperative color Doppler ultrasound revealed an over 50％ residual stenosis in 5 patients. The postoperative restenosis rate was 20. 8％. According to Malek scoring, 22 patients were scored 1 point, 1 patient scored 2 and one scored 4. Conclusions Endovascular angioplasty with stent placement is a safe and effective treatment. The restenosis rate could be futher reduced by technology improvement.

Objective:To determine the relationship between the curative effect of chemo radiotherapy and brain metastasis in limited-disease small cell lung cancer (LD-SCLC). Methods:Data of 149 patients with LD-SCLC who had undergone chemoradiother-apy between April 2009 and April 2012 were analyzed. The curative effect of chemoradiotherapy was evaluated using RECIST version 1.1, which includes complete response (CR), partial response (PR), stable disease (SD), and progression of disease (PD). The objective relief includes CR and PR. Survival was analyzed using Kaplan-Meier method.χ2 text was used to analyze the correlation between the factors. Results:The median overall survival (OS) was 20.0 months, and the 3-year OS rate was 33.0%. Brain metastasis occurred in 43 (28.8%) out of the 149 patients. Among the 43 cases, 12 (29.3%), 9 (11.8%), and 22 (68.8%) had CR, PR, and SD/PD, respectively (P=0.007). The curative effect of chemoradiotherapy correlates with the rate of brain metastasis (17.8%vs. 68.8%, P=0.027). Signifi-cant differences were found between the curative effect and the brain metastasis-free survival (BMFS) (P=0.005). The 2-year BMSF for CR patients was 79.5%, and the corresponding 2-year BMSF for PR, SD, and PD patients was 71.9%, 45.8%, and 49.6%, respectively. Further analysis showed that the performance of prophylactic cranial irradiation (PCI) had an important effect on the OS (P=0.007) of patients who achieved objective relief. Conclusion:The BMFS of patients with LD-SCLC who achieved CR after chemoradiotherapy is favorable, with low rate of brain metastasis. Patients who received PCI had a better OS. Thus, we suggest that timely PCI should be considered for the patients who achieved CR.

Objective:To comprehensively investigate the prognostic significance of nodal skip metastasis and lobe-specific me-tastasis for patients with IIIa-N2 non-small-cell lung cancer (NSCLC). Methods:A total of 218 completely resected pN2-NSCLC cases with systematic lymph node dissections from 2008 to 2009 at Tianjin Medical University Cancer Hospital were enrolled. Mediastinal lymph node metastasis was subdivided into continuous metastasis and skip metastasis according to whether N1 lymph nodes were in-volved. Mediastinal lymph node metastasis was also classified into extensive metastasis and lobe-specific metastasis on the basis of whether the lymph nodes involved were within or beyond lobe-specific regions. Overall survival (OS) and disease-free survival (DFS) were compared. Results:For the whole cohort, 5-year OS was 21.6%and 5-year DFS was 16.8%. The 5-year OS for patients with skip metastasis or continuous metastasis were 37.6%and 22.0%, respectively (P=0.008). The 5-year DFS of patients with skip metastasis or continuous metastasis were 29.1%and 15.0%, respectively (P=0.022). The 5-year OS of patients with lobe-specific metastasis and ex-tensive metastasis were 38.3%and 20.4%, respectively (P=0.005). The 5-year DFS of patients with lobe-specific metastasis and exten-sive metastasis were 28.4%and 15.1%, respectively (P=0.009). According to the two patterns, patients were subdivided into three sub-groups:Group A (presence of both skip metastasis and lobe-specific metastasis), Group B (presence of skip metastasis only or lobe-spe-cific metastasis only), and Group C (presence of non-skip metastasis and non-lobe-specific metastasis). The 5-year OS of the three sub-groups were 47.1%(Group A), 28.1%(Group B), and 16.6%(Group C) (P=0.001), and the 5-year DFS of these subgroups were 35.2%(Group A), 20.8%(Group B), and 11.2%(Group C), respectively (P=0.002). Multivariate analysis demonstrated that the combined pat-tern was an independent prognostic factor for both OS and DFS. Conclusion:This combined pattern of lymph node metastasis was a strong prognostic factor for IIIa-N2 NSCLC. This pattern should be considered when predicting prognoses and during the selection of patients that will receive postoperative treatments.