[Objective]To evaluate the long-term clinical results of Herbert screw in the treatment of intra-articular fractures by retrospective analysis.[Method]From 1991 to 2006,fifty-five patients of different parts of intra-articular fracture treated with Herbert screw were followed up effectively,including scaphoid fracture group of 19 cases,the radial head fracture group of 25 cases,the femoral head fracture group of 11 cases.[Result]After an average follow-up time of 5 years and 11 months(ranged,1-13 years),the good-to-excellent rates were 94.7%,96%,72.7% according to the modified Mayo score,the Broberg-Morrey score and the Tompson-Epstein score.[Conclusion]The Herbert screw can provide strong fixation and stability in the long-term follow-up.It is an ideal material in treating intra-articular fractures.

Objective To study the prevention,diagnosis and treatment of the pulmonary embolism after abdominal surgery.Methods The clinical data of patients with acute pulmonary embolism(PE) after abdominal surgery between July 2008 and June 2012 were analyzed retrospectively.The high-risk patients received D-dimer,deep venous ultrasound and pulmonary CT examination to confirm the diagnosis postoperatively.Anticoagulation,thrombolysis,inferior vena cava filter placement were carried out in these patients.The high-risk patients received low molecular weight heparin(LMWH) to prevent PE from January 2010.Results 5 patients with PE survived and 3 patients died.The incidence of venous thromboembolism event was 0.43％ (13/3012) before January 2010 and PE was 0.20％ (6/3012).The incidence of venous thromboembolism event was 0.15％ (7/4803) after taking preventive measures and PE was 0.04％ (2/4803).There was no PE within 1 week since using LMWH after 2010.Lower limb DVT was found in 7 patients including 2 patients with PE after LMWH discontinuance within 2-3 weeks postoperatively.Conclusions Early prevention,diagnosis and treatment of postoperative PE are important for high-risk patients.

Objective The purpose of this study is to investigate the influence of comprehensive intervention on the family and social functions in patients with schizophrenia. Methods The stratified randomization, controlled experiment was designed for this study. 300 cases were diagnosed as schizophrenia in accordance with the Chinese classification and diagnostic criteria of mental disorder-3 (CCMD-3) diagnosis standard, and they were randomly divided into intervention group and control group. All the cases were followed up for three years after hospital discharge. Comprehensive interventions were only taken in intervention group, but not in control group. All of the cases were e-valuated by family assessment device (FAD) and social disability screening schedule ( SDSS) at the time of pre - therapy, hospital discharge and the end of 1st, 2nd and 3rd year after hospital discharge. Results In the 3rd year after hospital discharge, the scores of PANSS, FAD and SDSS of intervention group were significantly lower than those of control group ( P < 0.05 ). Conclusion Comprehensive intervention can significantly improve the family and social functions in the patients with schizophrenia.

Objective To investigate the preliminary results and complications of a tapered proximal femur modular stem in total hip arthroplasty (THA).Methods From October 2010 to December 2011,tapered proximal femur modular stems were used for THA in 50 patients (56 hips).There were 14males and 36 females,at a mean age of 61 years (range,25-82 years).Forty-four patients had unilateral THA and six bilateral THA.Hip osteoarthritis secondary to developmental dysplasia of the hip occurred in 15 patients,femoral neck fractures in 12,avascular necrosis of the femoral head in 10,primary hip osteoarthritis in nine,rheumatoid hip arthritis in two,malunion of femoral neck fracture in one,and femoral head fracture combined with posterior dislocation of the hip in one.The adopted femoral component was a tapered proximal femur modular stem.Femoral head-acetabulum interface composed metal-polyethylene in 34 hips,ceramics-polyethylene in 12 hips,and ceramics-ceramics in 10 hips.There were 48 hips with standard femoral head (28 mm) and eight hips with non-standard femoral head (＞28 mm).Results Mean period of follow-up was 11 months (range,6-19 months) and two patients (two hips) were lost to follow-up.Harris hip score improved from 36 points (range,4-71 points) preoperatively to 89 points (range,55-98 points) at the final follow-up.There was one patient with mild pain in the thigh,one moderate pain,but none severe or critically severe pain at the final follow-up.At the final follow-up,no migration or loosening of the implanted prostheses occurred; periprosthetic bone ingrowth fixation on the femoral side was achieved in 53 hips and fibrous stable fixation in one hip ; apart from one hip of ＜ 2 mm prosthetic subsidence,the remained revealed no subsidence of the prostheses.Intraoperative complications included acetabulum perforation in one hip and periprosthetic femoral fracture in one hip.Conclusion The short-term results are satisfactory,but the potential risk of fretting/corrosion and even breakage at the modular stem junction remains.

From July 2006 to November 2008,16 patients with unstable intertrochanteric fractures were treated with cemented bipolar hemiprosthesis arthroplasty, including 5 males and 11 females, at a mean age of 84 years (range, 78-92 years) in the First Affiliated Hospital of Soochow University. Of them, 15 patients were followed with mean time of 14 months. The cemented bipolar hemiprosthesis was purchased from Beijing Montagne. The patients received 5-7 days of antibiotics following arthroplasty in addition to medicine of anticoagulation and analgesia. 1 case died of pulmonary heart disease 10 months after the operation and 3 cases had heterotopic ossification. There was no prosthesis loosening or dislocation. According to Harris hip scores, 3 cases were rated as excellent, 9 good, 3 fair, and 0 poor; the excellent and good rate was 80%. Results show that cemented bipolar hemiprosthesis arthroplasty is effective in treating elderly unstable intertrochanteric fractures, but operation indications require more attention.

Objective To compare the outcome of proximal femoral nail antirotation (PFNA)and third generation of Gamma nail (TGN) in the treatment of femoral intertrochanteric fracture in the elderly. Methods From January 2007 to June 2008, the patients with intertrochanteric fractures were divided into PFNA group ( n = 55 ) and TGN group ( n = 52 ) randomly. The two treatment groups were comparable in aspect of general data. The clinical data of surgical trauma, complications and postoperative function of the two groups were compared in our study. Results The mean operation time was (66.6 ± 15.4) min in PFNA group and (73. 1 ± 20.8 ) min in TGN group (P ＞ 0. 05 ). The mean intraoperative blood loss differed significantly, (219.5 ± 107.5 ) ml in PFNA group compared with (269.0 ±123.9) ml in TGN group ( P ＜ 0. 05 ). The mean fluoroscopy time was ( 2.97 ± 1.14 ) min in PFNA group and (3.43 ± 1.18) min in TGN group (P＜0.05). Unilateral femoral shaft splits at the distal end of the nail was observed intra-operatively in four patients of the PFNA group and in one of the TGN group,with no statistical difference between two groups. Of all, 91 patients ( n =46 in the PFNA group and n =45 in the TGN group) were followed up for a duration of ( 17.5 ±3.69) months. There was one re-fracture and one implant failure during the follow up period in PFNA group, which was not found in TGN group. Fiftyone patients recovered to normal activity status, including 27 in the PFNA group and 24 in the TGN group,with no statistical differences. Conclusions Intertrochanteric fracture can be treated successfully with PFNA and TGN. There is no significant difference in complications and functional outcome between the two groups. However, PFNA takes advantages of less blood loss, less operative time and less fluoroscopy time over TGN.

Objective To investigate the inhibitory effects of RNA interference on expression of matrix metalloproteinase-2(MMP-2)gene and invasiveness of human pancreatic cancer cell line PANC-1 in vitro.Methods Small interference RNA targeting MMP-2 gene was designed and constructed to plasmid pGCsi-U6.Recombinant plasmids were transfected to pancreatic carcinoma PANC1 cells with Lipofectamine 2000.The efficiency of transfection was evaluated by flow cytometry.RQPCR was used to detect the expression of MMP-2 mRNA.The expression of MMP-2 protein was determined by ELISA.The invasiveness of PANC-1 cells was measured by transwell chamber experiment.MTT assay was used to detect the proliferation and growth of PANC-1 cells.Results Sequencing confirmed that the MMP-2 siRNA plasmid was successfully constructed.The best efficiency of transfecting recombinant plasmid was 82.1%.After transfection of the MMP-2 siRNA plasmid, the MMP-2 gene expression of PANC-1 cells was suppressed to 71.74 %(P＜0.05),and protein expression of MMP-2 fell to 49.82%(P＜0.05).The corresponding inhibition ratio of invasiveness was 33.0%(P＜0.05).There was no marked difference in proliferation rate measured by MTT assay among different groups(P＞0.05).Conclusions RNAi targeting MMP-2 can suppress invasiveness of PANC-1 cells in vitro.This suggests that MMP-2 could be a target for gene therapy of pancreatic carcinoma.RNAi is expected to open up a new prospect for tumor therapy.

Objective To investigate the clinical value of emergent perspective stent implantation for leftside obstructive colonic cancer.Methods The clinical data of 26 patients with obstructive colonic cancer who received emergent perspective stent implantation at the Affiliated Xuzhou Hospital of Southeast University from October 2011 to February 2014 were retrospectively analyzed.A soft and a hard guidewire and a catheter were applied in the operation.The guidewires were put through the hole of the intestinal tumor,and then the metal stent and the conveyor were guided by the guidewires and were pulled through the hole of the intestinal tumor,finally the stent was released and the conveyor was adjusted to ensure that the stent was at the right position.Patients were followed-up through outpatient examination till 4 weeks after tumor resection.Results Of the 26 patients,9 were with rectal cancer,10 with sigmoid colonic cancer,6 with descending colonic cancer,1 with splenic flexure cancer.The median length of stenosis was 4.6 cm (range,2.0-8.0 cm).The surgery of the 26 patients was successful.The mean operation time was 35.2 minutes (range,15.2-72.0 minutes),and the mean time of stent implantation was 5.6 minutes (range,2.6-26.9 minutes).Patients had watery or loose stool for 4-8 times after stent implantation.Ten hours after the operation,all the patients were given liquid diet.The remission rate of clinical symptoms was 100.0％ (26/26).No colonic perforation was detected during the operation.Two patients were complicated with slight bleeding,and was alleviated by medication.Twenty-six patients received stage Ⅰ tumor resection procedure within 7-10 days after the symptoms of intestinal obstruction were remised.The success rate of surgery was 100.0％ (26/26).No infection and other drainage were detected after tumor resection through follow-up.Conclusion Emergent perspective stent implantation for left-side obstructive colonic cancer is safe and effective.

BACKGROUND:Studiesin vitro have suggested that icarin can attenuate lipopolysaccharide (LPS)-induced acute pneumonia. Is the anti-inflammatory effect of icarin stil valid in the presence of wear particles? OBJECTIVE:With studiesin vivo andin vitro, to investigate the regulatory effect of icarrin on titanium particle-induced inflammatory reaction. METHODS:(1) Studiesin vivo: Eighty male C57BL/6 mice aged 6-8 weeks were randomly divided into four groups: control group, icarin group, titanium particle group, and titanium particle+icarin group. Mice in the titanium particle group and titanium particle+icarin group received surgical procedure, and sterile and endotoxin-free titanium particles were implanted on the calvaria surfaces to induce inflammatory reaction. Mice in the control group and icarin group received the same surgery, but no wear particles were implanted. Then icarin was given oraly to mice in the titanium particle group and titanium particle+ icarin group with a dose of 200 mg/kg per day for 2 weeks from the day of modeling. Mice in the control group and icarin group were given oraly the same dose of placebo. Two weeks later, tumor necrosis factor-α and interleukin-1β at protein and mRNA levels were respectively detected with enzyme-linked immunohistochemical (ELISA) and quantitative real time reverse transcription PCR (qRT-PCR) analysis. (2) Studiesin vitro: Mouse monocyte/macrophage RAW264.7 cels were cultured with different conditioned media: control group, nuclear factor receptor ligand кB (RANKL); icarin group, RANKL+icarin; titanium particle group, RANKL+titanium particles; titanium particle+icarrin group, RANKL+icarin+titanium particles. Titanium particles stimulated RAW264.7 cels were co-cultured with RANKL and icarin for 72 hours. Tumor necrosis factor-α and interleukin-1β at protein and mRNA levels in the supernatant were detected with ELISA analysis and qRT-PCR, respectively. RESULTS AND CONCLUSION: (1) Resultsin vivo: icarin treatment obviously decreased titanium particle-induced inflammatory cellinfiltration and made the thickness of periosteum thinner, down-regulated tumor necrosis factor-α and interleukin-1β expressions at protein and mRNA levels. (2) Results in vitro: when RAW264.7 cels were stimulated with titanium particles for 72 hours, tumor necrosis factor-α and interleukin-1β expressions at protein and mRNA levels in culture media increased obviously; when icarin was administrated, tumor necrosis factor-α and interleukin-1βexpressions at protein and mRNA levels down-regulated significantly. These results suggest icarin can obviously suppress titanium particle-induced inflammatory reactionin vivo andin vitro.

BACKGROUND:The incidence of low serum level of vitamin D in patients undergoing hip arthroplasty and its impact has not been reported in China, indicating that it has not been brought to the forefront. OBJECTIVE:To determine the prevalence of low serum level of vitamin D in patients before total hip arthroplasty and its relationship with the hip function scores. METHODS:Forty-eight hips from 48 patients undergoing primary hip arthroplasty from July 2013 to August 2014 in the First Affiliated Hospital of Suzhou University were enrol ed. According to the serum level of vitamin D, patients were assigned to low-level (<20μg/L) and high-level (20≥μg/L) groups. The general information of patients, the hip function scores before and after replacement at the last fol ow-up in the two groups were observed and compared. The relationship between the serum level of vitamin D and the hip function scores before and after replacement was analyzed by multiple linear regression analysis. And the average fol ow-up was 12 months (11-14 months). RESULTS AND CONCLUSION:(1) The incidence of low vitamin D level was 82%(20 ng/mL serving as standard). (2) Compared with patients with high vitamin D level, patients with low level of vitamin D had lower preoperative Harris scores and Merle D′Aubigne-Postel score (P<0.05), and also at the last fol ow-up (P<0.05. (3) Based on the preoperative and postoperative Harris, the multiple linear regression analysis showed that there was a positive correlation between the level of vitamin D and Harris score both preoperatively and postoperatively (P<0.05). (4) These results suggest that there is a higher incidence of low level of vitamin D in patients undergoing arthroplasty, and hip function scores before and after replacement in patients with low level of vitamin D are lower than the high level patients. Moreover, there is a positive correlation between the level of vitamin D and the hip joint function scores. Therefore, it is advisable to supplement vitamin D and calcium preoperatively, and the level of vitamin D wil be helpful for disease assessment and prognosis.