Objective To evaluate the effect of gastroesophageal reflux disease(GERD)on exacerbations of chronic obstructive pulmonary disease(COPD).Methods All of 74 patients with COPD accomplishing the reflux diagnostic questionnaire(RDQ)were.divided into GERD group(n=38)and non-GERD group(n=36)according the scores of RDQ.The clinical data including the frequency of exacerbations of COPD were compared between the two groups.Results The frequency of exacerbations of COPD was significantly higher in GERD group compared with that in non-GERD group[(2.68±0.77)times/year vs (1.38±0.49)times/year,t=8.74,P＜0.05].The mean FEV;percentage was similar in the two groups [(39.82 4-10.95)%vs(37.11±12.24)%,t=1.00,P＞0.05].The score of RDQ was probably as a factor of predicting the frequency of exacerbations of COPD(R2a=o.39,t=6.98,P＜0.05).Conclusion The presence of GERD appears to be associated with increased exacerbations of COPD.

0.05).The total treatment costs were(1084.43?247.38)yuan for the treatment group and(1211.23?275.95)yuan for the controlled group,which had significant difference(P0.05).The total costs were(1270.45?218.12)yuan for the treatment group and(1407.51?51.01)yuan for the controlled group(P

OBJECTIVE:To evaluate the cost-effectiveness of 3 therapeutic regimes in the treatment of functional dyspepsia. METHODS:125 cases were randomly divided into 3 groups,group A was treated with domperidone,group B was treated with domperidone plus doxepin hydrochloride,and group C was treated with domperidone plus famotidine,the curative effects of the 3 group were observed after oral administration and the cost-effectiveness analysis was conducted as well. RESULTS:The costs for group A,B and C were 792.56 yuan,800.12 yuan and 803.76 yuan,respectively;The effective rates were 51.17%,82.50%and 71.43%,respectively;The cost-effectiveness ratio were 15.49,9.70 and 11.25,respectively;The incremental cost-effectiveness ratios of group B and C vs. group A were 0.24 and 0.55,respectively. CONCLUSION:Regime B was superior among the other two therapeutic regimes.

BACKGROUND:Intramedul ary nails and locking plates are widely used for two-part proximal humerus fracture. Which is better for two types of implants in patients remains controversial. OBJECTIVE:To determine the clinical outcome of intramedul ary nails versus locking plates for two-part proximal humerus fracture according to Cochrane Meta analysis. METHODS:We searched PubMed, SCI, Embase, the Cochranel Library and CBMdisc, VIP information, Wanfang Database, and CNKI for randomized control ed trials and quasi-randomized control ed trials on intramedul ary nails and locking plates for two-part proximal humerus fracture. RevMan 5.2 software was used to analyze operation time, intraoperative blood loss, fracture healing time, postoperative complications (heterotopic ossification, pain, screw penetration, necrosis of humeral head), and Constant Score. RESULTS AND CONCLUSION:Six articles of clinical control ed trials were included with 259 patients. 131 patients received intramedul ary nails, and 128 patients received locking plates. Meta-analysis displayed that no significant difference in fracture healing time, heterotopic ossification, pain, necrosis of humeral head and Constant Score was detected between intramedul ary nails and locking plates for two-part proximal humerus fracture. Operation time, intraoperative blood loss, and screw penetration were significantly less in the fixation with intramedul ary nails than that in locking plates (P<0.05). These findings suggested that compared with locking plates, intramedul ary nails method for two-part proximal humerus fractures could reduce screw penetration.

BACKGROUND:Some control studies attempt to answer the advantages and disadvantages of high-dose methylprednisolone sodium succinate therapy for acute spinal cord injury in adults, but have arrived at different conclusions. OBJECTIVE:To explore the therapeutic efficacy of high-dose methylprednisolone sodium succinate therapy on acute spinal cord injury in adults by Meta analysis. METHODS:PubMed, Embase, Cochranel Library, CBMdisc, VIP and WanFang Databases were searched by computer, and relevant Chinese and English orthopedic journals were retrieved by hand. Controled trials related to high-dose methylprednisolone sodium succinate therapy of acute spinal cord injury in adults were included. The methodology quality of included trials was criticaly assessed. RevMan 5.0 software was used for data analysis. RESULTS AND CONCLUSION:Nine clinical controled trials were included. Meta-analysis results showed that compared with the conventional therapy, the neurological recovery rate after 24 hours of administration, pneumonia incidence and gastrointestinal reactions increased significantly after high-dose methylprednisolone sodium succinate therapy. However, there were no statistical differences in the rate of urinary tract infection, nonunion rate and stress ulcer incidence between these two therapies. These findings indicate that the high-dose methylprednisolone sodium succinate therapy on acute spinal cord injury in adults has better outcomes in neurological function recovery, but can lead to higher incidence of lung infection and gastrointestinal reactions. Therefore, lung infection and gastrointestinal reactions should be avoided as much as possible during the course of treatment.

BACKGROUND:Intramedul ary nail and traditional steel plate fixation have been widely used in the treatment of distal tibial (extra-articular) fractures, but these two kinds of methods have shortcomings. Some control studies attempt to answer the advantages and disadvantages of the issue on the treatment of extra-articular distal tibial fractures with intramedul ary nail and steel plate fixation, but the conclusions are different.
OBJECTIVE:To determine the efficiency and safety of intramedul ary nail and plate fixation in the treatment of extra-articular distal tibial fractures by Meta analysis.
METHODS:PubMed, Embase, Cochrane Library, CBMdisc, Weipu information database and Wanfang were searched by computer, and relevant Chinese and English orthopedic journals were hand-searched. Control ed trials related to intramedul ary nail and plate fixation in the treatment of extra-articular distal tibial fracture were included. The quality of trials was critical y assessed. RevMan 5.0 software was used for data analysis.
RESULTS AND CONCLUSION:Four articles were included. Meta analysis showed that compared with the plate fixation, the malunion rate of the intramedul ary nail for extra-articular distal tibial fractures increased. There was no statistical difference in the rate of nonunion rate, delayed fracture healing, and infection rate after operation. These indicate that intramedul ary nail and plate fixation both have good effects on fracture healing.

Based on the surgical model using transforaminal lumbar interbody fusion (TLIF) to treat lumbar spondylolisthesis, this paper presents the investigations of the biomechanical characteristics of cage and pedicle screw in lumbar spinal fusion implant fixed system under different combinations with finite element method. Firstly, combining the CT images with finite element pretreatment software, we established three dimensional nonlinear finite element model of human lumbar L4-L5 segmental slight slippage and implant under different fixed combinations. We then made a comparison analysis between the biomechanical characteristics of lumbar motion range, stress distribution of cage and pedicle screw under six status of each model which were flexion, extension, left lateral bending, right lateral bending, left axial rotation and right axial rotation. The results showed that the motion ranges of this model under different operations were reduced above 84% compared with those of the intact model, and the stability of the former was improved significantly. The stress values of cage and pedicle screw were relatively larger when they were fixed by single fusion device additional unilateral pedicle screw, but there was no statistically significant difference. The above research results would provide reference and confirmation for further biomechanics research of TLIF extracorporal specimens, and finally provide biomechanical basis for the feasibility of unilateral internal fixed diagonal intervertebral fusion TLIF surgery.
Biomechanical Phenomena ; Finite Element Analysis ; Humans ; Lumbar Vertebrae ; Models, Anatomic ; Motion ; Pedicle Screws ; Posture ; Range of Motion, Articular ; Rotation ; Spinal Fusion

In the present study, a finite element model of L4-5 lumbar motion segment was established based on the CT images and a combination with image processing software, and the analysis of lumbar biomechanical characteristics was conducted on the proposed model according to different cases of flexion, extension, lateral bending and axial rotation. Firstly, the CT images of lumbar segment L4 to L5 from a healthy volunteer were selected for a three dimensional model establishment which was consisted of cortical bone, cancellous bone, posterior structure, annulus, nucleus pulposus, cartilage endplate, ligament and facet joint. The biomechanical analysis was then conducted according to different cases of flexion, extension, lateral bending and axial rotation. The results showed that the established finite element model of L4-5 lumbar segment was realistic and effective. The axial displacement of the proposed model was 0.23, 0.47, 0.76 and 1.02 mm, respectively under the pressure of 500, 1 000, 1 500 and 2 000 N, which was similar to the previous studies in vitro experiments and finite element analysis of other people under the same condition. The stress distribution of the lumbar spine and intervertebral disc accorded with the biomechanical properties of the lumbar spine under various conditions. The established finite element model has been proved to be effective in simulating the biomechanical properties of lumbar spine, and therefore laid a good foundation for the research of the implants of biomechanical properties of lumbar spine.
Biomechanical Phenomena ; Finite Element Analysis ; Humans ; Intervertebral Disc ; anatomy & histology ; Lumbar Vertebrae ; anatomy & histology ; Models, Anatomic ; Pressure ; Prostheses and Implants ; Range of Motion, Articular ; Rotation

Department of Orthopedics, Yang Pu Hospital Affiliated to Tongji University,

Objective To establish the three-dimensional (3D) finite element model of unicompartmental knee arthroplasty (UKA) with 3° and 7° posterior tibial slope at different knee flexion angles, and to study biomechanical properties and prosthetic wear of the knee joints with two types of posterior tibia slope and their effects on knee function. Methods Combining CT and MRI images of human knee joints with the 3rd-generation Oxford prosthesis, the finite element UKA model with 3° and 7° posterior tibia slope were established. The 1 kN load was applied to center point of the medial and lateral condyles of the femur to simulate the standing load of human body. The maximum stresses and distributions of the prosthesis and articular cartilage at different knee flexion angles were analyzed. ResultsThe maximum stress of the meniscus liner with 3° posterior tibia slope at 0°, 30°, 60°, 90°, 120° knee flexion angles increased by 28.06%, 68.99%, 19.45%, 21.06% and 53.38%, the distribution area was concentrated from the side of the meniscus liner to the central area, and the stress concentration was obvious at 120° knee flexion. The maximum stress of prosthesis with 3° posterior tibia slope was greater than that with 7 ° posterior tibia slope. The expansion of stress concentration area would cause wear and loosening of the prosthesis, contact stress and concentration area of the articular cartilage would subsequently increase with posterior tibia slope increasing, and stress concentration would be more obvious at high knee flexion angles. Conclusions Tibial prosthesis has the higher stress and greater wear under the condition of 3° posterior tibia slope than 7° posterior tibia slope. The research findings provide theoretical basis for the UKA design in clinic.