Objective To evaluate the clinical outcomes of cemented bipolar femoral head arthroplasty in treatment of intertrochanteric fractures in elderly patients combined with heart,lung,brain and other diseases.Methods The study comprised 23 cases,aged 75-86 years old,treated with cemented bipolar artificial femoral head arthroplasty between January 2005 and October 2013 (replacement group).Evans' classification of the fracture was type Ⅰ in 3 cases,type Ⅱ in 9,type Ⅲ a in 5,type Ⅲ b in 2,type Ⅳ in 3 and reverse intertrochanteric fracture in 1.Additionally,23 cases with the similar physical condition treated with anatomical locking plates were chosen as controls.For comparisons between groups,operation time,amount of bleeding,drainage volume,mean time to extract drainage tub,antibiotics dosage,perioperative complications,complications of lying in bed,fracture complications and Harris score were measured.Results There were no significant differences between replacement and control groups with respect to operation time (52.7 minutes vs 52.0 minutes),amount of bleeding (160.9 ml vs 156.5 ml),drainage volume (162.2 ml vs 158.3 ml),Harris score (73.7 points vs 74.2 points),time to extract drainage tub (69.9 hours vs 68.9 hours) (P ＞ 0.05).Both groups had 5 days of preventive antibiotic usage.Better results were observed in replacement group than in control group concerning mean time of ambulation (8.1 days vs 109.3 days),rate of perioperative complications (19％ vs 59％),rate of bed rest complications (0 vs 36％) and rate of internal fixation complications (0 vs 18％) (P ＜ 0.05).Conclusion Cemented bipolar femoral head arthroplasty is effective to prevent the complications of internal fixation,bed rest as well as perioperation and improve the quality of life during the treatment of intertrochanteric fracture in elder patients with heart,lung,brain and other diseases.

Objective To discuss the technical points and clinical effectiveness of the guidewire looping technique for re-canalizing chronic and total long-segment occlusions of femoropopliteal arteries.Methods The guidewire tip was formed into a U-shaped loop and then the guidewire loop was advanced to the occluded artery and was manipulated to re-open the occluded vessel. The catheter followed the guidewire gradually until the tip of the guidewire came into the true lumen of the outflow tract. Results The chronic long-segment occlusions of femoropopliteal arteries were successfully re-canalized in all 48 patients with a technical successful rate of 92.31% (48/51). The re-canalization procedure was failed in three cases.Conclusion Guidewire looping technique is an effective, safe and simple practical skill for re-canalizing chronic long-segment occlusions of femoropopliteal arteries.

BACKGROUND:Operative approaches of lumbar interbody fusion include anterior (ALIF),posterior (PLIF) and transforaminal lumbar interbody fusion (TLIF).The resected structures and cage implantation sites are different,and the initial stability of lumbar spine is varied.OBJECTIVE:To compare the initial stability of lumbar spine following ALIF,PLIF or TLIF in combination with bilateral pedicle screw fixation.DESIGN:Comparative observation.MATERIALS:Fifteen samples of fresh calf lumbar spine were used.METHODS:Models ofALIE PLIF and TLIF were simulated.After examination as normal group,the samples were randomly divided into three groups (n=5).Besides anterior,posterior and transforaminal lumbar interbody fusion include anterior,bilateral pedicle screw fixation was performed.MAIN OUTCOME MEASURES:Biomechanical characteristics of the lumbar spine before and after ALIF,PLIF or TLIF in combination with bilateral pedicle screw fixation.RESULTS:Following three approaches of lumbar interbody fusion,the stability of lumbar spine was significantly reduced,which was enhanced after bilateral pedicle screw fixation (torsion indexes were also increased).In addition,rigidity of the lumbar spine was enhanced.The stability indexes of lumbar spine following TLIF were significantly greater than the other approaches,indicating the initial stability of TLIF was the best.The rigidity,stress,and swain of lumbar spine following PLIF were greater than ALIE but torsion indexes were smaller than ALIE CONCLUSION:The stability of lumbar spine following lumbar interbody fusion was significantly reduced compared with normal sample.But bilateral pedicle screw fixation greatly increases the stability.Among three types of lumbar interbody fusion,the initial stability of lumbar spine following TLIF is the best.

Objective To explore the expression changes of C/EBP homologous binding protein (CHOP)in intermittent hypoxic rats with cognitive function decline and clinical significance.Methods We randomly divided 75 adult male Wistar rats into normal group (NC group),5% intermittent hypoxia group (5% CIH group)and 10%intermittent hypoxia group (10% CIH group),with 25 rats in each.Then the three groups were further divided into 3 d,7 d,14 d,21 d and 28 d subgroups,and each time a subgroup had 5 rats.The control group was exposed to the air while 10% CIH group and 5% CIH group were exposed to CIH for eight hours from 8:00 to 1 6:00 each day. After exposure for 3 d,7 d,14 d,21 d and 28 d,the cognitive function of rats was assessed with Morris water maze, the expression of CHOP in the hippocampus was assayed qualitatively by immunohistochemical technique,and the apoptosis of neurons was detected by TUNEL method.Results ① With prolonged hypoxia,the time of escape latency obviously prolonged,the time spent crossing the target quadrant shortened (P < 0.05 ),and the apoptosis index of hippocampal neurons in the CIH groups was increased gradually compared with those in control group (P <0.05).The above-mentioned indexes changed more significantly in 5% CIH group than in 10% CIH group (P <0.05).②.The expression of CHOP protein at each time point was increased (P <0.05 ).In 10% CIH group it reached the peak at 28 d while in 5% CIH group it decreased after it peaked at 21 d.③ The expression of CHOP in the two CIH groups was positively correlated with apoptosis index and animal escape latency time,but negatively correlated with the target quadrant time.Conclusion Intermittent hypoxia,which is likely to induce the high expression of CHOP and activation of neural CHOP mediated apoptosis,causes cognitive impairment of various degrees.

ObjectiveTo evaluate the clinical application of endovascular treatment for severe Takayasu's arteritis (TA).MethodsIn this study,35 target lesions in 32 patients [28 women,mean age (30 ±8) years] with severe Takayasu's arteritis were treated with endovascular merthod.The average length of lesion was 3.1 cm( range 2.7 -5.3).The overall average degree of diameter stenosis was 90％ ± 11％ (range 70- 100)in which 15 lesions were completely occlusive.There were 10 patients whose ESR were higher than 20 mm/h( range 25 -37).Follow-up included physical examination and patency evaluated by color duplex souography/computed tomography angiography/angiography at 6 months and then annually.ResultsRecanalization was unsuccessful in 3 completely occlusive lesions,with a successful rate of 80％(12/15).There was one case in which embolization leading to acute thrombogenesis developed during interventional procedure and resulting in severe stroke.The technical successful rate ( residual stenosis ＜ 50％ ) was 88.6％ ( 31/35 ).The transient cerebral ischemia attack ( TIA ) symptoms disappeared in 31 cases.26 cases were followed up for an average of (19 ± 10) months (range 13 -40).Occipital infarction following severe in-stent restenosis developed 13 months later in one case.Symptomatic in-stent restenosis18monthslaterwasfoundin2cases. Patencyratewas88.5％( 23/26 ).ConclusionsEndovascular treatment is safe and effective for severe TA.Strict indication and accurate targeting the lesions help ensure the success of management.

OBJECTIVETo study whether previously intravenous injection of anisodamine can prevent endotoxemia of heat stroke of rats.

METHODSExperimental animals were randomly divided into two groups, their average artery pressure, heart rate, survival time, survival rate and rectal temperature were measured at an environmental temperature of 38 degrees C-40 degrees C and 50%-60% retative humidity. Blood samples for endotoxins analyses were taken both before and after heat-stress.

RESULTSDuring heat stress, the animals of rectal temperature of the experimental and control groups continuously increased and two hours later, separately to (42.7 +/- 0.6) degree C and (43.1 +/- 0.5) degree C, without statistic difference(P > 0.05), and to (44.6 +/- 0.4) degree C and (44.2 +/- 0.3) degree C prior to death, with statistic difference(P < 0.05). Before the experiment, the contents of endotoxins of portal vein blood were (45.7 +/- 5.2) pg/ml and (42.6 +/- 5.4) pg/ml, and that of systemic blood was (14.8 +/- 4.5) pg/ml and (13.9 +/- 7.2) pg/ml, without statistic difference(P > 0.05). Two hours later, the contents of portal vein blood separately increased to (122.2 +/- 16.7) pg/ml and (49.7 +/- 10.2) pg/ml, obviously higher than that before heat-stress(P < 0.01). And there were clear statistic difference between the two groups(P < 0.01). The changing tendency of the heart rhythm is almost the same in two groups, that is, first rose and then fell. But it is without statistic difference before and two hours later(P > 0.05): before heat-stress, the average artery pressures were (13.3 +/- 0.6) kPa and (13.6 +/- 0.5) kPa, without statistic difference(P > 0.05), and two hours later, were (9.6 +/- 0.5) kPa and (8.6 +/- 0.6) kPa, with obvious statistic difference(P < 0.01). The survival time of the animals were (166.5 +/- 16.9) min and (144.5 +/- 18.2) min with obvious statistic difference(P < 0.01), the survival rate of heat stressed rats in the experimental group were obviously higher than control group(P < 0.01 or P < 0.05).

CONCLUSIONSAnisodamine can prevent endotoxemia in rats suffering heat stroke.

Animals ; Blood Pressure ; Body Temperature ; Endotoxemia ; prevention & control ; Endotoxins ; blood ; Heat Stress Disorders ; drug therapy ; mortality ; physiopathology ; Hot Temperature ; Rats ; Solanaceous Alkaloids ; therapeutic use ; Survival Rate