Objective To investigate the clinical effect of blocking nail in treatment of hypertrophic nonunion after interlocking intramedullary nailing of femoral shaft fractures.Methods A retrospective case series study was made on 11 patients with hypertrophic nonunion following interlocking intramedullary nailing of femoral shaft fractures from January 2006 to February 2016.There were 8 males and 3 females,aged (32.4 ± 6.8) years (range,19-48 years).Comminuted fractures were noted in three patients,long oblique or spiral fractures in two,multi-segment fractures in two,and transverse fractures in four.Time interval between this surgery and intramedullary nailing of femoral shaft fractures was (11.5 ±3.1) months (range,6-18 months).All blocking nails were inserted into pulp cavity of distal ends of the site of the bone nonunion.Fracture healing time,wound healing and postoperative complications were detected.Outcome was evaluated using the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI).Results All patients were followed up for (27.2 ± 4.6) months (range,24-36 months).Bone union was observed within (9.8 ± 3.4) months except that bone nonunion occurred in two cases requiring locking plate fixation and autologous bone grafting to provide union,with the healing rate of 91％.No wound infection,nail breakage and nail loosening occurred after operation.At postoperative 3 months,4 months,5 months,6 months,12 months and 24 months,VAS and ODI differed significant from the preoperative detections (P ＜ 0.05).Conclusion Blocking nail technique is associated with increased stability of intramedullary nails and fracture ends,low incidence of complications and high bone healing rate in treatment of hypertrophic nonunion after femoral interlocking intramedullary nailing.

Structure of natural product-ursolic acid was modified for increasing its antitumor activity. Ursolic acid was acylated, esterified, hydrolized or oxidized to obtain target pentacyclic triterpenoid compounds with different substitutes. Sixteen derivatives of ursolic acid were designed and synthesized including eleven new compounds. Anti-tumor activities of ursolic acid and these derivatives against HeLa, SKOV3 and BGC-823 cells in vitro were investigated by MTT assay. The results indicated that compounds 7a and 8a were found to have stronger cell growth inhibitory than ursolic acid on HeLa cells and SKOV3 cells separately, and are worth to be intensively studied further.

Objective Repair of aortic arch aneurysm is technically demanding and usually requiring complex circulatory management. Operative morbidity and mortality may be prohibitive with traditional surgical intervention. We described our experience with 5 hybrid endovascular procedure for aorta repair with different kinds of bypass followed by concomitant placement of stent graft in the aorta. Methods We retrospectively reviewed the clinical data of 5 consecutive patients presenting with aortic aneurysm or dissection from 2007 to 2008 treated by the hybrid aorta repair. Complete surgical rerouting of the supra-aortic vessels was followed by endovascular repair of aortic arch aneurysm with a Zenith TX2 stent graft. Hybrid left carotid-subclavian bypass with Zenith stent graft deployment covering the ostium of the LSA was performed in a Debakey type Ⅲ aortic dissection case. Procedures were successfully completed with exclusion of the aortic aneurysm. All stent grafts were deployed retrograde from the femoral artery in these patients. Results Technical success with complete aneurysmal exclusion was achieved in all patients (100%). At a follow-up period of 2-10 months, there was no incidence of endoleak. Documented perioperative neurelogic events did not occurred in all patients. Postoperatively one patient suffered from ARDS and cardiac failure and recovered. One patient died of myocardial infarction. Conclusions Hybrid arch repair provides an alternative to patients otherwise considered prohibitively high risk for traditional open arch and thoracoabdominal aorta repair.

ObjectiveTo investigate the efficacy of highly active antiretroviral therapy (HAART) for HIV/HCV co-infection patients. MethodsA randomized and double blinded trial was conducted in sixty-three HIV/HCV co-infected patients ( group A) and 62 HIV infected patients ( group B). The group A (study group) was further divided into A1, A2, A3 subgroups randomly by Spw-Pb network data system, and were given three different HAART regimens based on nevirapine (NVP), efavirenz (EFV) and lopinavir/ritonavir(LPV/r), respectively. CD4+ T lymphocyte counts, HIV virus load, glutamate-pyruvate transaminase (ALT) were detected at baseline and at the endpoint of study (48 weeks). SPSS 13.0 was used for statistical analysis. One-way ANOVA and LSD-t tests were performed. ResultsAfter 48 weeks treatment, HIV RNA became negative in 59 patients of group A (59/63, 93.7％ ), while that in group B was 61 (61/62, 98.4％ ) (x2 =0. 159, P ＞ 0.05 ). CD4+ T lymphocyte count in group A was (208 ± 77 )/μL, which was significantly lower than that in group B (263 ± 78)/μL (t =-2. 759, P = 0. 008 ).ALT level in group A was (57 ±49)U/L, which was significantly higher than in group B (31 ± 14) U/L (t = 2. 027, P = 0.047). CD4 + T lymphocyte count in group A3 was significantly higher than that in A1 (t=-2. 191, P =0.045), while ALT level in A1 was much higher than that in subgroups A2 and A3 ( t = 2.568 and 2.478, P ＜ 0. 05 ). The incurrence of drug-induced hepatitis in HIV/HCV co-infected group was much higher than that in HIV infected group (55.5％ vs. 27.4％, x2 = 10. 182, P = 0.001 ).ConclusionsHCV co-infection in HIV patients shows no impact on virological response to HAART, but the immunological response is poorer.Hepatotoxicity is common among patients receiving HAART, especially those who are receiving NVP containing regimens. LPV/r based regimens are recommend for HIV/HCV coinfected patients.

Abstract:To compare the morphology of spinal cord between healthy adolescents with adolescent Chiari malformation type I (CMI) patients and investigate the impact of syringomyelia on the morphology of spinal cord in CMI patients.Methods:The clinical and radiological data of 292 CMI patients diagnosed by our center between June 2012 and March 2019 were retrospectively reviewed. Among them 15 CMI patients without syringomyelia were recruited in the CM group. Among the remaining 277 CMI patients, 274 patients had syringomyelia below the C 3-4 intervertebral disc. According to the principle of best matching, CMI patients with syringomyelia were selected with the closest age to the CM group (±18 months), and 30 CMI patients with syringomyelia were included in the CMS group according to a ratio of 1∶2. Thirty healthy adolescents were enrolled as the control group (NC group) in the same way. The anteroposterior diameters of spinal cord at C 2 (DSCO-C 2), spinal canal at C 2 (DSCA-C 2), midbrain-pontine junction (DPJ), the distance between the tip of cerebellar tonsils and the foramen magnum (AB) and the maximal diameter of the syrinx (D-syrinx) were measured on MRI. All radiographic parameters were measured twice independently by two spine surgeons, and intraclass correlation coefficient (ICC) were determined to demonstrate intra- and inter-observer reliability. One-way ANOVA and SNK- q test were used to compare the above radiographic parameters and age between CM, CMS and NC group. The distribution of genders was compared between the three groups using Chi-square tests. Pearson correlation analysis were conducted to demonstrate the relationship between radiographic parameters in CM and CMS group. Results:ICC ranged between 0.91 and 0.95 in the current study, demonstrating "excellent" reliability of radiographic measurements. No significant difference was noted regarding age and the distribution of genders among the three groups. Patients in CM and CMS groups showed similar DSCO-C 2 values ( P=0.254), both of which were significantly lower than that in NC group ( P<0.001). DSCA-C 2 in CMS group was significantly larger than that in CM ( P=0.003) and NC ( P<0.001) groups, while no significant difference was found between the CM and NC groups ( P=0.216). Moreover, DPJ in CMS group was significantly lower than that in CM group ( P<0.001) and NC group ( P<0.001). There was no significant difference in AB between CM and CMS groups ( P=0.948). DSCO-C 2 was significantly positively correlated with DSCA-C 2 in CMS group ( r=0.906, P<0.001), while AB, D-syrinx, DSCO-syrinx, DSCA-syrinx and DPJ were not significantly correlated with DSCA-C 2. There were significant correlations observed between DPJ and other radiographic parameters in the CMS group (all P>0.05). Significant positive correlation between DSCO-C 2 and DPJ was observed in CM group ( r=0.703, P=0.005). There was no significant correlation between DSCO-C 2 and DSCA-C 2 and DPJ in NC group (all P>0.05). Conclusion:CMI adolescents have significant atrophic change of cervical spinal cord and midbrain-pontine junction compared with healthy adolescents, regardless of the existence of syrinx. Moreover, syrinx in CMI patients indicated more obvious atrophic change of midbrain-pontine junction and dilated spinal canal compared with isolated CMI patients.