Objective To investigate the risk factors for hemorrhagic transformation (HT) and poor outcomes in patients with acute ischemic stroke after mechanical thrombectomy.Methods The patients with acute ischemic stroke received mechanical thrombectomy were enrolled retrospectively.The demography,vascular risk factors and other clinical data of the patents were collected.The modified Rankin scale (mRS) was used to evaluate the clinical outcomes at day 90.Good outcome was defined as mRS score 0-2.The patients were divided into either a HT group or a non-HT group according to their HT conditions.Multivariate logistic regression analysis was used to identify the independent risk factors for HT and poor outcomes.Results A total of 48 patients with acute ischemic stroke received mechanical thrombectomy were enrolled,including 25 males (52.1％).Their mean age was 64.77± 9.14 years.The mean National Institutes of Health Stroke Scale (NIHSS) score was 17.70 ± 3.77.Twenty-two patients (45.8％) occured HT,of which 9 were symptomatic HT;24 (50.0％) had good outcomes.The proportion of males in the HT group was significantly lower than that in the non-HT goup (30.4％vs.72.0％;x2 =8.293,P =0.004),while the proportions in patients with diabetes (65.2％ vs.36.0％;x2 =4.090,P =0.043) and atrial fibrillation (78.3％ vs.44.0％;x2 =5.880,P =0.015),as well as the baseline fasting blood glucose level (8.514 ± 4.400 mmol/L vs.6.354 ± 1.472 mmol/L;t =2.319,P =0.025) were significantly higher than those in the non-HT group.Multivariate logistic regression analysis showed that the atrial fibrillation (odds ratio [OR] 6.136,95％ confidence interval [CI] 1.617-23.291;P =0.042) was a risk factor for the occurrence of HT after mechanical thrombectomy.The proportion of diabetic patients (29.2％ vs.70.8％;x2 =8.333,P=0.04) and baseline NIHSS score (16.050±4.865 vs.19.210±4.423);t=2.310,P=0.026) of the good outcome group were significantly lower than those of the poor outcome group,while the proportions of patients in atrial fibrillation (75.0％ vs.45.8％;x2 =4.269,P =0.039),anterior circulation stroke (87.5％ vs.62.5％;x2 =4.000,P =0.046) middle cerebral artery (75.0％ vs.29.2％;x2 =10.113,P =0.006),vertebral basilar artery (37.5％ vs.12.5％;x2 =10.113,P =0.006) occlusion and parenchymal hematoma (33.3％ vs.4.1％;P=0.011) were significantly higher than the poor outcome group.Multivariate logistic regression analysis showed that diabetes (OR 5.898,95％ CI 1.699-20.479;P=0.005),baseline NIHSS score (OR 1.167,95％ CI 1.011-1.347;P =0.035),and parenchymal hematoma (OR 1.295,95％ CI 1.099-1.875;P=0.028) were the independent risk factors for poor outcomes.Conclusions Atrial fibrillation is an independent predictor of HT risk in patients with acute ischemic stroke after mechanical thrombectomy.Diabetes mellitus,higher baseline NIHSS score,and concurrent brain parenchymal hematoma are the independent predictors of poor outcomes.Therefore,the risk of HT and adverse outcomes should be fully assessed before mechanical thrombectomy in patients with acute ischemic stroke.

Objective:To evaluate our self-designed easily-breaking compression bone bolt plus bone plate in the treatment of tibial plateau fracture.Methods:From July 2018 to December 2018, 12 patients with tibial plateau fracture were treated at Emergency Center of Trauma, The Third Hospital of Hebei Medical University using our self-designed easily-breaking compression bone bolt plus bone plate. They were 8 males and 4 females, aged from 20 to 65 years (average, 45.6 years), with 6 left sides and 6 right sides injured. According to Schatzker classification, there were one case of type I, 3 cases of type Ⅱ, 3 cases of type Ⅲ, 2 cases of type Ⅳ, one case of type Ⅴ and 2 cases of type Ⅵ. The width of tibial plateau was measured and compared before and after operation on X-ray films. Operation time, blood loss and fracture union time were recorded. Loss of reduction and postoperative complications were followed up. Knee function was evaluated at the final follow-up by Rasmussen scoring.Results:For this cohort, operation time averaged 54.6 min, blood loss 25 mL, and fracture union time 17.2 weeks. No nonunion or delayed union was observed. The postoperative width of tibial plateau was (78.9±7.2) mm, significantly narrower than the preoperative value [(87.4±6.1) mm] ( P < 0.05). No loss of reduction or surgical complications occurred postoperation. Deep venous thrombosis of the lower extremity developed in 2 patients but recovered after treatment. The Rasmussen scoring for knee joint function at the final follow-up yielded 9 excellent, 2 good and one poor. Conclusion:In treatment of tibial plateau fractures, our self-designed easily-breaking compression bone bolt plus bone plate can restore width of tibial plateau, compress fracture fragments tightly and allow for early exercise, leading to fine functional recovery of the knee joint.

Objective:To explore the factors related to functional recovery of the knee in patients with tibial plateau fracture complicated with intercondylar ridge fracture.Methods:Included in this retrospective study were 63 patients who had been treated at Emergency Center of Trauma, The Third Hospital of Hebei Medical University from January to June 2019 for tibial plateau fracture complicated with intercondylar ridge fracture. They were 43 males and 20 females, aged from 18 to 66 years (average, 43.9 years). According to our comprehensive classification of tibial plateau fractures, there were 27 simple ones (20 cases of type Ⅰ and 7 cases of type Ⅱ) and 36 complicated ones (16 cases of type Ⅲ, 17 cases of type Ⅳ, one of type Ⅴ and 2 cases of type Ⅵ). To screen out major influencing factors, a multiple linear regression model was used to analyze the 12 factors that might affect functional recovery of the knee by the Hospital for Special Surgery (HSS) scoring: age, gender, occupation, fracture type, way of medical payment, cause of injury, operation method, starting time for rehabilitation, postoperative brace installation, time from injury to operation, length of hospital stay, and presence or absence of a free intercondylar ridge fracture fragment.Results:The 63 patients were followed up for 6.0 to 7.1 months (average, 6.1 months). The HSS knee scores ranged from 45 to 100 points (average, 92.4 points). The HSS knee scores were significantly different between different fracture types ( P<0.05). The HSS scores were significantly higher for the patients without a free intercondylar ridge fracture fragment than for those with ( P<0.05). Multiple linear regression model analysis of the 5 variables with P<0.02 in the single factor analysis (age, fracture type, way of medical payment, hospital stay and presence or absence of a free intercondylar ridge fracture fragment) and HSS scores showed that only fracture type and presence or absence of a free intercondylar ridge fracture fragment had a significant impact on the knee function. Their regression equation was Y=125.591-7.790a-17.277b (Y indicates HSS score, a indicates fracture type and b indicates presence or absence of a free intercondylar ridge fracture fragment). Conclusions:The short-term prognosis for tibial plateau fractures of comprehensive types Ⅰ&Ⅱ (simple ones) may be better than that for tibial plateau fractures of comprehensive types Ⅲ, Ⅳ, Ⅴ&Ⅵ (complicated ones). For patients with a free intercondylar ridge fracture fragment on their lateral knee X-ray film, effective reduction and fixation is indicated but is not for those without.

Objective To evaluate the factors contributing to medial compartment knee osteoarthritis and the possible correlations between them.Methods Radiographic images were collected for analysis of 840 patients who had sought medical attention from January to July 2017 for 1,422 sides of knees varus at Department of Orthopedic Surgery,The Third Hospital of Hebei Medical University.They were aged from 17 to 87 years(average,61.0 years),involving 323 knees in males and 1,099 knees in females.The alignments and parameters of lower extremity were measured,including hip-knee-ankle angle (HKA),mechanical medial distal femoral angle (mMDFA),medial proximal tibial angle (MPTA) and joint line convergence angle (JLCA).The measurements were compared between HKA values and genders for correlation analysis.Results HKA,mMDFA,MPTA and JLCA were respectively 172.85° ± 4.27°,90.99° ± 2.59°,84.78° ± 2.82° and 2.83° ±2.33 ° for males,and 172.13 ° ± 4.63°,91.11 ° ± 2.74°,84.58 ° ± 3.30° and 3.48 ° ± 2.58 ° for females.The females had significantly smaller HKA and significantly larger JLCA than males (P ＜ 0.05),but there was no significant difference in mMDFA or MPTA between genders(P ＞ 0.05).Pearson correlation test showed that there were significant correlations between HKA and mMDFA,MPTA and JLCA (rmale1 =0.526,rmale2 =0.545,rmale3 =-0.562;rfemale1=0.547,rmale2=0.610,rmale3=-0.485;P ＜0.01).mMDFA (βmale=0.491,βfemale=0.464,P ＜0.01) and MPTA (βmale=0.487,βfemale=0.560,P ＜0.01) had significantly positive influences on HKA;the influence of JLCA was negative (βmale =-0.463,βfemale =-0.450,P ＜0.01).Conclusions Femoral mechanical axis varus,increased JLCA and collapse of medial tibial plateau all significantly contribute to the varus gonarthrosis.The effects of mMDFA,MPTA and JLCA on HKA may be almost the same.

Objective To compare and analyze the epidemiological features of adult patients with distal femoral fracture between the east and west areas in China from 2010 to 2011.Methods The data of adult patients with distal femoral fracture treated from January 2010 through December 2011 in 63 hospitals were collected through the PACS system and case reports checking system.The data from 35 hospitals in the east area were classified as group A and those from 28 hospitals in the west area as group B.The analytic items included gender,age and AO classification.Results A total of 2,523 adult distal femoral fractures were collected,involving i,544 males and 979 females,with a male to female ratio of 1.58:1.The adult femoral fractures predominated in an age range from 41 to 50 years (18.94％) and their high-risk type was 33-A (50.18％).In group A of 1,650 cases,there were 1,027 males and 623 females,with a male to female ratio of 1.65:1 and a median age of 48 years;in group B of 873 cases,there were 517 males and 356 females,with a male to female ratio of 1.45:1 and a median age of 45 years.There were no significant differences in the age distribution and gender proportion between groups A and B (P ＞ 0.05).The age distribution showed that the peak ranges were from 31 to 60 years in both groups.The proportion of type 33-A was the most and that of type 33-B the least in both groups.The proportion of type 33-A in group B (53.49％) was significantly higher than in group A (48.42％) while that of type 33-B in group B (16.84％) was significantly lower than in group A (21.39％) (P ＜ O.05).Conclusions Adult distal femoral fractures were common in middle-aged males and their high-risk type was 33-A.Their peak age was from 31 to 60 years in both east and west areas in China.They were more common in men.The predominant fracture type was 33-A in both areas.The east area witnessed a significant higher proportion of type 33-B and a significant lower proportion of type 33-A than the west area.

Objective To investigate the main risk factors of respiratory complications in patients with cervical spinal cord injury so as to provide reference for early nursing assessment and personalized nursing intervention model. Methods A retrospective case series study was conducted on the clinical data of 303 patients with cervical spinal cord injury admitted to the Third Hospital of Hebei Medical University between January 2015 and September 2016. There were 248 males and 55 females, aged (44.9 ±13.8)years (range, 14-70 years). There were 109 cases at fracture site C14 and 194 cases at C5-8. According to ASIA classification, 131 cases were grade A, 26 cases grade B, 42 cases grade C, and 104 cases grade D. The duration from injury to operation was (23.2 ± 69.9) hours (range, 6-48 hours). Univariate analysis was performed on the risk factors of respiratory complications, including gender, age (14-54, 55-65, and 66-70 years old), occupation, hospital stay, smoking history, previous history, ASIA grade (grades A to D), injury cause, complications (abdominal distension, hyponatremia, hypoproteinemia, and anemia). Multivariate logistic regression was used to analyze the significant risk factors in the univariate analysis so as to further identify risk factors associated with respiratory complications. Results Univariate analysis showed that age (55-65 and 66-70 years), ASIA grade A, ASIA grade B, smoking history, injury cause, complications (abdominal distension, hyponatremia, hypoproteinemia, and anaemia) were related to respiratory complication of patients with cervical spinal cord injury (P ＜0.05). The gender, occupation, length of hospital stay, and previous history were not associated with respiratory complications of patients with cervical spinal cord injury (P＞0.05). Logistic regression analysis showed that age between 55 and 65 years (OR = 3.989, P ＜ 0.05), age between 66 and 70 years(OR =0.301, P＜0.05), AISA grade A (OR=30.300, P＜0.05), ASIA grade B (OR =5.784, P ＜0.05), smoking history (OR=5.238, P ＜0.05), abdominal distension (OR = 1.975, P＜0.05), hypoproteinemia (OR =6.212, P ＜ 0.05), and hyponatremia (OR =3.233 ＜0.05) were independent risk factors for respiratory complications in patients with spinal cord injury. Except for ASIA classification, other factors might be easily ignored by doctors and nurses, leading to poor prognosis of patients. Conclusions Age (above 55 years), ASIA grades A and B, smoking history, abdominal distention, hypoproteinemia, and hyponatremia are the risk factors of respiratory complications in patients with cervical spinal cord injury. Based on the results, early nursing assessment can be carried out and personalized nursing measures can be taken to reduce the incidence of respiratory complications. It can also provide reference for constructing standardized nursing intervention model.

Objective To investigate the epidemiological characteristics of the in-patients with femoral supracondylar fracture in the Third Hospital of Hebei Medical University from 2009 through 2018.Methods The medical imaging computer archiving and transmission system and the medical record inquiry system were used to collect the data of all the in-patients with femoral supracondylar fracture who had been treated from January 2009 through December 2018 in The Third Hospital of Hebei Medical University.Their gender and age distribution,basic sociological data and cause of injury were characterized.The in-patients from January 2009 to December 2013 were assigned into group A while those from January 2004 to December 2018 into group B.The 2 groups were compared to find out the epidemiological characteristics and trends of the in-patients with femoral supracondylar fracture in the 10 years.Results Of the 508 in-patients with femoral supracondylar fracture,279 (54.9％) were male and 229 (45.1％) female.Their age ranged from 1 to 94 years,averaging 44.3 years.The age group from 41 to 50 years accounted for the largest proportion (104 cases,23.9％).In males,the age group from 41 to 50 years accounted for the largest proportion (33.3％,80/279);in females,the age group from 51 to 60 years the largest proportion (30.3 ％,59/229).The proportion of females in the in-patients under 50 years of age (37.1％) was significantly lower than that (62.9％) in the in-patients over 50 years of age (P ＜ 0.05).According to the AO classification,there were 193 cases (38％) of type 33-A1,117 ones (23％) of type 33-A2 and 198 ones (39％) of type 33-A3.There were 270 farmers (53.1％),164 workers (32.4％) and 74 students (14.5％).Most injuries were caused by high energy (56.5％).The age of in-patients with low-energy injury (50.5 ±20.7 years) was significantly higher than that of in-patients with high-energy injury (39.5 ± 19.6 years) (P ＜0.05).The proportions of urban residents (30.0％),patients with low energy injury (37.9％) and type 33-A1 fractures (23.9％) in group A were significantly lower than in group B (43.3％,46.9％ and 32.3％,respectively) (P ＜ 0.05);the age of group A (41.9 ± 21.8 years) was significantly younger than that of group B (45.9 ± 19.9 years) (P ＜0.05);type 33-A3 fractures in group A (46.5％) were significantly more than in group B (36.3％) (P ＜0.05).Conclusions Femoral supracondylar fractures were more common in farmers.Most of the fractures were type 33-A3.The fractures were common in males from 41 to 50 years old and in females from 51 to 60 years old.There were more males than females in the junior patients but more females than males in senior patients.There were more young patients in complex fractures but there were more old patients in simple fractures and there were more very old patients in low-energy injuries.In the past 10 years,the patients with femoral supracondylar fracture increased year by year.Compared with the first 5 years,the late 5 years witnessed significant increases in age of patients and proportions of low-energy injury and simple fracture.

Objective To analyze the epidemiological characteristics of all the patients with tibial plateau fracture admitted to the Third Hospital of Hebei Medical University in the past 10 years.Methods The picture achieving and communication system was used to collect the general information and disease-related information from the hospitalized patients with tibial plateau fracture who met the inclusion and exclusion criteria from January 1,2009 to December 31,2018.The patients from January 1,2009 to December 31,2013 were assigned into group A while those from January 1,2014 to December 31,2018 into group B.The 2 groups were compared to find out the epidemiological characteristics and trends of tibial plateau fractures in the past 10 years in gender,age,occupation,injury cause and Schatzker classification.Results A total of 1,936 patients with tibial plateau fracture were included in the study,including 1,352 males and 584 femaleswith a male to female ratio of 2.32∶ 1.The peak age ranged from 50 to 59 years,with 40 to 49 years for males and 50 to 59 for females.There were 793 cases in group A (a male to female ratio of 1.89∶1) and 1,143 ones in group B (2.69∶1),showing a significant difference between the 2 groups in the male to female ratio (P ＜ 0.05).The peak age ranged from 40 to 49 years (25.09％,199/793) in group A and from 50 to 59 years (23.27％,266/1,143)in group B.There were significant differences between the 2 groups in the constituent ratios of age groups from ≥50 years (P ＜ 0.05).Physical workers accounted for the highest proportion in group A (57.12％,453/793) and group B (52.58％,601/1,143).There were significant differences between the 2 groups in the constituent ratios of occupations (P ＜ 0.05).In all the 1,837 patients with a definite injury cause,the fall and indoor activity accounted for the highest proportion(41.92％,770/1,837),the traffic accident(33.25％,248/769) in group A did and the fall and indoor activity(48.88％,522/1,068) in group B did too.There were significant differences between the 2 groups in the injury causes (P ＜ 0.05).Of all the 1,658 patients with X-ray films available,by the Schatzker classification,types Ⅱ and Ⅵ were the most common.Type Ⅵ accounted for the highest proportion in group A (33.25％,248/769) while type Ⅱ did in group B (48.88％,522/1,068).There were significant differences between the 2 groups in the proportions of Schatzker types (P ＜ 0.05).Conclusions The tibial plateau fractures admitted to the Third Hospital of Hebei Medical University in the past 10 years were more common in males than in females,and predominant in physical workers.Fall and indoor activity was the most common injury cause.Schatzker types Ⅱ and Ⅵ prevailed.The fractures showed an aging trend by comparing the former 5 years and the latter 5 years.

Objective:To investigate the protective effect of insulin on burn serum-challenged cardiomyocytes in vitro. Methods:Primary culture of cardiomyocytes from Sprague-Dawley (SD) 2-day-old neonate rats were divided into Sham group, burn group, insulin group, and insulin activation inhibitor LY294002 pretreatment group (LY group). The model of cardiomyocytes injury induced by burn serum of 3-month-old SD rats [the serum of abdominal aortic was collected at 6 hours after modelling 30% total surface area (TBSA) Ⅲ degree scald rat] was reproduced. In the insulin group, 10% burn serum and insulin (10 U/L) were added into cell culture medium, and in the LY group, LY294002 (50 μmol/L) was pretreated for 30 minutes before the addition of burn serum and insulin. Sham group was only given 10% serum of sham injured rats (sham rats were only placed in 37 ℃ warm water). After the cells were cultured for 12 hours, the release of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and creatine kinase (CK) were determined by enzyme-linked immunosorbent assay (ELISA). The cardiac troponin T (cTnT) protein expression was examined by Western Blot. Apoptosis of cardiomyocytes was observed after Hoechst 33258 staining.Results:Compared with the Sham group, the cardiomyocytes were damaged and released inflammatory cytokines after burn serum-challenged. The levels of TNF-α, IL-6 and CK increased [TNF-α (ng/L): 273±48 vs. 21±6, IL-6 (ng/L): 416±83 vs. 44±11, CK (U/L): 1.44±0.24 vs. 0.14±0.08, all P < 0.01], while the expression of cTnT protein decreased (cTnT/β-actin: 0.12±0.04 vs. 0.86±0.34, P < 0.01), and the cardiomyocyte apoptosis increased [(19.1±5.6)% vs. (5.2±1.3)%, P < 0.01]. Insulin could significantly reduce the damage of cardiomyocytes, decrease the release of TNF-α, IL-6 and CK induced by burn serum [TNF-α (ng/L): 105±37 vs. 273±48, IL-6 (ng/L): 176±77 vs. 416±83, CK (U/L): 0.82±0.26 vs. 1.44±0.24, all P < 0.05], the expression of cTnT protein significantly increased (cTnT/β-actin: 0.41±0.16 vs. 0.12±0.04, P < 0.05), and the cells apoptosis rate significantly decreased [(10.7±3.2)% vs. (19.1±5.6)%, P < 0.05]. Further blocking experiments showed that LY294002 could mitigate the protective effects of insulin. Conclusion:For cardiomyocytes challenged by burn serum, insulin may decrease inflammation, apoptosis and then protect the cardiomyocytes.

Objective To investigate the survival of oral arsenic-containing Qinghuang Powder (QHP) and low intensive chemotherapy (LIC) in the treatment of elderly patients with acute myeloid leukemia (AML).Methods Forty-two AML patients older than 60 years in Xiyuan Hospital from January 2015 to December 2017 were retrospectively analyzed.Of them,20 cases were treated with QHP (QHP group),22 cases were treated with LIC (LIC group).The survivals of the two groups were compared.Results There was no significant difference of median survival time (13 months vs.13.5 months,x2 =0.096,P =0.757),1-year survival rates (59.1％ vs.70.0 ％,x2 =0.543,P =0.461),2-year survival rates (13.6 ％ vs.15.0 ％,x2 =0.016,P ＞ 0.05),and 3-year survival rates (4.6 ％ vs.5.0 ％,x2 =0.005,P ＞ 0.05) between LIC and QHP groups.There was no significant difference of median survival time in age ≥75 year (12 months vs.12.5 months,x2 =1.317,P =0.251),performance status scores ＞ 2 (12 months vs.12 months,x2 =0.834,P =0.361),hematopoietic stem cell transplantation with combined disease index ＞ 2 (12 months vs.13 months,x2 =1.726,P =0.189),secondary AML (10 months vs.14 months,x2 =1.552,P =0.213),and poor cytogenetics (12 months vs.8 months,x2 =0.479,P =0.489) between LIC and QHP group.Conclusion The survival of elderly AML patients is considerable in patients treated with oral QHP and LIC,which suggests that oral QHP may be an equivalent alternative treatment since elderly AML (especially more than 75 years) patients refused to LIC therapy.