With the increasing number of hip arthroplasty and the extension of implant survival,the risk of periprosthetic femoral fractures are gradually growing.The technical challenge of the surgical management of periprosthetic femoral fractures leads to poor functional outcome,implant survival and patient satisfaction compared to primary hip arthroplasty.The risk factors of periprosthetic femoral fractures involve both of the bone quality of the patient and the surgical techniques of the primary surgery,including age and gender of the patient,osteoporosis,previous surgical history and the type of the components.In order to avoid the occurrence of periprosthetic fractures,precautions including the assessment of the patient status and bone quality as well as the selection of proper prosthesis and surgical procedures should be taken before the primary surgery.During the primary surgery,more attention should be paid to prevent the damage of host bone and make sure the correct placement of the implants.The aseptic loosening should be detected and treated as early as possible in the regular post-operative follow up.The diagnosis of periprosthetic femoral fracture mainly bases on the detailed history,symptoms,signs and serial X-rays after operation.The most extensively used classification system of the periprosthetic femoral fracture is the Vancouver classification.For the treatment of different types of fractures,conservative therapy is recommended for most Vancouver type A fractures.The surgical management is the best choice for most Vancouver type B fractures.Whether the stem revision is necessary or not depends on the stability the component.The treatment of Vancouver type C fractures should be in accordance with the principles of regular femur fractures.However,more attention should be paid to choose proper device according to the existence of the femoral component in the proximal part of the fracture.Through the analysis of the pathogenesis and risk factors of periprosthetic femoral fractures and the discussion of the diagnosis,classification and treatment principles,we expect to provide a standard treatment protocol for the periprosthetic femoral fractures following hip arthroplasty.

AIM:To investigate the effect of atorvastatin on myocardial apoptosis , ventricular remodeling and cardiac function after acute myocardial infarction (AMI) in diabetic rats, and to explore whether the effect is mediated by hepatocyte growth factor ( HGF)/c-Met signaling pathway .METHODS:Diabetes in 70 male SD rats was induced by in-traperitoneal injection of streptozotocin (STZ, 65 mg/kg).After 8 weeks, AMI was induced by the ligation of the left ante-rior descending coronary artery in the diabetic rats , and 32 surviving rats were divided into AMI group (n=16) and AMI+atorvastatin group ( n=16, 20 mg· kg -1 · d-1 ) at random.The similar surgical procedure was completed in sham group (n=11) without coronary ligation.Atorvastatin was given daily by gavage from the first day after AMI .Two weeks later, the cardiac function , pathological changes of myocardial tissues , myocardial apoptosis , and the expression of HGF and c-Met were compared among groups .RESULTS: AMI significantly reduced cardiac function , increased collagen volume fraction ( CVF) and myocardial apoptotic index , and up-regulated the expression of HGF and c-Met at mRNA and protein levels in AMI control group (P<0.05).The cardiac function was improved , and CVF and myocardial apoptotic index were reduced by the treatment with atorvastatin , which also up-regulated the expression of HGF and c-Met (P<0.05).CON-CLUSION:Atorvastatin significantly attenuates myocardial apoptosis and cardiac remodeling , and improves cardiac func-tion after AMI in diabetic rats by further enhancing the activation of HGF /c-Met pathway .

Objective To investigate the peripheral blood neutrophil to lymphocyte ratio(NLR) for the early diagnosis of acute coronary syndrome(ACS) .Methods A total of 247 patients with suspected ACS and chest pain ,including 51 cases with acute ST segment elevation myocardial infarction(STEMI) ,42 cases with acute non‐ST segment elevation myocardial infarction(NSTEMI) , 87 cases with unstable angina pectoris(UA) and 67 cases with non‐cardiogenic chest pain(NCCP)were enrolled and detected for white blood cells count and classification .The sensitivity ,specificity ,positive predictive value ,negative predictive value ,receiver op‐erating characteristic(ROC) curve of NLR were analyzed .Results Among all patients ,the most common was UA ,followed by NC‐CP ,STEMI and NSTEMI .Level of neutrophil proportion and white blood cell count were lowest in NCCP group ,followed by UA , NSTEMI and STEMI group ,but lymphocyte proportion was with the opposite change tendency .Diagnostic sensitivity ,specificity , accuracy ,positive predictive value and negative predictive value of NLR for ACS were higher than white blood cell count .Conclusion NLR was with various advantages for the early diagnosis ,prognosis evaluation and state of ACS .

Objective To investigate the application value of serum pancreatic isled autoantibodies and biochemical indicators in classification diagnosis of type 1 diabetes mellitus (T1DM ) and type 2 diabetes mellitus (T2DM ) .Methods The clinical data and laboratory detection results in 99 cases of T1DM and 577 cases of T2DM were retrospectively analyzed .The levels of pancreatic isled autoantibodies and biochemical indicators were compared between the two groups and their characteristics were analyzed .Re‐sults The positive rates of single detection and combine detection of glutamic acid decarboxylase autoantibodies (GADA) ,insulino‐ma‐associated antigen‐2 autoantibodies (IA‐2A ) ,islet cell autoantibodies (ICA ) and ZnT8 autoantibodies (ZnT8A ) in the T1DM group were higher than those in the T2DM group ,the differences were statistically significant (P<0 .05) .The onset age ,fasting and postprandial 2 h CP ,fasting and postprandial 2 h insulin(2 h INS) ,triglyceride(TG) and body mass index (BMI) in the T1DM group were lower than those in the T2DM group ,while the levels of fasting and postprandial 2h blood glucose ,glycosylated hemo‐globin(HbA1c) and high‐density lipoprotein cholesterol(HDL‐C) were higher than those in the T2DM group ,the differences were statistically significant (P<0 .05);however total cholesterol and low‐density lipoprotein cholesterol levels had no statistical differ‐ence between the T1DM group and T2DM group (P>0 .05) .Moreover ,the fasting and postprandial 2 h CP levels in the T1DM group showed decreasing trend as the T1DM course extending ,and the difference had statistical difference among different disease courses ;but the fasting and postprandial 2 h CP levels in the T2DM group had no obvious decreasing trend .The areas under the receiver operating characteristic(ROC) curve of fasting and postprandial 2 h CP for differential diagnosis of T1DM and T2DM in the patients with the disease course < 2 year were 0 .902(95% CI:0 .850-0 .954) and 0 .905(95% CI:0 .852-0 .958) respective‐ly .The suitable threshold value of fasting CP was 0 .283 nmol/L ,its sensitivity and specificity were 82 .6% and 89 .2% ,respective‐ly ,which of postprandial 2 h CP was 0 .421 nmol/L ,its sensitivity and specificity were 84 .8% and 89 .2% respectively . Conclusion T1DM and T2DM are different in onset age ,BMI value ,serum GADA ,IA‐2A ,ICA ,ZnT8A ,insulin ,CP ,glucose , HbA1c ,TG and HDL‐C levels ,which may assist clinic in their classification diagnosis .

Objective To investigate w hether the iterative reconstruction (iDose 4 ) technique improves imaging quality of the low-radiation-dose w hole brain CT perfusion (CTP). Methods Thirty-five consecutive patients w ith clinical y suspected ischemic stroke w ere col ected. Bril iance 256 iCT w as used to perform low-radiation-dose w hole brain CTP, and the filtered back projection (FBP) and iDose 4 algorithm w ere used to conduct image reconstruction. The noise and signal to noise ratio of the 2 kinds of reconstruction algorithms, as w el as the imaging quality of each parameter map w ere compared. Results The effective dose of the w hole brain CTP w as 2.2 mSv. Compared w ith FBP, the noise of each region of interest in the iDose4 Tmax map was decreased significantly ( P<0.05) and the signal to noise ratio was increased significantly (P<0.05). The imaging quality scores (median, interquartile range) reconstructed by FPB group w ere significantly low er than by iDose 4 for cerebral blood flow (CBF) map ( 5.00 [3.00-6.00]vs. 6.00 [5.00-6.00]; Z= -2.784, P=0.005), cerebral blood volume (CBV) map ( 6.00 [5.00-6.00] vs. 6.00 [6.00-7.00]; Z= -3.674, P<0.001), and mean transit time (MTT) map (4.00 [3.00-5.00] vs. 5.00 [4.00-6.00]; Z=3.394, P=0.001). The proportions of the poor quality in CBF map ( 34.3%vs. 11.4%;χ2 =7.036, P=0.030), CBV map (11.4%vs.2.9%; χ2 =7.485, P=0.024 ) and MTT map (28.6%vs.11.4%;χ2 =5.318, P=0.070) reconstructed by FBP w ere significantly higher than by iDose 4 . Conclusions The iDose4 technique may improve imaging quality of low er-radiation-dose CTP.

Objective To compare the consistency and correlation of multiple breath-hold (BH) with respiratory-triggered (RT) 1H-MRS for quantification of hepatic lipid content. Methods Sixty subjects were underwent RT 1H-MRS of the liver (Couinaud segment VII) and BH 1H-MRS at 1.5 Tesla Magnetic Resonace Imaging (MRI). The peak areas of water and methylene obtained on RT and BH 1H-MRS were recorded respectively and the liver fat fraction was calculated. Pearson correlation coefficient , Bland-Altman 95% limit of agreement, and concordance correlation coefficient were calculated. Results Mean liver fat fraction measured in RT and BH 1H-MRS were (8.6 ± 8.7)% and (9.4 ± 9.3)% respectively. There was a strong correlation between RT and BH 1H-MRS(r = 0.973, P < 0.000 1, concordance correlation coefficient = 0.95). With the Bland-Altman method, 91.7% data points were within the 95% limits of agreement. Conclusion RT and BH 1H-MRS are alternative tools for intrahepatic lipid quantification. These two methods have a strong correlation and perfect consistency.

Objective To observe the clinical outcomes of the surgical management of periprosthetic femoral fractures following hip arthroplasty.Methods Twelve consecutive patients (6 male and 6 female) with the average age of 66.4± 15.0 years old (35 to 86 years old) undergoing surgical operation for periprosthetic femoral fractures between September 2009 and May 2016 were followed up at our center.Nine cases were fractured secondary to the primary hip arthroplasty while the others were patients with earlier revision surgery.The previous fixations of femoral components of 10 cases were cementless while the other two were cemented fixation.The enrolled patients were determined as Vancouver type B 1 (n=2),type B2 (n=7),type B3 (n=1) and type C (n=2) respectively.The occurrences of the fractures were observed at 3 weeks to 17 years post-operation (average 9.0±7.0 years).The patients were treated individually according to different Vancouver types.Type B 1 patients received simple cerclage fixation,as well as revisions with long-stem femoral implants and cerclage band were chosen for type B2 patients.In addition to the treatment for type B2 patients,allogenic cortical bone graft was also required for type B3 patients.Open reduction with locking plate internal fixations were options for patients with Vancouver type C fractures.The following-up included the X-ray images of the hips,Harris hip score and the visual analogue scale (VAS) for the pain of fracture site.The unions of the fractures were determined by both X-ray images and pain intensity of the fracture sites.Results The mean follow-up period was 41.6±26.0 months (range,12-92 months),without patient lost to follow up.VAS scores were 0,implying the clinical union of the fractures.One patients received multiple debridement post-operatively due to the periprosthetic infection.The VAS score of this patient was 6 at the follow up and the X-ray image indicated the nonunion of the fracture.The fracture union rate was 91.7％ (11/12).The Harris hip score was 23-92 (mean score,74.8±18.8),excellent for 2 cases,good for 6 cases,fair for 3 cases and poor for 1 case.The excellent and good rate was 66.7％ (8/12).Post-operative complications were observed in 4 patients (33.3％,4/12).One drainage tube was misplaced and sutured subcutaneously required a further exploration surgery.One periprosthetic infection occurring post-operatively induced the nonunion of the fracture.Aseptic loosing of femoral stem was observed in 2 cases and subsequent revision surgeries were conducted.Conclusion High incidence of complications is observed after the surgical treatment of periprosthetic femoral fractures following hip arthroplasty.Individually customized management regarding to the Vancouver type of periprosthetic femoral fractures leads to the clinical fracture union in 91.7％ of the patients in this case series.The excellent and good rate of the hip function in the early and mid-term stage after operation is 66.7％.

OBJECTIVETo investigate the changes in whole brain gray matter volume in patients with trigeminal neuralgia using voxel-based morphometry (VBM).

METHODSTwenty-eight patients with trigeminal neuralgia and 28 healthy controls underwent magnetic resonance imaging with a Philips 1.5T MRI scanner. VBM was used to compare the structural differences in the whole brain gray matter between the two groups based on the DARTEL after data preprocessing with SPM8 software package.

RESULTSCompared with the healthy controls, the patients with trigeminal neuralgia presented with decreased gray matter volume in several brain regions including the bilateral middle temporal gyrus, bilateral superior/middle frontal gyrus, left pre-/post-central gyrus, right fusiform and anterior cingulate gyrus.

CONCLUSIONSPatients with trigeminal neuralgia had abnormal gray matter volume in some brain regions associated with perception and processing of pain sensation. These changes may provide clues for further exploration of the neuropathogenic basis of trigeminal neuralgia.

Brain Mapping ; Case-Control Studies ; Frontal Lobe ; pathology ; Gray Matter ; pathology ; Humans ; Magnetic Resonance Imaging ; Temporal Lobe ; pathology ; Trigeminal Neuralgia ; pathology

Objective:To evaluate the early clinical outcomes of 5G remote telesupervised robot assisted total hip arthroplasty in the treatment of Kaschin-Beck disease with hip problems in Tibet through retrospective analysis of the hip surgery cohort.Methods:According to the operation procedure, 55 Kaschin-Beck disease patients (59 hips) undergoing total hip arthroplasty from November 2020 to November 2021 in the Karub District People's Hospital in Qamdo were divided into the conventional THA group (cTHA) and the 5G remote telesupervised robot assisted THA group (rTHA). Two of them underwent cTHA on both hips, while the other two patients underwent cTHA and rTHA separately of each hip, and the rest underwent single hip surgeries. In the cTHA group, there were 30 patients (32 hips), 16 males (17 hips) and 14 females (15 hips), aged 56.56±9.33 years (range, 36-76 years); In the rTHA group, there were 27 patients (27 hips), 10 males and 17 females, aged 55.41±10.90 years (range, 24 to 79 years). Before operation, Harris hip score was recorded and femoral offset (FO) and leg length difference (LLD) were measured via X-ray images. The operation time was collected during the hip surgery and an average network delay of 172.28±36.58 ms and a 1.08% data packet loss ratio is obtained during telesupervision. 24 hours post-operatively, the FO and LLD were both measured via the X-ray images, as well as the inclination and anteversion of the acetabular cup. The Harris scores were collected in the following up. The operation time, FO, LLD, inclination, anteversion and Harris score were compared between the two groups.Results:All cases in both groups were followed up for an average of 9.39±2.43 months (range, 6-19 months). There were no significant differences in pre-operative FO and LLD, preoperative Harris scores or average follow-up time between the two groups. The operation time in rTHA group was 126.41±12.78 min, which is significantly longer than the time 88.81±8.83 min in cTHA group ( t=13.31, P<0.001). After operation, the FO was significantly increased and the LLD was significantly decreased ( P<0.05). The postoperative LLD was 0.63±0.65 cm in the robot group and 1.15±0.71 cm in the conventional group, the difference was statistically significant ( t=2.88, P=0.006). However, there was no significant difference in the FO, inclination and anteversion between the two groups post-operatively ( P>0.05). The Harris scores of both groups were significantly improved compared with that before the operation. Additionally, the Harris score of the two groups was significantly higher than that before surgery, and the postoperative Harris score of the rTHA was 69.00±12.33 higher than that of the cTHA (62.31±11.87), with statistical significance ( t=2.12, P=0.039). The ratio of excellence of Harris score was 19% (5/27) in the rTHA and 9% (3/32) in the cTHA, with no significant difference between groups (χ 2=1.05, P=0.522). Conclusion:Compared to conventional surgery, 5G remote telesupervised robot assisted total hip arthroplasty has more advantages in improving the joint functions in the treatment of hip problems caused by Kashin-beck disease in Tibet Autonomous Region, and facilitates more accurate adjustment of lower limb length difference, even though it consumes more operation time.

Objective To explore the regional spontaneous activity changes in patients with trigeminal neuralgia (TN) using resting-state functional MRI.Methods Resting-state functional MRI datasets were acquired from 30 patients with TN,admitted to our hospital from July 2012 to December 2013,and 20 age,gender and education level matched healthy controls.The regional homogeneity (ReHo) method and independent-sample t-test were used to compare the brain activity differences between these two groups.Results Decreased ReHo values in the left temporal,left pam-hippocampal,as well as increased ReHo values in the bilateral thalamus and left parietal lobe were noted in TN patients as compared with those in the healthy controls.Conclusions The abnormal spontaneous activity exists in TN patients,and these abnormal regions are mainly associated with the perception and processing of pain.In addition,spontaneous activity alternation might promote the exploration of mechanism of TN.