Objective To evaluate the effect of enteral nutrition emulsion on the immunologic function and intestinal mucous barrier in diabetic patients. Methods Eighty diabetic patients were randomly divided into con-trol group (n=40) and enteral nutrition group (n=40). The urine lactulose (L) and mannitol (M) levels and the blood immunologic indicators recorded on day 1 and day 8. Results The L/M ratio was significantly lower in enteral nutrition group than in control group on day 1 and day 8 ( P < 0. 05 ). The IgG level was significantly higher in enteral nutrition group than in control group on day 8 ( P = 0. 02 ). Conclusion Enteral nutrition emulsion can decrease the permeability of intestinal mucous membrane and improve the immunologic function in diabetic pa-tients.

BACKGROUND: The distal femur resection in total knee arthroplasty is commonly made using a fixed angle relative to an intramedullary rod. Does a fixed distal femur resection angle influence radiographic alignment in primary total knee arthroplasty? OBJECTIVE: To research the femoral mechanical-anatomical angle in Chinese and how it affects the femoral component angle and postoperative mechanical alignment for total knee arthroplasty. METHODS: Totally 109 cases (148 knees) underwent primary total knee arthroplasty. One surgeon used a fixed resection angle of 5° (group A; n=56 cases, 76 knees). The second surgeon adjusted the resection angle according to preoperative coronal alignment, using 5° for neutral/mild varus, 6° for more severe varus, 4° for mild valgus and 3° for severe valgus knees (group B; n=53 cases, 72 knees). Preoperative hip-knee-ankle angle, femoral mechanical-anatomical angle, postoperative hip-knee-ankle angle, femoral component angle and tibial component angle were measured from standing hip-knee-ankle angle radiographs. For postoperative hip-knee-ankle angle, 177°-183° were considered as neutral mechanical axis. For femoral and tibial component angles, the target results were 88°-92°.RESULTS AND CONCLUSION: (1) There was no statistically significant difference between groups in postoperative hip-knee-ankle angle (group A: (178.78±3.57)°, group B: (178.23±2.78)°; P=0.302) and good rate of hip-knee-ankle angle (group A: 62%, group B: 65%). (2) The mean femoral mechanical-anatomical angle was (6.70±1.34)°preoperatively. There was no significant difference in the good rate of hip-knee-ankle angle (hip-knee-ankle angle < 7°:69%; hip-knee-ankle angle ≥7°: 55%; P=0.108) postoperatively. There was a statistically significant difference about good rate of femoral component angle between different femoral mechanical-anatomical angle angles (femoral mechanical-anatomical angle < 7°: 76%; femoral mechanical-anatomical angle ≥7°: 39%; P < 0.01). (3) There was a statistically significant correlation between preoperative femoral mechanical-anatomical angle and postoperative hip-knee-ankle angle (r=?0.42, P < 0.01) and postoperative femoral component angle (r=?0.58, P < 0.01). (4) The mean femoral mechanical-anatomical angle was larger than foreign values. When the resection angle less than femoral mechanical-anatomical angle, the femoral component may tend to be varus which could affect the lower extremity mechanical alignment. For the larger femoral mechanical-anatomical angle, we advise to adjust the resection angle according to measured value preoperatively.

BACKGROUND:As a more common method in the orthopedic field, the method of intra-articular injection drugs has distinct curative effects, but there are some complications. In a certain extent, this method caters to the psychological fear of surgery, and can serve as a kind of conservative treatment. But some experts believed that because of the limit of sterile conditions, intra-articular injection of drugs wil increase the risk of intra-articular infection and they opposed this method.
OBJECTIVE:To review the efficacy and adverse reactions of intra-articular injection drugs in recent years, and explain clinical applications of intra-articular injection drugs in orthopedics.
METHODS:A computer-based search was conducted in PubMed and Wanfang database for articles related to the application of intra-articular injection drugs in orthopedics published between January 2007 and December 2013. The English and Chinese key words were“intra-articular, injection, orthopaedics, tranexamic acid, hyaluronic acid, corticosteroid, drugs”. Data were checked in the first trial, old articles and repetitive studies were excluded. The relevant 43 articles accorded with inclusion criteria were reviewed.
RESULTS AND CONCLUSION:In orthopedics, the method of intra-articular injection drugs is simple, economic and effective, but at the same time, there are some side effects. Tranexamic acid by intra-articular injection can significantly reduce blood loss after total joint replacement, is safety and economic. Intra-articular injection joint lubricant can reduce internal friction of joints and improve the adhesion of joint cavity, can be used as a good conservative treatment for osteoarthritis. Intra-articular injection hormone drugs can treat inflammatory arthritis, and short-term curative effect is obvious, but due to large long-term side effects, the method is not recommended now. Intra-articular injection of analgesic drugs and other drugs have both advantages complications. The efficacy of intra-articular injection drugs in orthopedics is obvious;meanwhile, this method has some complications. Orthopedic surgeons should select related drugs by indications. We stil need to further make reasonable regimen with intra-articular injection drugs in future large-scale study.

Objective To discuss the effective nursing method of severe erythema multiforma exudativum children patients complicated with bronchopneumonia.Methods Two cases of erythema multiforma exudativum were reviewed,and the nursing methods were summarized,including protective isolation,care of wound surface,care of intravenous infusions,psychological care,oral care,eyes care,perineal care,care of fever,and discharge instructions.Results Two children patients were both cured.Conclusions For severe erythema multiforma exudativum children patients complicated with bronchopneumonia,proper nursing method and careful observation can decrease the complications and help patients to cure quickly.

BACKGROUND:Tranexamic acid has been more and more used in reducing bleeding after joint replacement, but its usage method and dosage remain controversial, and become a hot focus in recent years. OBJECTIVE:To investigate the efficacy of intra-articular injection of tranexamic acid on postoperative blood loss and limb circumference changes in patients who received unilateral total knee arthroplasty. METHODS:From March to October 2013, clinical data of 90 patients undergoing primary unilateral total knee arthroplasty were randomized to the tranexamic acid group and the control group, including 19 males and 71 females. The 30 patients in the tranexamic acid group received 50 mL of 3%tranexamic acid dilute solution inside knee joint after capsule closure, and 60 patients in the control group received the same volume of physiological saline. No significant difference in age, height, body mass index, anticoagulation, the type of prosthesis, tourniquet time and preoperative diagnosis was detected between the two groups (P>0.05). The amounts of intraoperative and postoperative blood loss and blood transfusion, postoperative drainage volume, the preoperative and postoperative limb circumference 10 cm above the operated knee were recorded. Routine blood test was reviewed after the surgery. RESULTS AND CONCLUSION:There were no significant differences in total blood loss, postoperative drainage volume and limb circumference changes between tranexamic acid and control groups (P>0.05). The amount of postoperative hidden blood loss was significantly less in the tranexamic acid group than in the control group (t=-2.683, P<0.05). These data suggested that the intra-articular injection of tranexamic acid intraoperatively in patients receiving total knee arthroplasty could significantly reduce the amounts of postoperative hidden blood loss, and did not affect the postoperative limb circumference changes.

ObjectiveTo find out the incidence of triple-negative breast cancer(TNBC) in all kinds of breast cancers.To compare and analyze the clinicopathological features,recurrence,metastasis,and prognosis of patients with TNBC and non-triple negative breast cancer (non-TNBC).MethodsThe clinicopathological features and follow-up data of 387 patients with primary breast cancer histopathologically conffirmed in our hospital from Sep.2004 to Sep.2006 were retrospectively analyzed.The 387 patients were divided into 2 groups:79 cases of TNBC and 308 cases of non-TNBC.The clinical features and prognosis of the 2 groups were compared.Results Compared with non-TNBC group,patients in TNBC group had their special features:1.higher ratio of patients ＜ 35 years( P =0.012 ) ; 2.higher ratio of patients with family history of breast cancer( P =0.031 ) ; 3.higher ratio of tumors with maximum diameter ≥ 5 cm ( P =0.044 ) ; 4. higher ratio of patients with positive lymph nodes(P =0.011 ) ; 5.higher ratio of tumors in clinical stage Ⅲ(P =0.007) ; 6.higher ratio of tumors in histological stage Ⅲ(P =0.028 ).The 5-year-disease-free survival (DFS) and overall survival (OS) rate for patients with TNBC were 72.15％ and 88.61％ respectively,lower than those of non-TNBC ( P =0.003 and 0.031 respectively).ConclusionsCompared with non-TNBC patients,patients with TNBC have the features of younger age,more advanced clinical stage upon diagnose,higher rate of lymph node metastasis,larger tumors,higher histological grade,faster and easier recurrence and metastasis,and lower rate of DFS and OS.The information of age,the maximum diameter of the tumor,lymph node status,clinical stage,histological grade and pathological types,especially the age and lymph node status,play an important role in predicting the prognosis of TNBC.

Objective To assess the abstracts on randomized controlled trials ( RCT) in non-small cell lung cancer ( NSCLC) published in Chinese and their influencing factors.Methods RCT in NSCLC published in Chinese were included according to the CONSORT statement and their influencing factors were analyzed by RevMan 5.3 soft-ware.Results The titles were identified as random, randomization, blinding, statistical method, recruited partici-pants, trial registry and fund-supported, respectively, in 20%of the 2677 abstracts included in this study.Con-clusion The titles are identified as random, randomization, blinding, statistical method, recruited participants, trial registry and fund-supported in RCT published in Chinese.Although the abstracts are improved after the publication of CONSORT, they need to be further brushed up.

BACKGROUND:Previous animal studies have revealed that osteogenic growth peptide (OGP) applied locally or systemically could promote fracture healing. But the disadvantages of short in vivo half-life and low oral bioavailability limit its clinical application.OBJECTIVE: To study the encapsulation and delivery of synthetic OGP (sOGP) from biodegradable polymeric microspheres in vitro so as to choose better carrier for the future study.DESIGN: Grouping observation and comparative trail.SETTING: Laboratory of School of Life Science and Technology, Xi'an Jiaotong University.MATERIALS: sOGP was synthesized by Xi'an Langene Bio-science Co., Ltd. with Fmoc system. The purity of sOGP after purification was over 98 % identified by reverse phase high performance liquid chromatography, and the molecular weight of sOGP was 1 523 650, which was consistent with the theoretical value (Mr 1 523 750); the result of whole sequence analysis of sOGP was consistent with the theoretical sequence of OGP. Poly (lactic-co-glycolic acid) (PLGA,50:50, Mr 30 000; 75:25 Mr 80 000) was obtained from Shandong Medical Instrumental Institute (Ji'nan, China)METHODS: PLGA with a 50:50 or 75:25 lactide to glycolide ratio was used for microsphere preparation using a modified double emulsion solvent extraction Water-in-oil-in-water (w/o/w) technique. The surface structure and appearance of microsphere was observed under scanning electron microscope; particle size distribution of microsphere was counted by laser diffraction particle sizer; efficiency of encapsulation, release time and the structural integrity of sOGP released from PLGA were assessed using high performance liquid chromatography (HPLC).RESULTS: ①Spherical microspheres of sOG-PLGA were formulated successfully. The average particle diameter of the PLGA 50:50 microsphere was (19.6±4.5) μm, efficiency of encapsulation (83.9±4.2)% with (83.9±4.2) % drug-loading efficiency, while the PLGA 75:25 microspheres showed an average size of (35.8±3.6) μm, efficiency of encapsulation (65.6±6.8)% with (65.6±6.8)% drug-loading efficiency. ②HPLC results indicated that sOGP were not chemically altered,physically aggregated but presented a intact structure as the original sOGP. An initial burst release was observed for both PLGA microspheres, especially from PLGA 75:25. sOGP was released from PLGA 50:50 microsphere for 56 days,and from PLGA 75:25 microspheres for over 70 days. The cumulative release of sOGP from PLGA 50:50 for 35 days was significantly lower than from PLGA 75:25 (P ＜ 0.05).CONCLUSION: The controlled release of sOGP encapsulated within PLGA 50:50 is better than the delivery from PLGA 75:25. Moreover, the release time could meet the requirements for fracture or bone defect site.

Objective To assess the methodology of papers on systematic reviews and meta-analysis of interventions published in Journal of Evidence-Based Medicine .Methods Basic data were extracted from 70 papers on systematic reviews and meta-analysis of interventions published in Journal of Evidence-Based Medicinefrom 2001 to 2011 .Methodology used in these papers was assessed according to the AMSTAR Scale.The data were input into the Excelland analyzed using the SPSS7.0 and Meta-Analyst software.Results The methodology used in 34 papers (48.6%) was assessed using the Cochrane bias risk assessment tools.Fund support, number of authors and their affiliated institutions did not sig-nificantly affect the total score of methodology used in the 70 papers .Conclusion The methodology used in papers on systematic reviews and meta-analysis of interventions published in Journal of Evidence-Based Medicine is not quite valid as its early design program and retrieval strategies are imperfect , and it does not provide the excluded literature list and the interest conflict.

Objective To analyze the risk factors of fevers after percutaneous nephrostolithotomy (PCNL) and to determine a more effective prophylaxis method.Methods A retrospective analysis of 320cases who underwent PCNL for renal calculi from 2008 to 2011 (men 233,women 87,age between 22 years to 72 years) was made.The average age of the patients and the average diameter of the stones were 42 years and 3cm(0.8 -6 cm),respectively.We analyzed factors such as age ( ＞60 years and ≤60 years),stone size ( ＞2.0 cm and ≤2.0 cm),operative time ( ＞60 min and ≤60 min),irrigation pump pressure ( ＞120 mm Hg and ≤ 120 mm Hg),obstructive conditions,preoperative urinary tract infection and fever.Wethen compared the fever rate with each of the risk factors.Results There were 59 cases with fever after PCNL; 18.4％ of the cases had a temperature over 38 ℃.There were two cases of pyemia.The patients whose stone diameter ＞ 2 cm had a post-operative fever rate of 22.4％.The fever rate in patients whose stone diameter ≤2.0 cm was 10.4％.The fever rate in patients with an operative time ＞60 min and ≤60 min was 27.2％ and 10.4％,respectively.Patients with irrigation pump pressure ＞ 120 mm Hg and ≤ 120mm Hg had post-operative fever rates of 28.3％ and 11.0％,respectively.There was statistical significance between each post-operative fever risk factor group.Conclusions The post PCNL fever risk factors are stone diameter ＞ 2.0 cm,operation time ≤60 min and irrigation pump pressure ＞ 120 mm Hg.The effective prophylaxis policy of post-operative fever are the pre-operative using of broad-spectrum antibacterial agents,shorter operative time and lower irrigation pump pressure.A two-stage operation procedure will also reduce the post-operative fever.