BACKGROUND:Currently, the study of total hip arthroplasty in elderly is more. Perioperative treatment and postoperative rehabilitation are increasingly perfect, but the study of middle-aged total hip arthroplasty is less, especialy long curative effect in postoperative and long-term folow-up stil has many problems to be solved. In China, there are few studies addressing how to select the prosthesis during total hip arthroplasty in middle-aged patients, which kind or material of prosthesis is better, so the evidence for clinical application is less. OBJECTIVE:To compare and analyze the repair effects of bone cement total hip arthroplasty and uncemented total hip arthroplasty in middle-aged patients. METHODS:A total of 60 middle-aged patients who received total hip arthroplasty in the Department of Orthopedics, Xinjiang Uygur Autonomous Region Chinese Medicine Hospital from January 2005 to January 2008 were folowed up for 5 years. Their mean age was (37±6) years. There were 32 cases undergoing uncemented total hip arthroplasty and 28 cases receiving bone cement total hip arthroplasty. At 6 months, 2 and 5 years after replacement, Harris score for recovery of limb function and imaging findings were compared and analyzed. RESULTS AND CONCLUSION: Harris score for recovery of limb function was significantly better in the uncemented total hip arthroplasty group than in the bone cement total hip arthroplasty group at 6 months, 2 and 5 years after replacement (P < 0.01). No complications were found at 6 months in the uncemented total hip arthroplasty group, but one case affected osteolysis at 2 years and two cases experienced prosthesis loosing at 5 years after arthroplasty. In the bone cement total hip arthroplasty group, two cases had osteolysis and one case had prosthesis loosing at 6 months after arthroplasty, three cases had prosthesis loosing at 2 years, and two cases affected linear permeability dissolvement at 5 years after arthroplasty. These findings suggest that uncemented prosthesis achieved a high rate of functional restoration and a low rate of complications in middle-aged patients. Uncemented total hip arthroplasty had satisfactory clinical and radiographic outcomes at a minimum of 5-year folow-up.

BACKGROUND:Artificial total disc replacement is one treatment of low back pain in recent years, but the report on the effect of disc replacement on lumbar sagittal plane is rare. OBJECTIVE:To analyze the effect of lumbar disc replacement on lumbar lordosis. METHODS:Retrospective analysis of radiographic data of 17 patients who underwent lumbar disc replacement for single segment degenerative disc disease was carried out. Data measurement included preoperative and postoperative lumbar lordosis, diseased segmental lordosis and lumbar intervertebral angle. RESULTS AND CONCLUSION:Al the 17 patients were fol owed-up for more than 12 months. Lumbar disc replacement was performed at L4-5 segment in three cases and L5-S1 segment in 14 cases. The average diseased segmental lordosis and lumbar lordosis were increased significantly after replacement when compared with those before replacement (P<0.05);the lumbar intervertebral angle was increased after replacement when compared with that before replacement, but the difference was not significant. The results indicate that lumbar disc replacement for the treatment of single segment degenerative disc disease can increase the lumbar lordosis and diseased segmental lordosis, which can help to improve the lumbar sagittal balance. The postoperative lumbar intervertebral angle has no correlation with the implant angle of the prosthesis on the replace segment.

BACKGROUND:Transforaminal endoscopic discectomy needs to dissociate the ligamentum flavum, and if
combined with the continuous dilator and working channel, it can keep the intact ligamentum flavum no matter how smal the incision may be (even 3-5 mm).
OBJECTIVE:To present the technique of interlaminar endoscopic lumbar discectomy with ligamentum flavum splitting.
METHODS:We performed operations on 16 male and 14 female patients by interlaminar endoscopic lumbar
discectomy with ligamentum flavum splitting. The average age of the patients in the study was (48±15) years. The chief complaint before surgery was radiculopathy confined to one leg. The anatomic operative level was L 3-4 in
one case, L 4-5 in 13 cases and L 5-S 1 in 16 cases. The ruptured disc migrated superiorly in four cases and
inferiorly in seven cases, and intraoperative electromyo-graphic monitoring was performed in al surgeries. The
ligamentum flavum was split, and after withdrawing the working channel, the ligamentum flavum could reset itself. RESULTS AND CONCLUSION:The total operation time was 20-40 minutes, and the fol ow-up period was
(149±108) days. There were no abnormal signals on the intraoperative electromyography in any cases, and the reported symptoms were immediately improved in al patients after the operation. Fol ow-up magneticresonance imaging showed a disappearance of the ruptured disc without defect in the ligamentum flavum. There were no operation-associated complications in al the patients. Interlaminar endoscopic lumbar discectomy with
ligamentum flavum splitting is a feasible approach.

BACKGROUND:The selection of metal implant for old patients with femoral intertrochanteric fracture should focus on patient’s age, osteoporotic degree, perioperative status and type of fracture. Individual therapeutic program should be made. OBJECTIVE:To compare the therapeutic effects of four types of metal implant fixation for femoral intertrochanteric fracture in old patients. METHODS:180 old patients with femoral intertrochanteric fractures treated from September 2009 to September 2012 were analyzed. Four kinds of metal implants were used for repair of fracture. There were 45 patients in the dynamic hip screw group, proximal femoral nail anti-rotation group, Gamma nail group and anatomical dynamic hip lock nickelclad group, separately. Operation time, blood loss, hospital time, Harris score after operation, fracture healing time and complications in different groups were compared. RESULTS AND CONCLUSION:Operation time and hospital time were shorter, and blood loss was fewer in the anatomical dynamic hip lock nickelclad group and proximal femoral nail anti-rotation group compared with the dynamic hip screw group and Gamma nail group (P<0.05), but the excellent and good rate of Harris score after operation was higher (P<0.05). No significant difference was detected between anatomical dynamic hip lock nickelclad group and proximal femoral nail anti-rotation group (P>0.05). The incidence of complications was significantly lower in the anatomical dynamic hip lock nickelclad group and proximal femoral nail anti-rotation group compared with the Gamma nail group and dynamic hip screw group (P<0.05). Results suggested that anatomical dynamic hip lock nickelclad and proximal femoral nail anti-rotation are reliable in treatment of intertrochanteric fracture in old patients, show less postoperative complications, and are ideal choices for implant fixation of femoral intertrochanteric fracture in old patients.

Objective To investigate the feasibility,security,indication and prophylactic measures of postpartum hemorrhage during the fetalintrapartum operation by analyze the maternal prognosis after intrapartum fetal operation(IFO) performed.Methods We performed a retrospective evaluation of 10 cases that has been performed intrapartum fetal operation(IFO group,n=10) successfully between August 2008 and October 2009 at Department of Obstetrics and Gynecology,Shengjing Hospital,China Medical University.Healthy pregnant women(n=10) were chosen as control group,who received Caesarean section for refusing to vaginal delivery.Between the two groups,we compared the indexes including blood lose during the operation and 24 hours post-operation,the hemoglobin level pre-operation and 24 hours post-operation,the involution of uterus,the puerperal infection,and the follow-up at 42 days post-operation.Results Good involution,no primary and secondary postpartum hemorrhage and no puerperal infection were found in both of the 2 groups.Intra-operation,24 hours post-operation and the total volumes of blood lose,the hemoglobin level before operation,24 hours post-operation and 42 days post-operation had no statistic significant difference between the IFO group and control group(P>0.05).No significant difference was found in the operation time between IFO group and the control group(66.40±53.40 minutes and 34.50±4.97 minutes,respectively.Intra-operation,24 hours post-operation and the total volume of blood lose had no relation to the maternal age and gestational weeks(P>0.05).The blood lose of intra-operation in IFO group had positive linear correlation to the operation time.(Pearson relation coefficient R=0.458,.P=0.021).The linear recurrence equation was:the volumes of blood lose intra-operation(ml)=172.68+1.342x(operation time).Conclusion IFO was safe to the mother.It did not affect the involution of uterus and could not increase the blood lose of postpartum and the puerperal infection morbidity.Through the effective measures of preventing postpartum hemorrhage,the postpartum blood lose of the patients that performed intrapartum fetal operation could be no more than that of the patients that had normal Caesarean section.Improving the technique of the intrapartum fetus operation and shortening the operation time are important to prevent postpartum hemorrhage.

Objective To evaluate the role of multi-slice CT (MSCT) perfusion in early diagnosis of liver fibrosis. Methods Thirty-three subjects underwent CT perfusion of the liver. Among whom, 11 subjects were volunteers without hepatic disease and the other 22 subjects were pathologically confirmed with liver fibrosis who were further divided into slight (n= 10) and severe (n=12)liver fibrosis according to the lshak system. Parameters of CT perfusion were measured and compared among three groups. Results The mean hepatic arterial fraction in controls, light and severe fibrosis tended to increase with the severity of liver fibrosis[(18. 49 ± 9. 69) %, (19. 92 ± 6.01) % and (21.31±7.47)% ,respectively], and the mean mean transit time tended to decrease with the severity of liver fibrosis [(13.80 ± 2. 60) s, (12.35 ± 1.31) s and (12.19 ± 3.33) s, there was no significant difference in all parameters between any two groups (P>0.05). Conclusions Quantitative measurement of hepatic blood supply can be obtained by CT perfusion. Some parameters will be helpful in staging fibrosis to a certain extent. But its clinical usefulness for the evaluation of the early diagnosis may not be affirmed yet.

Objective To assess the efficacy and safety of oral fosfomycin trometamal in patients with lower urinary tract infections ( UTIs) caused by multi drug resistant ( MDR) bacteria in the clinical setting in China.Methods Multicenter study was conducted from January 2011 to December 2011 in 12 hospitals in China.Three hundred and fifty-six patients with non-fever lower UTls were treated by fosfomycin trometamal 3 g once daily.Three hundred and fifty cases with complete data were further evaluated .One hundred and twenty ( 34.3%) were male and 230 ( 65.7%) were female.The average age was ( 49.9 ± 16.6) years.Depending of the results of urine culture at the first visit ,142 patients with E.coli, Klebsiella pneumonia, proteus, Staphylococcus aureus, Staphylococcus epidermidis and entercocous were analyzed.The susceptibility of MDR bacteria to fosfomycin trometamol were calculated . The clinical efficacy , bacteriological efficacy of fosfomycin trometamol to these patients was evaluated .Results For the gram-negative bacteria detected by culture , among the E.coli, Klebsiella pneumonia and proteus, 50%(52/104) were Extended-Spectrum β-lactamases producing organisms . For the gram-positive bacteria ( n =38 ) detected by culture, methicillin-resistant staphylococcus accounts for 55%(11/20) of all the Staphylococcus and the other gram-positive bacteria were Enterococcus ( n=18 ) .Higher susceptibility rates to fosfomycin trometamol were observed among MDR bacteria (85.7%) and the clinical effective rate and bacteriological effective rate of fosfomycin trometamol were 96.4%( 53/55 ) and 87.5%( 42/48 ) , respectively .The incidence of drug-related adverse events (AEs) was 5.6%(20/356).The most common AE was diarrhea. No drug-related serious adverse events were found .Conclusions The distributions of uropathogens in China are complicated. The detection rate of MDR uropathogens is high . The dosing regimen of fosfomycin trometamal 3 g once daily is effective and tolerable for the patients with lower UTIs caused by MDR bacteria . It may represent good options for the empiric therapy for the patients with lower UTIs .

Objective:To explore the intervention effect of moderate intensity aerobic exercise on body composition and glycolipid metabolism in obese adults.Methods:This was a self-controlled study, which enrolled 280 obese adults who received weight loss treatment in the Health Management Institute of the Chinese PLA General Hospital from November 2017 to March 2018 and performed a 12-week precise aerobic exercise intervention (40%-60% of heart reserved rate) based on an independently developed aerobic exercise intervention system for chronic diseases. The following requirements also need to be met as effective exercise time of ≥40 minutes every time, total exercise time of ≤100 minutes per day, effective exercise time of ≥200 minutes per week, exercise frequency of ≥4 times per week, and an interval of ≤48 hours between two exercises. During the research, 77 subjects were excluded due to illness, sports injuries, work reasons, etc., and 203 subjects were included in the analysis. These patients were divided into three groups based on weekly exercise duration, including 97 cases in short-term group (weekly exercise time <300 minutes), 63 cases in medium-term group (weekly exercise time of 300-400 minutes), and 43 cases in long-term group (weekly exercise time >400 minutes). Paired t-tests were used to compare the differences in indicators before and after intervention, and covariance analysis was used to compare the differences in indicators among three groups. The intervention effect of moderate intensity aerobic exercise on the body composition and glucose and lipid metabolism in obese adults was analyzed. Results:The resting heart rate, body weight, body mass index, body fat rate, body fat mass, muscle mass, visceral fat area, subcutaneous fat area, fasting insulin, insulin resistance index, total cholesterol, triglycerides, and low-density lipoprotein cholesterol were all decreased significantly in the 203 patients after the intervention [(66.67±9.38) vs (71.48±10.13)/min, (86.02±13.13) vs (90.16±13.93) kg, (30.33±3.08) vs (31.80±3.27) kg/m 2, 35.64%±7.19% vs 37.87%±7.21%, (30.78±8.14) vs (34.30±8.73) kg, (52±10.30) vs (52.74±10.61) kg, (100.82±38.63) vs (119.53±43.08) cm 2, (270.14±74.19) vs (305.24±77.12) cm 2, (12.33±6.92) vs (17.86±14.23) mmol/L, 3.08±2.22 vs 4.52±4.09, (4.42±0.78) vs (4.62±0.89) mmol/L, (1.46±0.82) vs (1.71±1.11) mmol/L, (2.93±0.70) vs (3.08±0.80) mmol/L] (all P<0.05). The reduction degree of indicators including body weight, body mass rate, body fat rate, and body fat mass were all significantly higher in long-term group when compared with those in medium-term and short-term group [(5.56±0.62) vs (3.97±0.51) vs (3.63±0.41) kg, (1.98±0.21) vs (1.39±0.17) vs (1.31±0.14) kg/m 2, 3.38%±0.40% vs 2.27%± 0.33% vs 1.69%±0.27%, (4.90±0.53) vs (3.54±0.43) vs (2.89±0.35) kg]. Besides, patients in long-term group had significantly higher reduction degree of fasting insulin and higher rising degree of high-density lipoprotein cholesterol [(7.38±0.94) vs (4.54±0.62) mmol/L, (0.07±0.02) vs (0.01±0.02) mmol/L] and higher reduction degree of visceral fat area [(28.45±4.53) vs (12.55±3.67) cm 2] than medium-term group (all P<0.05). Conclusions:Moderate intensity aerobic exercise can be an effective intervention for the body composition and glycolipid metabolism in obese adults. If the weekly exercise time is greater than 400 minutes, the potential benefits of improvement may be more evident.

Objective:To investigate the role of RNA m6A reader YTHDF2 in neurodegeneration of the aged mice.Methods:Eighteen 18-month-old control C57BL/6 mice and 22 Ythdf2 conditional knockout (cKO) mice of the same age (that exhibited significant aging characteristics) were used. Five pairs of mice were used for morphological analysis. Thirteen control mice and 17 cKO mice were used for behavioral experiments. Immunofluorescence analysis was performed to detect the expression of YTHDF2 in the brains of 18-month-old C57BL/6 mice. After establishing the neural progenitor cell-specific knockout mice of Ythdf2, their phenotypes were analyzed through comparison of body weight, brain weight and H&E staining. Subsequently, immunohistochemistry and immunofluorescence analyses were used to detect the expression of various neural cell-specific markers in the aged control mice and Ythdf2 cKO mice. Finally, behavioral tests, including the open field test, new object recognition, and water maze, were used to assess the levels of anxiety, depression, learning and memory abilities.Results:Immunofluorescence staining showed that YTHDF2 was mainly expressed in the neurons. Compared with the age-matched control mice, there was no significant change in the body weight of the Ythdf2 cKO mice, but the brain weight decreased significantly ( P<0.05). The immunostaining showed that Ythdf2 cKO mice had fewer neurons, fewer astrocytes with defective morphology, more microglia and activation of microglia ( P<0.05). Behavioral tests showed that the aged Ythdf2 cKO mice exhibited impaired movement, learning and memory abilities ( P<0.05). Conclusions:YTHDF2 is mainly expressed in the neurons of the aged brain. Conditional knockout of Ythdf2 causes quantitative and structural abnormalities in hippocampal neuronal cells, and impairs motor ability and learning and memory of the aged mice, suggesting that YTHDF2 plays an important role in neurodegeneration of the aged mice.

Objective:To investigate the perioperative impact of closure of mesenteric fissure in laparoscopic right hemicolectomy.Methods:The prospective randomized controlled trial was conducted. The clinical data of 320 patients who underwent laparoscopic right hemicolectomy in 11 medical centers, including The First Affiliated Hospital of China Medical University et al, from November 2022 to August 2023 were selected. Based on block randomization, patients were alloca-ted into the mesenteric fissure non-closure group and the mesenteric fissure closure group. Observa-tion indicators: (1) grouping of the enrolled patients; (2) intraoperative conditions; (3) postopera-tive conditions. Measurement data with skewed distribution were represented as M( Q1, Q3) and com-parison between groups was conducted using the Mann-Whitney U test. Count data were represen-ted as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test or Fisher's exact probability. Comparison of ordinal data was conducted using the rank sum test. Comparison of visual analog scores was analyzed using generalized estimating equations. Results:(1) Grouping of the enrolled patients. A total of 320 patients with colon cancer were screened for eligibility, including 156 males and 164 females, aged 68(59,73)years. All the 320 patients were allocated into the mesenteric fissure non-closure group with 164 cases and the mesenteric fissure closure group with 156 cases. There was no significant difference in the age, body mass index, American Society of Anesthesiologist score, maximum tumor diameter, anastomosis location, anastomosis method, surgical approach, range of lymph node dissection, tumor staging between the two groups ( P>0.05) and there was a significant difference in the sex between them ( P<0.05). (2) Intraoperative conditions. There was no significant difference between the mesenteric fissure closure group and the mesenteric fissure non-closure group in the volume of intraoperative blood loss, operation time, conversion to laparotomy, intraoperative complication ( P>0.05). Three patients in the mesenteric fissure non-closure group were converted to laparotomy. One patient in the mesenteric fissure closure group was converted to laparotomy, and 2 cases with intraoperative complication were mesenteric hematoma. (3) Postoperative conditions. There was no significant difference between the mesenteric fissure non-closure group and the mesenteric fissure closure group in the overall postoperative complications ( χ2=0.28, P>0.05). There was no significant difference in the occurrence of postoperative intestinal obstruction, abdominal distension, ascites, pleural effusion, gastric paralysis, anastomotic bleeding, anastomotic leakage, or surgical wound infection between the two groups ( P>0.05). There was no significant difference between the two groups in the reoperation, postoperative gastric tube replacement. There was no significant differ-ence in time to postoperative first flatus, time to postoperative initial liquid food intake, time to post-operative resumption of bowel movements, duration of postoperative hospital stay, total hospital expenses between the two groups ( Z=-0.01, 0.43, 1.04, -0.54, -0.36, P>0.05). One patient in the mesenteric fissure non-closure group received reoperation. No perioperative internal hernia or death occurred in either group. The visual analog score decreased with time in both groups. There was no significant difference in the visual analog score between the mesenteric fissure closure group and the mesenteric fissure non-closure group [ β=-0.20(-0.53,0.13), P>0.05]. Conclusion:Compared with closure of mesenteric fissure, non-closure of mesenteric fissure during laparoscopic right hemi-colectomy dose not increase perioperative complications or postoperative management risk.