Objective To analyze the risk factors related to intraoperative femur fracture in hip replacement and discuss the treatment countermeasures. Methods The medical records and radiographs of 38 patients with intraoperative femur fracture who were treated at Tianjin Orthopedic Hospital from December 2002 to December 2009 were retrospectively studied. Fractures were classified according to the Amstutz system or AAOS standard and the treatment methods were selected accordingly. Reduction and fixation was performed in 25 patients including 14 patients treated with interfragmentary or cerclage fixation, five with plate fixations and six with cortical strut graft. Shank prosthesis was replaced in 12 patients. Results The mean follow up period was 4.5 years, which showed successful union of the fractures in 36 patients and delayed union in two. Replacement of the prosthesis was needed in one patient for prosthesis loosening four years postoperatively. Conclusions Osteoporosis, violence, abnormal femur canal and over large prosthesis are the main causes of intraoperative femur fracture in hip replacement.Proper selection of treatment method according to fracture types may attain fracture union with a stable implant.

Objective To quantitatively evaluate the difference in global longitudinal strain(GLS)and global circumferential strain (GCS)of three-layers of cardium between diabetes mellitus (DM)patients using layer-specific speckle-tracking imaging.Methods Fifty-seven DM patients and sixty matched controls were enrolled in the study.GLS and GCS of three-layer cardium were assessed using layer-specific speckle-tracking imaging,available by GE Vivid E9 and EchoPac workstation.Results GLS of three-layer cardium in DM patients were significantly lower than those in normal controls (all P <0.05).GCS of endo-and mid-cardium were significantly lower in DM patients than in normal controls (P < 0.05 ).There was no statistical difference of GCS of epi-cardium between the two groups (P > 0.05 ).GLS and GCS of three-layer cardium was highest in endo-cardium and lowest in epi-cardium.Conclusions GLS of three-layer cardium may be a sensitive indicator of early left ventricular systolic dysfunction in DM patients with normal ejection fraction.

ObjectiveTo study the indications and mid-term outcomes of periacetabular osteotomy on adult patients of developmental dysplasia of the hip (DDH). MethodsTwenty-five adult patients with DDH underwent periacetabular osteotomies through modified Smith-Peterson approach. There were 19 females and 6 males with an average age of 25.5 years(range, 18-45). Every patient had a single dysplasia hip, including 14 hips in the left, and the other 11 in the right. Three cases were operated formerly, 2 of them received Chari osteotomy and 1 received Salter osteotomy. Before operation 13 hips were T(o)nnis Grade 0 osteoarthritis, 9 hips were Grade Ⅰ , 3 hips were Grade Ⅱ. The Shenton line of 18 hips was broken. The lateral center-edge angle was 4.57°±7.39°, the anterior center-edge angle was 0.95°±6.02°, the horizontal tilt angle was 32.50°±5.96°, the femoral head extrusion index was 38.11％±5.70％, the Harris hip score was 75.32±7.51 points. Changes of the indexes mentioned above were observed during the period of follow-up.ResultsAll patients were followed up for average 4.5 years(range, 2.0-7.5). Compared with the preoperative radiographic severity at the latest follow-up, 3 hips of T(o)nnis Grade Ⅰ improved to Grade 0, 2 hips of Grade Ⅱ improved to Grade Ⅰ, 1 hip of Grade Ⅰ changed into Grade Ⅱ. The incident of the break of Shenton line decreased to 10 hips. The lateral center-edge angle improved to 29.07°±5.81° the anterior centeredge angle improved to 29.52°±4.51°, the horizontal tilt angle decreased to 19.17°±4.95°, the femoral head extrusion index decreased to 24.20％±4.83％, the Harris hip score increased to 84.88±4.88 points. The major complication included 16 cases of lateral femoral cutaneous nerve palsy(7 cases of them didn't recover forever) and 1 case of ectopic ossification of Brooker Ⅰ . ConclusionPeriacetabular osteotomy through a modified Smith-Peterson approach were performed to the dysplasia hip of adults, it can increase congruence,improve hip function; it can also prevent subchondral sclerosis and cysts forming, preserve joint space and delay the occurrence of osteoarthritis.

Objective To investigate the association between serum ferritin(SF) level at early and mid trimester of pregnancy and gestational diabetes mellitus (GDM) and insulin resistance (IR).Methods A total of 192 cases of women who were accepted antenatal examination from the first trimester of pregnancy at Yueqing People Hospital from July,2012 to October,2013 was prospectively analyzed and followed up.All cases were divided into two groups:96 cases of GDM pregnant women who were diagnosed as GDM at mid trimester of pregnancy as GDM group,and 96 cases of pregnant women with normal glucose tolerance at the same time as the control,normal glucose tolerance (NGT group).The differences in clinical data were compared between two groups.The relationship between SF level and fasting plasma glucose (FPG),fasting insulin (FINS),homeostasis model assessment insulin resistance (HOMA-IR),and C-peptide was investigated with Spearman rank correlation analysis.The predictive values of SF and relative variables to GDM were calculated by receiver operating characteristic curve (ROC) or Logistic regression analysis.Results (1) There was statistically significant difference in body weight and body mass index (BMI) at prepregnancy and mid trimester of pregnancy,Hb,FPG,FINS,SF,and C-peptide at the first trimester of pregnancy,SF level and FPG and HOMA-IR and C-peptide at mid trimester of pregnancy between two groups (P ＜ 0.01 or P ＜ 0.05).(2) As showed by Spearman rank correlation analysis,there was statistical correlation between SF at mid trimester of pregnancy,and FPG,FINS,HOMA-IR and C-peptide (P ＜0.01 or P ＜ 0.05);while no statistical correlation was found between SF at the first trimester of pregnancy and the same factors above (P ＞ 0.05).(3) The area under the ROC curve of SF at mid trimester of pregnancy for GDM was 0.653.The sensitivity and specificity were 68.8％ and 59.4％ in predicting GDM at the cut-off value of 16.61 ng/ml.As showed by Logistic regression analysis,high level of SF at mid trimester of pregnancy was a independent risk factor for GDM.Odds ratio (OR) was 1.032 (95％ CI:1.008 ～ 1.058,P ＜ 0.01).Conclusions The relationship between SF at different trimester of pregnancy and GDM is variant.There is relationship between high level SF of mid trimester of pregnancy in GDM pregnant women and IR.The level of SF might predict the occurrence of GDM.

Objective To investigate the risk factors of bronchopulmonary dysplasia(BPD)in very low birth weight infant.Methods The clinical data of 49 very low birth weight infants in our NICU from Sep 2006 to Sep 2009 were reviewed,and divided into BPD group(n =15)and without BPD group(n =34).The risk factors of BPD were analysed.Results Compared with the infants without BPD,there were significant differences in gestational age[(29.30 ± 1.48)week vs(30.54 ± 1.60)week],hospital-acquired infection(9 cases vs 10 cases),intrauterine infection(9 cases vs 8 cases),the time for continuous positive airway pressure(CPAP)[(12.47 ± 5.83)d vs(4.24 ± 4.19)d],the time for hyperoxia[(1.47 ± 1.41)d vs (0.18 ±0.63)d],patent ductus arteriosus(5 cases vs 1 cases)(P＜0.05).Logistic regression revealed that intrauterine infection and the time for CPAP were independent risk factors of BPD(P ＜0.05).Conclusion Prophylaxis of intrauterine infection may decrease the mortality and severity of BPD.The prolonged time for CPAP may predict the risk of BPD.

AIM: To investigate the effects of PAR-2 agonist peptide on the proliferation and cytosolic calcium concentration ([Ca~(2+)]_c) in human hepatoma cells HepG2. METHODS: Human hepatoma cell line HepG2 was cultured. The cells were treated with PAR-2 agonist peptide SLIGKV-NH_2 and the reverse PAR-2 agonist peptide VKGILS-NH_2, respectively. The [Ca~(2+)]_c of hepatoma cells were measured by microfluorimetric techniques based on calcium indicator fura-2/AM. The influences on proliferation of hepatoma cells were determined by MTT method. The changes of cell cycle were evaluated by flow cytometry, and the changes of cyclin D1 mRNA expression were detected by RT-PCR. RESULTS: After treated with 50 μmol/L SLIGKV-NH_2, a rapid rise of [Ca~(2+)]_c in HepG2 cells was induced (P<0.01), percent S phase, G_2/M phase and proliferation index (PI) of HepG2 cells were elevated (P<0.01), and cyclin D1 mRNA expression was significantly upregulated (P<0.01). The proliferation rates of HepG2 cells treated with 1-50 μmol/L SLIGKV-NH_2 were significantly increased, and the effect was in a dose-dependent manner (P<0.01 or P<0.05). No statistical significance of the difference between VKGILS-NH_2 and control group was observed (P>0.05). CONCLUSION: PAR-2 agonist peptide induces the rise of [Ca~(2+)]_c in HepG2 cells, upregulates the expression of cyclin D1 mRNA, accelerates the progress of cell cycle, promotes the synthesis of DNA and the proliferation of hepatoma cells via activating PAR-2 in vitro.

Objective To investigate the effect and mechanism of oxymatrine on invasion and metastasis of human pancreatic cancer line SW1990 in vitro. Methods Human pancreatic cancer cell line SW1990 was cultured in vitro. Oxymatrine was added into the culture media of SW1990 cells. Then MTT assay was used to determine the effect on proliferation. The adhesive capability, the mobile ability and invasive ability of SW1990 cells were detected by the adhesion assay, the crossing-river test, the transwell migration assay and the matrigel invasion method, respectively. RT-PCR was used to detect the mRNA expression of MMP-2 and VEGF. ELISA method was used to detect the protein levels of the VEGF. Results The growth of SW1990 cells was inhibited by oxymatrine in a dose and time-dependent manner. After 2 mg/ml of oxymatrine treatment for SW1990 cells for 1 h, the adhesive capability inhibitory rate was (35.23 ±8.56) % ; 24 h later, crossing-river time was (65.46 ±4.25) h, which was significantly longer than that in control group [ (34.50 ± 4.12) h, P <0.05)], the number of penetrating cells was 91.9 ±9.6, which was significantly lower than that in control group (144.2±17.2, P <0.05). The mRNA expression of MMP-2 and VEGF, expression of protein of VEGF in SW1990 cells was significantly down-regulated [0.515 ±0.063 vs. 0.817 ±0.054, 0.343 ± 0.072 vs. 0.650 ±0.068; (265.50 ±5.45) pg/ml vs. (441.06 ±16.70) pg/ml, P <0.05]. Conclusions Oxymoron can inhibit the invasion and metastasis ability of pancreatic cancer line SW1990 in vitro, and the mechanism is possibly related to the down-regulation of MMP-2 and VEGF expression.

Objective To retrospectively analyze the clinical characteristics of 5 cases with recurrence of congenital tracheoesophageal fistula (rTEF) and to further understand the diagnosis and treatment of this disease.Methods We totally diagnosed 5 cases of rTEF from September 2015 to July 2016 in the department of respiration of Shenzhen Children′s Hospital.The clinical materials,characteristics,risk factors of recurrence and diagnostic methods were analyzed.Results Two cases were diagnosed of rTEF at 8 years after the first repair,one case was at one year after the initial repair and two cases were at 1 to 2 months after their operations.Three cases manifested mainly in bucking after feeding,recurrent pneumonia and growth retardation.One case was admitted for vomiting and abdominal distension.One case was asymptomatic.Esophageal anastomotic leaks occurred in three cases and esophageal trictures occurred in four cases after their repairs.Three cases accompanied with gastroesophageal reflux and five cases with tracheomalacia.Four cases were performed esophagography,but only two cases were suspected of recurrence.All of five cases were performed bronchoscopy.One case was diagnosed of rTEF directly.Two cases were found suspected fistulas.And another two cases were only found surgical scars.But these four cases were confirmed by Methylene blue test observed by bronchoscopy.Conclusion Although the leading clinical manifestations of rTEF are respiratory symptoms and feeding difficulties,sometimes rTEF is asymptomatic.Because rTEF is usually complicated with the other diseases with similar symptoms,it is possible to miss the diagnosis.Esophageal anastomotic leaks and trictures are the risk factors of recurrence.Bronchoscopy is the first choice for the diagnosis of rTEF,and Methylene blue test is golden standard.Thoracotomy is recommended for the treatment of rTEF.

Objective:To evaluate the changes of quality of life in patients with axial spondyloarthritis (ax-SpA) after treatment with non-steroidal anti-inflammatory drugs (NSAIDs) by the 36-item Short Form Health Survey (SF-36).Methods: 120 patients diagnosed with ax-SpA were collected in the first Affiliated Hospital of Zhengzhou University from October 2014 to September 2015.They all agreed to be treated with the special drugs and assessed by special scale.Then they all signed the agreement.In the 3 months,double-blind,parallel controlled trial patients were randomized to 200 mg twice daily (bid) imrecoxib,or 200 mg twice daily (bid) celecoxib.They were assessed for the changes of quality of life at enrollment and after three months of NSAIDs therapy by the SF-36 of Chinese edition.The correlation between quality of life and erythrocyte sedimentation rate (ESR),C-reactive protein (CRP),Bath Ankylosing Spondylitis Disease Activity Index (BASDAI),Bath Ankylosing Spondylitis Functional Index (BASFI),Spondylo Arthritis Research Consortium of Canada (SPARCC) was analyzed.Results: A total of 116 ax-SpA patients completed the study and 4 patients were lost to follow-up.We used the SF-36 scale to assess the quality of life in patients with ax-SpA before and after 3 months,NSAIDs treatment.The treatment effects were not statistically significant difference between the two drugs (P>0.05).After all the patients were treated with NSAIDs for 3 months,there was statistically significant difference (P<0.05) of the physical functioning,role-physical,bodily pain,general health,social functioning,role-emotional;and there was no statistically significant difference (P>0.05) of vitality and mental health.The positively significant correlations had been identified between BASDAI and PF,RP,BP,GH,VT,SF,RE (P<0.05),while no significant correlation was found between BASDAI and MH (P>0.05).A positively significant correlation had been identified between BASFI and PF,RP,BP,GH,SF,RE,MH (P<0.05),while no significant correlation was found between BASFI and VT (P>0.05).The ESR was positively correlated with SF,RE (P<0.05);and CRP was positively correlated with SF,MH (P<0.05);and SPARCC was positively correlated with PF (P<0.05).BASDAI and BASFI were the important influence factors of PF (P<0.05);and BASDAI was the important influence factor of BP,GH,VT,RE(P<0.05);BASFI was the important influence factor of RP,SF,MH(P<0.05).Conclusion: Non-steroidal anti-inflammatory drugs can improve the quality of life of the ax-SpA patients.Imrecoxib and celecoxib have the equivalent curative effect.SF36 scale is suitable for the assessment of the quality of life in patients with ax-SpA.

AIM: To study the quality control of Fuyankang Capsule(Radix et Rhizoma Salviae Miltiorrhizae,Radix Paeoniae Rubra,Radix Scutellariae,etc.) METHODS: The presence of Radix Paeoniae Rubra,Herba Taraxaci,Radix Scutellariae,Rhizoma Polygoni Cuspidati were identified by TLC.The content of hydroxybenzyl laxticacid,dansensu in the capsule was assayed by HPLC. RESULTS: Linearity of dansensu was found in the range from 0.04 ?g to 0.20 ?g.The average recovery was 98.8% and RSD was 1.5%. CONCLUSION: The method is highly sensitive,simple,precise and reproducible and can be used for the quality control of the capsule.