Objective To compare the results of locking intramedullar nail and Locking plate in treating proximal humerus fractures and discuss features of each instrument. Methods A total of 54 patients with fresh two-part surgical neck fracture of proximal humerus were divided into intramedullar nail fixation group(26 patients)and locking plate fixation group(128 patients).with no statistical difference upon age,gender and dominate hand involvement in two groups.At final follow-up,physical examination and X-ray films were used to evaluate fracture healing of shoulder ioint.In the meantime,VAS score,ASES score,Constant-Murley score,UCLA and SST questionnaire were used to evaluate the function of the shoulder in two groups. Results All fractures were healed basically within 8 weeks postoperative-ly.No infection or av&scular necrosis were fouml during follow-up.The incidence rate of complication in locking plate fixation group was higher than that in intramedullar nail fixation group.Both groups obtained satisfactory functional recovery of shoulder ioint.There was no statistieal difference in regard to active for-ward elevation,external rotation besides body,active height of internal rotation,Constant-Murley scores,and SST scores in both groups.The average ASES score and VAS score of locking plate fixation group was significantly better than those of intramedullar nail fixation group. Conclusions Both fixations can treat surgical neck fractures of proximal humerus well.Locking intramedullar nail causes less trauma to the patient while Locking plate has advantages in patients'final functional recovery.

Objective To evaluate the results of delayed proximal humeral fractures treated by open reduction and internal fixation. Methods From January 2005 to July 2008, 26 patients with delayed proximal humeral fractures were treated by open reduction and internal fixation. There were 11 males and 15 females. The patients ranged from sixteen to 22-81 years old, with an average age of 49.3 years. The interval from injury to operation ranged 22 to 510 days, with a mean of 88 months. There were two-part fractue in surgical neck in 12 cases, two part in lesser tubercles of in one case,two part in greater tubercles in seven cases, three part in greater tubercles in three cases, four part in 2 cases and the splitting fracture in the head of humerus in one ease.The range of motion, VAS for pain, ASES (American sboulder and elbow surgeon's form) score, Constant score, UCLA (University of California-Los Angels scoring system)score and SST(Sim-pie Shoulder Test) for function evaluation were all recorded. The results were evaluated according to sex,age, injury side, operation times and combined injury by ANOVA.The correlation analysis was performed between operative time and results. Results The average forward flexion was 137.3°±35.1°, average exter-nal rotation was 28.9°±24.1° and internal rotation was T_(10). The mean VAS score was 0.7±1.2, the mean Constant was 83.1±17.9, the mean UCLA was 28.9±6.0, the mean SST was 8.7. There were no difference re-gaming sex, age, injury side, operation time and combined injury, fracture type and complications groups. No correlation existed between operative time and results. Conclusion It is very hard to treat delayed proximal humeral fracture due to high complication and demanding experience. With appropriate surgical technique, satisfactory results can be expected by open reduction and internal fixation.

Tumor-associated macrophages (TAMs) exist in the tumor microenvironment,and can be affected by various anticancer treatments and further affect tumor progression.Increasing evidence suggests that many of the clinical antitumor measures can play a unique and effective antitumor effect by regulating the recruitment,polarization and related pro-tumor behavior of macrophages in the tumor microenvironment.Now,tumor microenvironment immune remodeling has become a hot spot in the research of anti-tumor therapy.This paper reviews the related research progress on antitumor effects of TAMs as an therapeutic target.

Objective: To evaluate the therapeutic effects of early enteral nutrition in the treatment of severe acute pancreatitis by nasojejunal tube.Methods: Forty-one cases of SAP were retrospectively analyzed and divided into 2 groups.There were 20 cases in conventional therapy group and 21 cases in enteral nutrition group.Major causes,treatments and clinical results were analyzed and APACHEⅡ score,CT score,serum albumin and prealbumin were compared between two groups.Results: Fortyone cases were cured and no one needed surgical intervention except six pateints with pseudocysts.EN cases were fed via a nasojejunal tube placed at the seventh day after admission.EN was well tolerated throughout the course of disease.The improvement of APACHEⅡ score of the EN group was significantly higher than that of conventional therapy group(P

Objective To investigate and compare the biomechanical stability between anatomical and overlapping reconstruction of the greater tuberosity in cadaveric humeral head replacement model. Methods Eight pair (16) fresh-frozen shoulder cadavers were match-paired into 2 groups. Four-part fracture model was created in all cadavers. Standardized humeral head replacement procedure was carried out in all specimens, and anatomical and overlapping reconstruction of the greater tuberosity was applied to each group respectively. Custom mounting apparatus and fixation jigs were designed for designated shoulder motion. A Binocular 3D Computer Vision metrical method was employed to measure the displacement of greater tuberosity relative to the humeral diaphysis. Results When the shoulder was external rotated to neutral position, the mean displacement of greater tuberosity in anatomical reconstruction group was (1.81?1.75) mm,while the mean displacement was (3.23?2.91) mm in overlapping group. Statistical difference was found between the 2 groups. When the glenohumeral joint was elevated to 30? and 60? forward flexion, the mean displacement of greater tuberosity in anatomical group was (4.01?5.00) mm and (5.99?6.97) mm respectively, while the mean displacement was (3.02?5.27) mm and (6.97?7.00) mm respectively in overlapping group. No statistical difference was found between the 2 groups during forward flexion measurement. Conclusion In cadaveric humeral head replacement model, anatomic greater tuberosity reconstruction shows better mechanical stability compared with overlapping reconstruction during external rotation to neutral position. This result suggests that there may be some loss in mechanical stability in overlapping fixed greater tuberosity. Even though standardized postoperative rehabilitation protocol are strictly followed, evident displacement of the greater tuberosity was detected. Postpone of the postoperative rehabilitation program after humeral head replacement for a decent period of time may benefit tuberosity healing.

Objective To report the clinical application of Dynamic Condylar Screw(DCS) in treatment of 15 cases of distal femoral fractures. Methods All cases of the distal femoral fractures were treated with DCS, and given different fixation according to different types of the fracture,and CPM was used after operation. Results All patients were followed up for a period from 6 months to 12 months.The excellent and good rate of functional recovery was 86.7%. Conclusions DCS is a good method to treat distal femoral fractures.

Objective To observe the anti-shock effect of rapid infusion of 7.5% sodium chloride(NaCl) in dog with hemorrhagic shock. Methods Five mongrel dogs were bled to mean arterial pressure(MAP) of 5.33～6.70kPa, and this pressure was maintained for 1 hour. Each dog received 7.5% NaCl (4ml/kg) intravenously, the infusion time was 2 min. The observation time was 4 hours. Results During the infusion period, the blood pressure was obviously lower than that of the shock period(P

Objective To investigate the effects of angiotensin Ⅱ AT1 receptor antagonist-Candesartan on production of leptin, adiponectin and TNF-? in rat. Methods 20 male Wistar Kyoto rats were randomly divided into vehicle and Candesartan treated groups. The dosage of Candesartan was 10mg?kg~ -1 ?d~ -1 . Food intake and bodyweight were recorded each week. Rats were sacrificed by decapitation after 17 weeks. Epididymal and perirenal fat were collected and weighted. Adipocytes were isolated from epididymal adipose tissue with collagenase. Diameter of adipocyte was evaluated. Blood chemistry, insulin, leptin, adiponectin and TNF-? were assayed. mRNA expressions of leptin, adiponectin and TNF-? of epididymal adipose tissue were assayed with RT-PCR. Results In Candesartan treated group, bodyweight and content of adipose tissue were significantly decreased, and adipocytes shrunk. Blood glucose and insulin levels showed no difference between two groups. Plasma leptin level and leptin mRNA expression in adipose tissue were lower, and plasma adiponectin level as well as adiponectin mRNA expression were higher in Candesartan treated group. Plasma TNF-? level was too low to detect with super sensitive kit, and mRNA expression of TNF? was decreased in Candesartan treated group. Conclusions Angiotensin Ⅱ AT1 receptor antagonist decreases the production of leptin and TNF-?, enhances synthesis as well as release of adiponectin in rat adipose tissue.

Objective To study the clinical changes of von Willebrand factor( vWF) and interleukin-8 (IL-8) in patients with severe pulmonary contusion. Methods Sixty-three patients with severe pulmonary contusion were divided into three different classifications for the sake of comparison in different respects, namely (1) severe pulmonary contusion with ARDS group and severe pulmonary contusion without ARDS group, (2) survival group and non-survival group, and (3) ISS score <20 group and ISS scored 20 group. In addition, the normal control group was set up. The levels of plasma vWF and serum IL-8 were respectively detected by double-antibody sandwich enzyme-linked immunosorbent assay (ELISA) within 24 hours of injury and 1,3,5 and 7days after injury. The regularity of their changes was observed and the correlation factors were analyzed from the data. Results Compared with normal controls, the concentrations of plasma vWF and serum IL-8 were significantly increased in patients with severe pulmonary contusion in all intervals of detection. The concentrations of plasma vWF escalated gradually in severe pulmonary contusion with ARDS, and reached significantly higher levels in 5 days and 7 days after injury compared with those without ARDS group (P <0. 05). The increase in concentrations of serum IL-8 peaked in 5day after injury, and then declined. The levels of serum IL-8 were higher in patients with severe pulmonary contusion with ARDS group than those in this kind of patients without ARDS group. The levels of plasma vWF and serum IL-8 were higher in non - survival group than those in survival group (P < 0.05). The increase in levels of plasma vWF and serum IL-8 peaked and then declined in 5 days in ISS score 3:20 group, whereas it peaked and declined in 3 days after injury in ISS score < 20 group. The level of plasma vWF was positively correlated with platelets and negatively correlated with oxygenation index. The levels of serum IL-8 was positively correlated with white blood cell count and ISS score, and negatively correlated with oxygenation index. Conclusions The levels of plasma vWF and serum IL-8 were increased in patients with severe pulmonary contusion, reflecting the severity of pulmonary injury. The levels of plasma vWF and serum IL-8 were the sensitive markers for evaluating the severity of pulmonary injury and the prognosis of ARDS caused by severe pulmonary contusion.

A retrospective study of endocrine dysfunction in 65 patients with Rathke's cleft cyst (RCC) was conducted. Before surgical operation, most patients with RCC had various degrees of pituitary dysfunction.Impaired gonadotropin secretion and prolactinemia were the prevalent abnormalities. Erectile dysfunction or diminished libido in male and menstrual disorder or galactorrhea in female were frequently seen. The panhypopituitarism appeared in a few patients with RCC. The patients would benefit by surgical removal, however,attention should be paid to avoid new damage of the pituitary gland during operation.