OBJECTIVETo evaluate the clinical efficacy of manipulative reduction combined with percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP) in treating osteoporotic vertebral compression fracture (OVCF) using meta-analysis method, in order to provide a reference for clinical treatment.

METHODSA systematic computer-based search (from January 1987 to April 2014) from CNKI, Wanfang database, Web of Science and PubMed were performed for the collection of controlled clinical researches on manipulative reduction combined with PVP or PKP in treating OVCF. The quality of selected researches was evaluated. Meta-analysis was adopted to evaluate visual analog scale, Cobb angle, anterior height ratio of the injured vertebra.

RESULTSA total of 7 researches of 410 patients were included in the present analysis, there were 5 RCTs and 2 non-RCTs and all come from China. Manipulative reduction combined with PVP could got better improvement in Cobb angle (WMD=-7.35; 95%CI: -12.15, -2.54) and anterior height ratio of the injured vertebra (P<0.01) than simple PVP, but no significant difference was found in improvement of visual analog scale (WMD=-0.01; 95%CI: -0.45, 0.42). There were no significant differences in the improvement of visual analog scale, Cobb angle, anterior height ratio of the injured vertebra between manipulative reduction combined with PKP and simple PKP (P>0.05).

CONCLUSIONCompared with simple PVP, manipulative reduction combined with PVP may result in more clinical efficacy on the improvement of Cobb angle and anterior ratio of the injured vertebra. And compared with simple PKP, manipulative reduction combined with PKP has no obvious advantages on the improvement of visual analog scale, Cobb angle, anterior height ratio of the injured vertebra. However, the number and quality of the literatures, may resulted in the effect of mistrust, so more large sample and high-quality RCTs are needed in future.

Combined Modality Therapy ; Fractures, Compression ; therapy ; Humans ; Manipulation, Spinal ; methods ; Minimally Invasive Surgical Procedures ; methods ; Osteoporotic Fractures ; therapy ; Spinal Fractures ; therapy

Objective To investigate the influence of pulmonary microembolism of early stage on hemodynamics, respiratory function and blood coagulation in dogs. Methods Eight mongrel dogs (6 male, 2 female) weighing 15.5-16.5 kg were anesthetized with intravenous atropine 0.02 mg?kg-1 , propofol 2-3 mg?kg-1 and pancuronium 0.4 mg?kg-1 . The animals were intubated and mechanically ventilated with 100% O2. The ventilatory settings were as follows : VT 12 ml? kg-1 , RR 15 bpm and I: E = 1:2. Anesthesia was maintained with intravenous infusion of propofol at 200-300 ?g ? kg-1? min-1 and intermittent iv boluses of pancuronium. A 7.5 F Swan-Ganz catheter was placed via femoral vein for hemodynamic monitoring and injection of microemboli. 50 ml of blood was removed from artery and mixed with methylene blue. The clot was cut into small pieces 1-2 mm in diameter. After being washed with normal saline, 100 microemboli in normal saline 10 ml were rapidly injected into pulmonary artery via Swan-Ganz catheter. BP, HR, pulmonary arterial pressure (PAP), pulmonary arterial wedge pressure(PAWP), arterial blood gases, airway pressure, lung compliance, D-dimer, tissue plasminogen activator (t-PA), protein C and S were measured and recorded before (T0 ) , immediately after (T, ) and 30 min (T2) , 60 min (T3 ) , 120 min (T4) after embolization. Two hours after embolization, chest was opened and lung tissue was obtained for microscopic examination. Results Both systolic and diastolic PAP, PAWP and pulmonary vascular resistance (PVR) were significantly increased immediately after embolization (T1 ), and then decreased to the baseline level (T0) at Ih after embolization (T3) . There were no significant changes in respiratory function. D-dimer was increased at 30 min after embolizatiion (T2 ) and decreased to the baseline level at T4 . Microscopic examination showed that the lung exhibited hemorrhage and consolidation with microemboli in arterioles. Conclusion Pulmonary microembolism induces pulmonary hypertension and change in D-dimer level in the early stage but respiratory function is not affected. It causes injury to the lung parenchyma.

Objective To investigate the prognostic risk factors for surgery in patients with cirrhotic portal hypertension.Methods One hundred and sixty one patients with cirrhotic portal hypertension who received surgery in our hospital in the past 10 years were studied.The data were entered into a pre-designed form.24 predictors including patients′ age,sex,degree of liver atrophy,ChildPugh classification,coagulation profile,splenic size,renal function,blood pH,base excess (BE),operative time,volume of ascites,and intraoperative and postoperative hemorrhage were recorded and analyzed.For each of the predictors,2-3 subgroups were compared.Results Seven predictors were clearly related to surgical prognosis:postoperative bleeding within 30h (B0.356,P＜0.001) and a bleeding volume ＞2 L were awarded 3 points; liver volume (B-0.160,P＜0.001) and severe liver atrophy (antero-posterior diameter of the left liver lobe ≤55 mm,oblique diameter of the right lobe ≤110 mm) were awarded three points; blood pH (B0.141,P＜0.001),pH＜7.35 was awarded 2 points; BE (B-0.123,P＜0.001),BE＜-3 (mmol/L) was awarded 2 points; decrease in PLT (B0.065,P =0.015),PLT＜ 3 (T/L) was awarded 2 points; intraoperative bleeding (B0.062,P=0.014),bleeding volume ＞2 L was awarded 2 points; decrease in RBC (B0.053,P=0.024),＜3(G/L) was awarded 1 point.Of the 147 patients who recovered from surgery,all had ≤3 points,except one who had 4 points.Of the 14 patients who died,all had ≥5 points except one who had 4 points.Conclusions Postoperative bleeding (＞2 L),severe liver atrophy (antero-posterior diameter of the left live lobe ≤55 mm,oblique diameter of the right lobe ≤110 mm),blood PH＜7.35,BE ＜-3 (mmol/L),PLT＜30 000(T/L),intraoperative major bleeding (＞2 L) and RBC＜3 (G/L) were significant prognostic risk factors for surgery.For patients who had a score of 5-6 points; death was likely following surgery.A score ≥8 points should be considered as a contraindication to surgery.To reduce operative mortality,active treatment should be given before surgery to keep the score to be 4 points or less.

Objective To discuss method,operative characters and curative effect of total hip arthroplasty(THA)in treatment of acetabular fractures combined with ipsilateral femoral head or neck fractures.Methods One stage THA was done in seven patients with acetabular fractures combined with ipsilateral femoral head fracture(one patient)or femoral neck fractures(six patients)7-21 days after fractures.There were five males and two females,at age range of 41-65 years(average 50 years).According to AO classification,there were one patient with type A fracture,three with type B and three with type C.Of all,five patients received biological acetabular replacement after reduction and internal fixation of acetabular fracture and two received PMMA acetabular replacement with metal enforcement ring.All patients received biological femoral stem.Results Of all,six patients were followed up for from 2 years and 3 months to 6 years and 5 months(mean 3 years and 9 months),which showed heterotopic ossitlcation in one patient and dislocation in one who recovered after manipulative reduction.The Harris score was increased from mean prooperative 48 points to mean postoperative 91 points.X-ray found no loosening of prosthesis during follow-up.Conclusions THA can improve function of hip joint significantly,avoid further operation and lessen the burden of patients mentally and economically and hence is effective in treatment of acetabular fracture combined with ipsilateral femoral head or neck fractures.

Adult ; Aged ; Airway Obstruction ; therapy ; Cricoid Cartilage ; surgery ; Female ; Humans ; Laryngeal Diseases ; therapy ; Male ; Middle Aged ; Punctures ; methods ; Thyroid Cartilage ; surgery

Viral hepatitis is a major liver disease caused by virus infection .Viral hepatitis is popular in China , mainly caused by hepatitis B and hepatitis C viruses .Experimental animal model is a necessary platform for the research on mechanism of viral infection and pathogenicity , for treatment and vaccine development .Up to date, a great progress in the development of viral hepatitis animal models has been achieved in spite of the most of findings are limited to hepatitis B and C.Here, we summarize the recent findings of viral hepatitis animal models , focusing on the tree shrew animal model and its modeling strategy .

Objective To assess the values of automated breast volume scanner (ABVS) for differentiating of benign and malignant breast masses.Methods A total 174 breast masses in 148 patients were subjected both to conventional handheld B-mode ultrasound (HHUS) and ABVS examinations.The masses were defined as five categories of benign,probably benign,equivocal,probably malignant,and malignant with each method.The results of ABVS and HHUS were compared with pathology.By using the definitive diagnosis and the five levels of suspicion categories,receiver operating characteristic (ROC) curves were drawn to evaluate their diagnostic results.In addition,the diagnostic accuracy for breast masses of futures including retraction phenomenon and hyperechoic rim in coronal plane of ABVS was evaluated.Results The area under the ROC curve of ABVS (0.927) was larger than that of HHUS (0.903) (Z =2.256,P =0.024).The specificity and the positive predictive values both reached to 100％ and false positive rate was 0 with retraction phenomenon,and the specificity and the negative predictive value were 88.89％ and 94.51％ respectively with hyperechoic rim in coronal plane of ABVS.Conclusions ABVS plays an important role in the clinical practice.The retraction phenomenon and hyperechoic rim of breast masses in coronal plane of this new modality have high specialty for differentiating malignant from benign breast masses.

Objective To analyze clinical outcome of kidney transplantation from elderly livingrelated donors. Methods The clinical data of living-related kidney transplantation between November 2005 to June 2011 in the First Affiliated Hospital of Zhengzhou University were retrospectively analysed.The patients were divided into elderly donor kidney transplantation group (elderly group,36 cases) and non-elderly living related donor kidney transplantation group (nonelderly group,208 cases).The mean recipients' serum creatinines before and 3 days,7 days,1 month,3 month,6 month,12 month,24 month,36 month after surgery,peri-operation complications,the incidence rate of acute rejection,calcineurin inhibitor (CNI)-induced renal toxicity,delayed graft function(DGF),1 year and 3 year recipient/kidney survival were compared respectively between the two groups. Results The serum creatinine levels were higher in elderly group than in non-elderly group at 3 days,7 days,1 month after surgery [(245.2±135.2)μmol/L vs.(185.6±148.4)μmol/L,(150.5±86.8)μmol/L vs.(122.2± 136.8)μmol/L,(140.6±42.5)μmol/L vs.(117.8±33.2)μmol/L,t =84.07,31.90,21.54; all P =0.000].In addition,the incidence rate of CNI induced renal toxicity was higher in the elderly group than in non-elderly group [22.2％(8/36)vs.1.9％(4/208),x2=27.04,P=0.000].Nevertheless,there were no significant differences between the two groups in recipients' serum creatinines before and 3 month,6 month,12 month,24 month,36 month after surgery,in peri-operation complications,the incidence rate of acute rejection,delayed graft function,and in 1 year and 3 year recipient/kidney survival (all P ＞ 0.05). Conclusions With stringent screening and overall assessment of elderly donors,healthy elderly donors should not be barriers to organ donation.Renal toxicity of CNI agents should be carefully monitored in recipients of elderly donor.

Objective To investigate the effect of icariin on renal ischemia-reperfusion injury (IRI) and the action mechanism.Methods SD rats were divided into 3 groups.The model of unilateral renal IRI was established in SD rats,and Icariin (100 mg/kg) was orally administrated by gavage daily from 2 days before operation to 12 days after operation (icariin group).The vehicle of icariin was administrated to IRI model rats as control group,while in the sham-operation group the renal pedicel was only dissociated without treatment.Body weight and kidney function were monitored within 14 days after reperfusion.The kidney was harvested at 24 h after reperfusion,and then malonaldehyde (MDA) and activity of reactive oxygen species (ROS) scavenger enzymes were examined.Histopathological changes were observed at postoperative day (POD) 3 and 14.Results At POD 3,7,11 and 14,the creatinine clearance rate was significantly higher in icariin group than in control group (P＜0.01). Icariin group had significantly lower Paller scores which indicated tubules injury than in control group at day 3 after reperfusion (P＜0.01 ).In icariin group,MDA level was obviously decreased at 24 h after operation.Compared to control group,icariin group had statistically higher activity of glutathion reductase (GR),catalase and superoxide dismutase (SOD),as well as higher level of reduced glutathione (GSH) (P＜0.05).Conclusion Icariin has protective effects on renal IRI,and can promote recovery of kidney function. Icariin can reduce oxidative stress through increasing activity of ROS scavengers.

AIM: To observe the effects of sera containing Kang xian ling (a traditional Chinese medicine) on c-Met and its downstream MAPK signal molecules in HK-2 cells treated with transforming growth factor-β_1(TGF-β_1), so as to further explore the effective mechanism of anti-renal fibrosis of the traditional Chinese medicine. METHODS: Rat sera containing herbs were collected after rats were intragastrically administered with the herbs. HK-2 cells activated by TGF-β_1 were incubated with different heat-inactivated sera. The proliferation and expression of MAPK and the phosphorylation of MAPK in HK-2 cells were detected by Alarm blue and immunoblotting. RESULTS: No significant difference of cell proliferation between any two groups was observed. C-Met and the phosphorylation of its downstream molecules were also observed after incubated with different sera. CONCLUSION: The receptor c-Met of hepatocyte growth factor, and the phosphorylation of its downstream MAPK molecules can be regulated by the sera containing Kang xian ling.