Total elbow arthroplasty was initially used to manage the rheumatoid arthritis of elbow. With the developement of technology in recent decades, the indication of total elbow arthroplasty include the trauma associated unstable joint, traumatic arthritis and distal humerus fractures in elderly. But the high risk of complications, which includes infection, ulnar nerve deficit and tricep insufficiency, is still an unsolved issue. The most widely used approach nowadays is the Bryan-Morrey approach, while some authors also report triceps on approach recently. This article is an overview in approaches and biomechanical researches of total elbow arthroplasy by reviewing the domestic and overseas involved literatures.
Arthroplasty, Replacement, Elbow ; adverse effects ; methods ; Humans ; Muscles ; physiopathology ; Recovery of Function ; Ulnar Nerve ; injuries

Objective To explore the protective effect of hesperidin pretreatment on concanavalin A (Con A)-induced acute liver injury and the effect on expression of TNF-α and IFN-γ. Methods Seventy-two SPF C57BL/ 6 mice were randomly divided into three groups: normal control group, model control group and hesperidin group. Acute liver injury model was established by injected with Con A. The hesperidin group was treated intragastrically with 1 000 mg·kg-1 hesperidin for 10 days. Model control group was treated intragastrically with the same volume of 0. 5% of sodium carboxymethyl cellulose. Serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase ( AST) were measured. Pathological changes in hepatic tissue were observed under microscope. The expression of TNF-α and IFN-γ mRNAs in hepatic tissue was measured by reverse transcription polymerase chain reaction ( RT-PCR). The contents of TNF-α and IFN-γ in serum were detected by ELISA. Results Compared with model control group, the contents of ALT and AST in serum were significantly decreased (P<0. 01) in hesperidin group. Pathological changes in hepatic tissue were markedly improved. The expression of TNF-α and IFN-γ in the hepatic tissues and serum were significantly downregulated (P<0. 01). The concentrations of TNF-α and IFN-γ in hesperidin group were (717. 05±205. 22) and(611. 06±92. 82)pg·mL-1 in 2 h,(811. 56±167. 47)and(786. 19±215. 44)pg·mL-1 in 6 h. Compared with model control group, the expressions of TNF-α and IFN-γ in the hesperidin group were significantly downregulated (P<0. 01). But there was no significant difference between hesperidin group and model control group in 6 h after treated with Con A(P>0. 05). Conclusion Hesperidin pretreatment protects mice from Con A-induced acute liver injury possibly by inhibiting the expression of TNF-α and IFN-γ in the liver of mice.

Objective To evaluate the influence of antiplatelet therapy prior to intravenous thrombolysis (IVT) on acute ischemic stroke (AIS) patients receiving IVT with recombinant tissue type plasminogen activator (rt-PA).Methods Researches about the safety of pre-existing antiplatelet treatment on AIS patients undergoing rt-PA IVT published before 31st December 2013 were retrieved based on internet databases.A meta-analysis of included clinical trials was performed by RevMan 5.2 and Stata 12.0 software.Simultaneously,funnel plot and Egger's test were used to evaluate the publication bias.Results A total of 10 papers were included.Eight researches based meta-analysis showed that pre-existing antiplatelet therapy increased the risk of symptomatic intracranial hemorrhage (SICH ; OR =1.67,95％ CI 1.44-1.93,P ＜ 0.01),6 researches based analysis suggested pre-existing antiplatelet therapy increased the risk of any intracranial hemorrhage (ICH ; OR =1.23,95％ CI 1.04-1.47,P ＜ 0.05) and 3 trials based analysis indicated the functional independence of patients receiving antiplatelet treatment was a bit worse than control group (OR =0.86,95％ CI0.80-0.93,P ＜0.01).Funnel plots and Egger' s test showed that there was no significant publication bias (P ＞ 0.05).Conclusions Antiplatelet therapy might increase the risk of post thrombolysis SICH and ICH,and their 3-month function independence is not so satisfied as those who had no antiplatelet agents before IVT.However,this review has limitations and the above results should be validated in future large prospective clinical studies.

Objective To explore the diagnosis,treatment,risk factors and prognosis factors of postpancreaticoduodenectomy hemorrhage (PPH).Methods The retrospective case-control study was adopted.The clinical data of 703 patients who underwent pancreatoduodenectomy at Hospital 401 of the People's Liberation Army from January 2008 to July 2013 were collected.Standard pancreatoduodenectomy was carried out for the malignant tumors of the head of pancreas or ampulla,pylorus-preserving pancreatoduodenectomy was operated for the benign tumor or the duodenal papilla tumor.The corresponding treatment was adopted for PPH.The observation indicators included:(1) the surgical situation (surgical method,operation time and the volume of intraoperative blood loss),(2) diagnosis of PPH,(3) treatment of PPH,(4) univariate and multivariate analyses for the risk factors affecting the occurrence of PPH,(5) univariate and multivariate analyses for the risk factors affecting prognosis of PPH patients.The measurement data with normal distribution were represented as x ± s.The measurement data with skewed distribution were represented as M (range).The chi-square test or Fisher exact probability was used for univariate analysis.Logistic regression model was used for multivariate analysis.Results (1) The surgical situation:among 703 patients,409 patients underwent standard pancreatoduodenectomy and 294 underwent pylorus-preserving pancreatoduodenectomy,including 1 combined with right hemihepatectomy,27 with portal vein reconstruction and 2 with hepatic artery reconstruction.Pancreaticojejunostomy was applied to 658 patients using mucosa anastomosis of the pancreatic duct to jejunum and 45 patients using invagination anastomosis.Supporting tube was routinely deposed in the pancreatic duct,598 patients had internal drainage and 105 patients had external drainage.The end-to-side anastomosis between common bile duct and jejunum was used for choledochojejunostomy.The 409 patients received the gastrojejunostomy using side-to-side anastomosis of gastric part and jejunum and 294 patients using end-to-side anastomosis of duodenum and jejunum.Operation time and volume of intraoperative blood loss were (324 ± 54) minutes and (428 ± 118) mL.(2) The diagnosis of PPH:among 703 patients after pancreatoduodenectomy,62 patients had PPH,the hemorrhage reasons of 38 patients had been identified,and the hemorrhage reasons of 24 patients had not been identified (A level in 5 patients,B level in 17 patients,C level in 2 patients).① The site of hemorrhage:the hemorrhage outside the cavity were detect in 27 patients,the hemorrhage inside the cavity in 28 patients,and the hemorrhage from both outside and inside part of the cavity in 7 patients.② The time of hemorrhage:early-stage hemorrhage were detected in 5 patients and the delayed hemorrhage in 57 patients.③The volume of postoperative blood loss was (885 ± 253)mL,30 patients had mild hemorrhage and 32 patients had severe hemorrhage.④ The clinical classification of PPH:5,32 and 25 patients were detected in level A,B,C,and 19 patients combined with sentinel hemorrhage.(3) The treatment of PPH:①5 patients with PPH in A level were given clinical observation,blood volume supplement and other treatment,then the symptoms gradually turned better.② Among 32 patients with PPH in B level,15 patients became better after symptomatic and supportive treatments,6 patients received successful hemostasis after guglielmi detachable colis embolization,4 patients received successful hemostasis under gastroscopic hemostasis,7 patients received emergency exploratory laparotomy.Thirty-two patients were improved and then out of hospital after treatment,without occurrence of death.③ Among 25 patients with PPH in C level,4 patients received successful hemostasis after guglielmi detachable colis embolization,17 patients received hemostasis by emergency exploratory laparotomy,4 patients with undiscovered bleeding points received the treatment of fluid infusion,blood volume supplement and antacid.Among 25 patients after corresponding treatment,10 patients were improved and 15 patients were dead.(4) The result of univariate analysis showed that the combined hypertension,vascular resection and reconstruction,postoperative pancreatic leakage and postoperative intraabdominal infection were risk factors affecting the occurrence of PPH (x2 =4.950,5.300,7.568,5.505,P ＜ 0.05).The results of multivariate analysis showed that the combined pancreatic leakage and postoperative intraabdominal infection were independent risk factors affecting the occurrence of PPH [OR =2.761,2.216,95％ confidence interval (CI):1.389-5.489,1.198-4.101,P ＜ 0.05].(5) The risk factors affecting the prognosis of PPH patients:the results of univariate analysis showed that postoperative sentinel hemorrhage,postoperative pancreatic leakage,site,degree and level of hemorrhage were risk factors affecting the prognosis of PPH patients (x2 =8.022,4.448,11.853,18.551,28.285,P ＜ 0.05).The results of multivariate analysis showed that postoperative sentinel hemorrhage and site of hemorrhage (outside and inside part of the cavity) were independent risk factors affecting the prognosis of PPH patients (OR =5.550,0.233,95％ CI:1.595-19.314,0.086-0.635,P ＜ 0.05).Conclusions Pancreatic leakage and intraabdominal infection are independent risk factors after pancreatoduodenectomy.The treatment effect of the early-stage hemorrhage is better than that of the delayed hemorrhage,and angiographic embolization is the first choice of diagnosis and treatment for the delayed hemorrhage.Sentinel hemorrhage could result from aneurysm or continuous arterial hemorrhage of vascular erosion,it is the independent risk factor affecting the death of hemorrhage after pancreatoduodenectomy.

Objective To compare the uniformity between spine MRI and 18F-FDG PET/CT in detection of spinal metastatic tumor, and to analyze the reasons for the discrepancy between them.Methods Data of 42 malignant tumor patients underwent spine MRI and 18F-FDG PET/CT were analyzed retrospectively.And the two tests were underwent within 30 days.The author censused and analyzed the number of centrums with metastatic tumor detected by spine MRI and 18F-FDG PET/CT,and supposed that 18F-FDG PET/CT was gold standard,to evaluate the sensitivity and specificity of spine MRI.The inconsistent between two tests was analysed.Results The study included 509 centrums of 42 patients.123 positive centrums (24.2%) were detected on spine MRI,and 114 positive centrums (22.4%) on 18F-FDG PET/CT(P=0.22>0.05).The uniformity between two tests was good (Kappa=0.76).Supposing that 18F-FDG PET/CT was gold standard,the sensitivity,specificity,positive predictive value, negative predictive value,false negative rate and false positive rate of spine MRI was 85.1%(97/114),93.4%(369/395),85.1%(97/114),93.4% (369/395),14.9%(17/114) and 6.6%(26/395) respectively.43 centrums of 14 patients were diagnosed inconsistently by spine MRI and 18F-FDG PET/CT.The main reasons for the inconformity were as following: types of primary tumors, insensitivity of spine MRI for diffuse scattered spinal metastatic tumors, the existence of misdiagnosis on spine MRI, misdiagnosis of spine MRI for metastatic lesions located in the vertebral appendix and paramedian vertebral body,misdiagnosis of 18F-FDG PET/CT for metastatic lesions located in the sacral centrum, existence of false positive on 18F-FDG PET/CT and so on.Conclusion The uniformity between spine MRI and 18F-FDG PET/CT is good.The inconformity still existes in some cases.Carefully comparative analysis of them contributes to find metastatic lesions.

Objective To investigate the effect of chest physiotherapy (CPT) on patients undergoing mechanical ventilation (MV).Methods A prospective randomized controlled trial (RCT) was conducted. Sixty-eight adult patients undergoing invasive MV over 48 hours admitted to intensive care unit (ICU) of Affiliated Hospital of Zunyi Medical College from December 2014 to October 2016 were enrolled, and they were divided into CPT group (n = 37) and control group (n = 31) by random number table. The patients in control group received routine physical therapy; while those in the CPT group received comprehensive CPT including manual lung inflation, vibration expectoration and early functional exercise etc. on the basis of the treatment in control group. Acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score and oxygenation index (PaO2/FiO2) before and after the treatment in both two groups were observed as well as the respiratory function and vital signs before and after CPT. The laboratory indicators after treatment, incidence of complications, duration of MV and the length of ICU stay in the two groups were recorded.Results The incidence of ventilator associated pneumonia (VAP) in the CPT group was significantly lower than that of control group (5.4% vs. 25.8%,P < 0.05), the patients in control group also had atelectasis, deep vein thrombosis and other complications, while no such complications were found in the CPT group. The duration of MV (hours: 77.4±41.0 vs. 133.9±117.2) and the length of ICU stay (hours: 134.4±71.4 vs. 207.4±177.7) in CPT group were significantly shorter than those of the control group (bothP < 0.05). There was no significant difference in APACHE Ⅱ score and PaO2/FiO2 before treatment between the two groups. After treatment for 2 days, the APACHE Ⅱ score in both groups was gradually decreased, and that in CPT group was more significantly, it was significantly lower than that of control group after treatment for 4 days (8.6±3.9 vs. 12.5±5.3,P < 0.05). The PaO2/FiO2 in the two groups was gradually increased after treatment. PaO2/FiO2 in CPT group was significantly increased at 3 days after treatment as compared with that before treatment [mmHg (1 mmHg = 0.133 kPa): 278.1±79.0 vs. 224.2±98.9], while PaO2/FiO2 in the control group did not appear significantly increased until after 4-day treatment (mmHg: 302.3±93.1 vs. 232.3±116.7, both P < 0.05). There was no significant difference in vital signs andrespiratory function parameters including tidal volume (VT), respiratory rate (RR), peak airway pressure (Ppeak) and mean airway pressure (Pmean) before and after treatment in CPT group excepting pulse oxygen saturation (SpO2) was significantly higher than that before treatment (0.985±0.016 vs. 0.978±0.018,P < 0.05), indicating that CPT treatment did not cause fluctuations in respiratory function and vital signs. Blood lactate in CPT group was significantly lower than that of control group (mmol/L: 1.10±0.79 vs. 1.32±1.09, P < 0.05), indicating that CPT treatment, especially early functional exercise, could improve the oxygen supply and limb circulation.Conclusion CPT treatment has some effect on prevention of VAP and other complications in patients undergoing MV, which could shorten the duration of MV and the length of ICU stay, and promote the recovery of patients.

OBJECTIVEThis study aimed to observe the postoperative pain rate and degree of pain in preschool children with cleft lip and palate, and investigate the effect of nursing intervention on pain relief.

METHODSA total of 120 hospitalized cases of three- to seven-year-old preschool children with cleft lip and palate were selected from May to October 2011. The subjects were randomly divided into the control group and experimental groups 1, 2, and 3. The control group used conventional nursing methods, experimental group 1 used analgesic drug treatment, experimental group 2 used psychological nursing interventions, and experimental group 3 used both psychological nursing intervention and analgesic drug treatment. After 6, 12, 24, and 48 h, pain self-assessment, pain parent-assessment, and pain nurse-assessment were calculated for the four groups using the pain assessment forms, and their ratings were compared.

RESULTSThe postoperative pain rates of the four groups ranged from 50.0% to 73.3%. The difference among the four groups was statistically significant (P < 0.001). The differences among the control group and experimental groups 1 and 2 were not statistically significant (P = 0.871), whereas the differences among experimental group 3 and the other groups were statistically significant (P < 0.001).

CONCLUSIONPostoperative pain in preschool children with cleft lip and palate is common. Psychological nursing intervention with analgesic treatment is effective in relieving postoperative pain.

Objective To investigate changes in serum levels of antinuclear antibody(ANA), anti?double?stranded DNA(dsDNA)antibody and anti?extractable nuclear antigen(ENA)antibody before and after anti?tumor necrosis factor?α(TNF?α)therapy in psoriatic patients. Methods Clinical data obtained from 32 patients with psoriasis were analyzed retrospectively. Of the 32 patients, 13 received intravenous injection of 5 mg/Kg infliximab at week 0, 2, 6 for 3 sessions, then once every 8 weeks(infliximab group), while other 19 received subcutaneous injection of 25 mg etanercept twice every week(etanercept group). The treatments in the 2 groups both lasted more than 3 months. Serum levels of ANA, anti?dsDNA antibody and anti?ENA antibody and changes of clinical symptoms were detected and observed respectively before each treatment in the infliximab group, as well as every 3- 6 months in the etanercept group. The 75%reduction in psoriasis area and severity index(PASI75)and disease activity score of 28 joints(DAS28) were used to evaluate clinical efficacy. Serum levels of ANA, anti?dsDNA antibody and anti?ENA antibody were measured by indirect immunofluorescence(IIF)assay, Western blot analysis combined with enzyme?linked immunosorbent assay(ELISA), and Western blot analysis, respectively. Results After 3?month treatment, the 32 patients achieved clinical remission to different extents. Of 32 patients receiving anti?TNF?αtherapy, 7(21.9%)developed new autoantibodies. Concretely speaking, 4 patients in the infliximab group developed autoantibodies in 8.3 ± 5.1 months, including 3 cases positive for ANA and 3 for anti?ENA antibody. Three patients in the etanercept group developed autoantibodies in 9.0 ± 3.0 months, including 3 cases positive for ANA and 1 for anti?ENA antibody. Conclusion Partial patients with psoriasis may develop autoantibodies after anti?TNF?αtherapy.

Objective To establish a method for detection of aminophylline in blood samples of preterm infants . Methods A molecularly imprinted electrochemical sensing film on the glassy carbon electrode surface was prepared by electropolymerization using aminophylline as the template molecule and pyrrole as the functional monomer in 0.2 mol/L HAc-NaAc buffer solution ( pH 4.0).The surface morphology and properties of molecularly imprinted sensing films were characterized by three dimensional laser scanning microscopy , differential pulse voltammetry ( DPV) and electrochemical impedance spectroscopy ( EIS) while the effects of scanning cycle number and incubation time were investigated by square wave voltammetry(SWV) method in 5 mmol/L K3[Fe(CN)6] -0.1 mol/L KCl solution.Results Under optimized experimental conditions ,the SWV peak current difference was linear to the negative logarithm of aminophylline concentration in the range from 1.0 ×10 -7 to 1.0 ×10 -3mol/L with a detection limit (S/N=3) of 0.5 ×10 -8mol/L.The recovery rate was 92.2% -101.4%.Also, the molecularly imprinted electrochemical sensor for aminophylline had good selectivity , stability and reproducibility .Conclusion The molecularly imprinted electrochemical sensor for aminophylline can be used for rapid and accurate detection of clinical blood concentrations of aminophylline molecules in preterm infants in the future .

ObjectiveTo explore the appropriate teaching methods for medical international students.MethodsTotally 84 students in grade 2005 and 63 students in grade 2006 took part in clinical skills training in 2010 and 2011.The traditional method was employed in grade 2005 and interactive teaching and imagery training was applied in grade 2006 combined with the traditional methods.ResultsThe scores of clinical skill tests ( posterior thorax puncture test,abdomen puncture test,bone puncture,catheterization test) were significantly higher in grade 2006 than in grade 2005 with statistical differences,P ＜ 0.01.The clinical skill test scores were not statistically different between grade 2005 and 2006 before training,P ＞ 0.05,but the scores were statistically different between grade 2005and 2006 after training,P ＜ 0.05.Conclusion Using polynary teaching methods synthetically is helpful to improve the clinical skill training effect for medical international students.