Objective To evaluate the clinical results using modified Richards nail treating femoral intertrochanteric comminuted fractures.Methods From March 2002 to March 2005,69 patients suffered from femoral intertrochanteric comminuted fractures belong to Evan Ⅲ type or Ⅳ type were randomly divided into experimental group and control group.The experimental group was treated with modified Richards nail,including 34 patients,18 males and 16 females.The patients were from 61 to 78 years old,and the mean age was 67.5 years old.In this group,21 patients were involved in left femoral intertrochanteric comminuted fractures,13 patients were involved in right.The pattern of the fractures included EvanⅢ type in 24 cases and Ⅳ type in 10 cases.The control group including 35 patients was treated with DHS,and there were 19 males and 16 females with an average age of 65.9 years(ranged 61 to 80 years).In this group,19 patients were involved in left femoral intertrochanteric comminuted fractures,16 patients were involved in right.The pattern of the fractures included EvanⅢ type in 25 cases and Ⅳ type in 10 cases.Results The experimental group were followed-up 9-23 months with a mean of 11.60?3.78 months.The control group were followed-up 9-24 months with a mean of 11.40?4.12 months.In experimental group,the average fracture healing time was 3.65?0.97 months.While in the control group,the average fracture healing time was 4.32?1.38 months.In experimental group,the leg length measured at the 9th month post-operatively was averagely(0.82?0.36)cm shorter in the diseased side than in the healthy side,while in control group the leg length was averagely(1.08?0.51)cm shorter.There was significant difference between two groups.Compared to the control group,the curative effect was better in the experimental group.Conclusion Treating femoral intertrochanteric comminuted fractures with the modified Richards nail shows a good result,which can effectively diminish the non-union or mal-union of the fractures.

Objective To investigate the CT characteristics of retroperitoneal extra-adrenal paraganglioma(PGL).Methods CT findings of 11 patients with pathologically confirmed retroperitoneal extra-adrenal PGL were analyzed retrospectively,and the relevant literature was reviewed.All patients received plain CT as well as contrast-enhancement CT scan.Results All of the 11 tumors were located in the retroperitoneal space around large blood vessels,including 2 functional and 9 unfunctional extra-adrenal paragangliomas.Eight of 11 cases were benign tumors which presented as round or oval masses with sharp margins,separated from surrounding structures clearly;while the rest 3 cases,which with indistinct edge,even more with the invasion of surrounding structures (renal artery,renal venous and pancreas),were confirmed to be malignant.Most of the tumors were heterogeneous on plain CT.It was common to see intratumoral necrosis or cystic degeneration in the tumors (9 cases),while hemorrhage or calcification was uncommon,which was found in 3 and 2 cases,respectively.Homogeneous intensity was only observed in 2 masses with diameter less than 4 cm.On contrast-enhanced CT image, the solid part of the tumors presented continuously significant enhancement.Dilated feeding artery was found in or around the masses (8 cases) in artery phase.Conclusion There are certain characteristics of retroperitoneal extra-adrenal paraganglioma on CT scanning, which are helpful for preoperative diagnosis and treatment of this disease.

Objective To analyze the incidence,bacterial spectrum and clinical features of peripherally inserted central catheter-associated bloodstream infection in neonates, and to investigate the effect of infection control strategies on the occurrence of infection,by which it is helpful in choosing effective strategies for clinical practice. Methods Clinical data, results of blood culture and culture of the catheter tip were collected from 72 infants (66 of them were very low birth weight) admitted to NICU from July, 2007 to August, 2008. The incidence of PICC-associated bloodstream infection (PICC-BSI) in the old hospital was compared with that of the new hospital. Results Bacterial colonization was not found. PICC-BSI was found in 15 cases (18. 1%), including 11 cases (13.2%) with definite sepsis and 4 cases (4. 8 %) with clinical sepsis.The incidence of PICC-BSI was 10. 2/1 000 PICC-days as a whole,with 16. 1/1 000 PICC-days in the old hospital and,7. 7/1 000 PICC-days in the new hospital respectively. Eleven organisms were isolated including Coagulase negative staphylococcus (CoNS) (4 strains), Acinetobacter baumannii (3 strains), Klebsiella pneumonia (2 strains), Enterococcus(1 strain), and Candida parapsilosis (1 strain). The incidence of PICC-BSI in the new hospital was lower compared with that of the old hospital. Conclusion Most of the isolated organisms of PICC-BSI are opportunistic and multi-drug resistant pathogen. PICC-BSI can be reduced by the effective infection control strategies in NICU.

A total of 33 non-neurological symptoms patients with thoracolumbar fractures underwent unilateral pedicle screw fixation plus short segment pedicle screw through para-vertebral muscles. Preoperative computed tomography ( CT) scan showed one side pedicle was complete.The average follow-up period was 22 (12-40) months.There was no internal fixation failure.The posterior paraspinal approach for unstable thoracolumbar fractures , retaining posterior ligament complex and fixation by unilateral pedicle screw fixation through the pedicle of fractured vertebra , is both safe and effective for thoracolumbar fractures.

Objective:To evaluate the effectiveness of integrated pediatric training course of extracorporeal membrane oxygenation(ECMO)based on simulation teaching.Methods:The instructors of ECMO team of Children′s Hospital of Fudan University developed the teaching curriculum.Team members as a unit were recruited to study simulation-based courses, whose theoretical knowledge, skills and teamwork were assessed, and feedback from the trainees were gathered.Results:Since May 2018, 22 teams of pediatric specialized hospitals or general hospitals have taken part in our ECMO simulation, with totally 132 participants, including 45 ICU doctors(34.1%), 60 ICU nurses(45.5%), 23 thoracic surgeons(17.4%) and four anesthesiologists(3.0%). Twelve of them(9.1%)had a little ECMO experience.After training, the trainees had a high evaluation on each part of the course, with average score more than four, of which the theoretical score was lowest.Their self-evaluation on the theory, skills, teamwork and confidence in the implementation of ECMO had been significantly improved.Most(80.3%)of the trainees were confident to carry out ECMO in their local hospitals.The trainees′ baseline score of theoretical knowledge was 55.2±7.6, and increased to 67.1±7.3 after training( P<0.001). The average teamwork score of the 22 teams was 70.2±8.2, and the qualified rate was up to 86.4%.The most prominent skill problems in operation assessment were no albumin and blood priming(90.9%), non-skill problems were extremely anxious during the overall assessment(84.8%)of the participants, poor team work(74.2%), poor leadership(68.2%). For the feedback of the whole course, 97.0% and 94.7% of the trainees thought that integrated training and simulation teaching were the highlights of the course.At present, 13(59.1%)units have successfully developed ECMO technology after the course, and the number of children treated has been up to 83, with a survival rate of discharge of 54.2%.However, it was found that the skill level of some participants decreased about 2 weeks after the course. Conclusion:As a new attempt of ECMO teaching, this curriculum has achieved certain efficiency in both teaching and clinical practice.At the same time, our study also plays a role in promoting the development of ECMO in pediatrics.

Objective To investigate the initial CT characteristics and dynamic changing features of invasive pulmonary aspergillosis (IPA).Methods CT findings of 40 patients with IPA confirmed by histopathology or clinics were analyzed retrospectively,including the initial and follow-up CT features.Results Multiple lesions in the bilateral lung were found in the initial CT of all 40 patients.The coexistence of no less than two different CT features were showed in 27 patients(67.5 ％),and the same CT morphologic feature were showed in 13 patients (32.5 ％).The common features of the initial CT:nodules/masses (34,85.0 ％),halo sign (24,60.0％),patchy opacities (13,32.5 ％),cavities (9,22.5 ％) and wedge opacities adjacent to pleura (3,7.5 ％).The follow-up CT showed that cavities or air meniscus sign emerged in the nodules/masses after an effective treatment in 29 patients (72.5％) of all 40 cases.The lesion volume decreased subsequent to the collapse of the cavities or air meniscus,and then vanished.Conclusion Thoracic CT scanning play an important role in the diagnosis of IPA.Coexistence of the multiple lesions in number and morphology is the most common CT feature.The findings of follow-up CT is characteristic,and can be helpful in guiding the clinical treatment and evaluating therapeutic effect.

Objective:To investigate the driving effect of prostate cancer associated transcript 4 (PCAT4) on the up-regulation of upregulator of cell proliferation (URGCP) expression in breast cancer progression through sponging miR-508-5p.Methods:The microarray data of lncRNA and miRNA with differential expression in breast cancer tissue were analyzed by Cancer Genome Atlas. The expression of PCAT4 in breast cancer was evaluated by real-time quantitative polymerase chain reaction (RT-qPCR). Cell proliferation was measured by MTT and colony formation, cell apoptosis was analyzed by TUNEL, and cell migration and invasion were analyzed by Transwell. The correlation between PCAT4 and miR-508-5p, and miR-508-5p and URGCP was analyzed by RNA pull-down and double luciferase assay. Tumor xenograft studies were performed to analyze the correlation between PCAT4/miR-508-5p/URGCP axis and breast cancer cell growth in vivo. Measurement data were expressed as mean ± standard deviation ( ± s). T-test was used for comparison between two groups, and one-way analysis of variance was used for comparison between multiple groups. The correlation between PCAT4 and URGCP and miR-508-5p expression was evaluated by Pearson correlation analysis. Results:The expression level of PCAT4 was up-regulated in breast cancer tissues and cells. Knockout of PCAT4 inhibited cell proliferation and metastasis and promoted cell apoptosis. miR-508-5p was the target of PCAT4 and was negatively correlated with PCAT4. Overexpression of miR-508-5p in breast cancer can inhibit cell growth, migration and invasion, and promote cell apoptosis. URGCP is the target of miR-508-5p and induces progression of breast cancer. Tumor xenograft studies showed that PCAT4 drives breast cancer progression by affecting miR-508-5p/URGCP.Conclusion:The expression of PCAT4 is up-regulated in breast cancer tissues and cells, and PCAT4 can act as a molecular sponge of miR-508-5p, and significantly promote breast cancer progression by activating URGCP protein expression.