OBJECTIVETo analyze effects of fracture of processus styloideus ulnae on prognosis in the treatment of distal radial fracture of type C according to AO classification.

METHODSThis was a retrospective case-control study, and the information was got ten through case evaluation and follow-up, including sex, age, patient satisfaction, Gartland & Werley score and radiographic score. There were 76 patient treated with open reduction and plate fixation in People's Hospital Affiliated to Peking University from July 2006 to July 2011. All the patients were divided into two groups: no combination with fracture of processus styloideus ulnae (group A, 56 cases), combination with fracture of processus styloideus ulnae (group B, 20 cases). The patients in group A and B were treated with open reduction and internal fixation; however the fracture of processus styloideus ulnae was not fixed. The indexes such as clinical data, bone grafting, joint movement, Gartland & Werley score and radiographic score were compared between two groups.

RESULTSThe ulnaris pain of patients in group B was more obvious than that in group A. The local VAS, palmar and dorsal flexion degree of wrist joint, motion VAS, patients satisfaction score, radial and ulnar deviation degree, pronation and supination of forearm degree, Gartland & Werley score and radiographic score were separately 0.1 ± 0.1, (51.1 ± 1.9)°, (60.2 ± 1.9)°, 0.6 ± 0.1 (23.1 ± 0.9)°, (28.7 ± 1.3)° (81.5 ± 2.6)°, (68.2 ± 2.7)° 1.9 ± 0.3, 89.6 ± 12.3 in group A; and separately 0.3 ± 0.3, (51.4 ± 2.3)°, (66.6 ± 1.7)°, 0.5 ± 0.2, (24.5 ± 2.0)°, (26.9 ± 1.8)°, (80.3 ± 2.5)°, (70.3 ± 3.7)°, 1.2 ± 0.4, 92.5 ± 7.5 in group B; there were no statistical differences in above indexes between two groups.

CONCLUSIONWhether the distal radial fracture with a concomitant unrepaired ulnar styloid fracture or not exerts no influence on mainly outcomes including function, radiography and motion of the wrist.

Bone Plates ; Case-Control Studies ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Middle Aged ; Prognosis ; Radius Fractures ; surgery ; Retrospective Studies ; Ulna Fractures ; surgery

This paper analyses the defects of bubble oxygen inhalators currently used, and investigates into their solutions for improvement.
Oxygen Inhalation Therapy ; instrumentation ; methods ; Oxygenators ; standards

OBJECTIVETo investigate the clinical features of invasive pulmonary fungal infections (IPFIs) after biliary atresia (BA) surgery and related risk factors.

METHODSA retrospective analysis was performed for the clinical data of 49 children with IPFIs after BA surgery, including clinical features, lung imaging findings, and pathogenic features. The risk factors for IPFIs after BA surgery were also analyzed.

RESULTSThe most common pathogens of IPFIs after BA surgery was Candida albicans (17 strains, 45%), followed by Candida tropicalis (7 strains, 18%), Aspergillus (6 strains, 16%), Candida krusei (3 strains, 8%), Candida glabrata (3 strains, 8%), and Candida parapsilosis (2 strains, 5%). Major clinical manifestations included pyrexia, cough, and shortness of breath, as well as dyspnea in severe cases; the incidence rate of shortness of breath reached 78%, and 35% of all children had no obvious rale. The multivariate logistic regression analysis showed that age at the time of surgery, time of glucocorticoid application, cumulative time of the application of broad-spectrum antibiotics, and recurrent cholangitis were major risk factors for IPFIs after BA surgery.

CONCLUSIONSThe three most common pathogens of IPFIs after BA surgery are Candida albicans, Candida tropicalis, and Aspergillus. It is important to perform surgery as early as possible, avoid recurrent cholangitis, and shorten the course of the treatment with broad-spectrum antibiotics and glucocorticoids for decreasing the risk of IPFIs.

Objective To assess the efficacy of two antibiotic prophylactic regimens in a prospective randomized trial in 1 year for patients undergoing insertion of catheters,and to provide the evidence for uniform consensus existing on the timing,route,and choice of antibiotic.Methods During a period of 12 months,78 patients,who consecutively entered the peritoneal dialysis programme,[45 women and 33 men,mean age (48.2?15.7)years] were included.The prophylactic regimens were a single dose of ceftriaxone (1.0 g) given intravenously 30 minutes before surgery (Group A) and given cefazolin (0.25 g/L) i.p.in the each dialysis bag for 3 days postoperatively (Group B).All operations were performed in one room.The wound was observed every day,and body temperature,Count of white blood corpuscle and type,dialysate were examined every day. Results In Group A and B,none of the patients showed peritonitis or wound infection during the post-operative period (within 10 days).One of 39 patients(2.5%) in the group A,and 2 of 39 patients (5.1%) in the group B had exit site infection (P＞0.05).Conclusions There is no significant difference in the incidence of peritonitis and wound infection between two groups. Prophylactic preoperative single-dose antibiotics intravenously do as well as antibiotics given intraperitoneally for peritoneal dialysis catheter insertion,but is much more convenient.

OBJECTIVETo analyze the therapeutic effects of percutaneous vertebroplasty versus percutaneous kyphoplasty for treatment of osteoporotic vertebral compression fractures.

METHODSFifteen patients (24 vertebrae) underwent percutaneous vertebroplasty and 15 (18 vertebrae) received percutaneous kyphoplasty for osteoporotic vertebral compression fractures. The postoperative recovery of the anterior vertebral body height, visual analogue scale (VAS) and locomotor activity before and after the operations were compared between the two groups.

RESULTSAll the patients were available for the follow-up lasting for 3-15 months (average 7 months). In the vertebroplasty group, the VAS score decreased from 8.68 preoperatively to 1.74 postoperatively and to 1.13 at the final follow-up. The VAS score in the kyphoplasty group decreased from 8.62 preoperatively to 1.72 postoperatively and to 1.21 at the final follow-up. Both vertebroplasty and kyphoplasty were effective in improving the anterior vertebral body height, but kyphoplasty showed a better effect. None of the patients developed serious complications associated with the operations.

CONCLUSIONPercutaneous vertebroplasty and percutaneous kyphoplasty both achieve rapid and significant improvement of back pain in patients with osteoporotic vertebral compression fractures, but kyphoplasty shows a better effect in terms of vertebral body height restoration and cement leakage reduction.

Aged ; Aged, 80 and over ; Female ; Fractures, Compression ; surgery ; Humans ; Kyphoplasty ; methods ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Osteoporotic Fractures ; surgery ; Thoracic Vertebrae ; surgery ; Treatment Outcome ; Vertebroplasty ; methods

BACKGROUNDThere are few researches for the healing of metaphyseal fractures; moreover, the animal models to study the metaphyseal fractures are usually made by the oscillating saw osteotomy without reliable fixation, which is not in accordance with our current clinical practice. In this study, we established a new model to observe the healing process of metaphyseal fractures.

METHODSEighteen New Zealand rabbits were used in the study. The fracture model was created by splitting the medial tibial plateau in rabbits, then reset, and fixed with compression screws. At 1, 2, 3, 4, 6, and 8 weeks postoperatively, the tibial specimens were collected; firstly, a general observation and an X-ray examination of the specimens was done, and then they were embedded in methylmethacrylate and cut into sections with hard tissue slicer. The sections were stained with Giemsa reagent and examined under light microscopy.

RESULTSThere was no fracture displacement in the tibial specimens of all time points, except for one showing a collapse. No external callus formation could be observed by X-ray and general examination. After 1 week of the operation, the fracture gap was filled by mesenchymal tissue; 2 weeks postoperatively, a large number of woven bones were formed; from the third week onwards, the woven bone began to turn into lamellar bone, and new trabecular structure began to form. In all of the slices, no obvious chondrocytes formed in fracture areas; thus, there was no endochondral ossification.

CONCLUSIONSThis model was an ideal fracture animal model and suitable for the study of metaphyseal fracture healing. The X-ray and histological images demonstrated that metaphyseal fracture healing was a process of direct bone healing through intramembranous bone formation under the conditions of minor trauma, good reduction, and firm fixation.

Animals ; Fracture Healing ; physiology ; Fractures, Bone ; diagnostic imaging ; pathology ; Rabbits ; Radiography

OBJECTIVETo discuss the efficacy of total elbow replacement in the treatment of complex distal humeral fractures.

METHODSFrom May 2005 to October 2008 12 patients were retrospectively studied who were diagnosed complex fractures of the distal humerus and treated by total elbow replacement (Coonrad-Marrey). The mean age was 60 years old, the mean follow-up time was 12 months. According to AO classification, there was 3 C2 and 9 C3. The study included: pain evaluation, range of motion, elbow stability, muscle strength, complications, Mayo elbow score, DASH score, radiological assessment of ectopic bone formation and loosening.

RESULTSTwo cases with mild pain. The mean flexion is 98.3 degrees, extension limit is 17.9 degrees, mean pronation is 82.9 degrees and supination is 70.8 degrees. All joints were stable postoperatively. All patients were satisfied with the outcome. There was 1 case of superficial soft tissue nonhealing and 2 cases of ulnar nerve symptoms. No ectopic bone formation or loosening was found. Mayo elbow score was 3 cases of excellent and 9 cases of good. The mean DASH score was 41.3.

CONCLUSIONTotal elbow replacement can be used in such conditions as severe osteoporosis, severe comminution that internal plates can not get stable fixation, severe cartilage damage (because of fracture or inflammatory arthritis) that indicate traumatic or inflammatory arthritis.

Adult ; Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Elbow ; Female ; Follow-Up Studies ; Humans ; Humeral Fractures ; surgery ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome

This study was designed to investigate whether prolactin (PRL)affects coordinated regulation of tissue plasminogen activator (tPA) and plasminogen activator inhibitor type-Ⅰ (PAI-Ⅰ) gene expression in rat granulosa cells in vitro. Several methods, such as SDS-PAGE, immunoblot etc. were used to detect the effect of PRL on tPA and PAI-Ⅰ gene expression. The results demonstrated: (1) PRL increases PAI-Ⅰ mRNA production in cultured granulosa cells. Inclusion of follicle stimulating hormone (FSH) with PRL has a synergistic effect on the increase of PAI-Ⅰ mRNA levels. After 48 h culture in the presence of FSH with PRL, a 7.8-fold increase in PAI-Ⅰ mRNA levels is observed as compared with PRL alone. The synergistic increase in PAI-Ⅰ mRNA levels occurs in a dose- and time-dependent manner; (2) the increase in PAI-ⅠmRNA synthesis in the cells by PRL alone, or PRL in combination with FSH, is well correlated with the changes of PAI-Ⅰ activity levels in the conditioned media; (3) PRL in culture also decreases FSH-induced tPA activity level in a dose-dependent fashion. The decrease in FSH-induced tPA activity level by PRL is correlated with an increase in the amount of PA-PAI-Ⅰ complexes in the conditioned media. This suggests that the decline of tPA activity is related to neutralization of tPA by the increased PAI-Ⅰ activity in the media.

BACKGROUNDFor some specific comminuted unstable intra-articular fracture, the plaster cast can not maintain the alignment of the articular surface effectively. The aim of this study was to evaluate the clinical effects of distal radius fracture treated with open reduction and internal plate fixation retrospectively.

METHODSFrom January 2002 to March 2010, 539 cases of distal radius fracture were treated with open reduction and internal fixation, including 184 males and 355 females aging 21 - 72 years (mean 57 years). Fractures were caused by falling to the ground in 459 cases, by traffic accident in 62 cases and by athletic injuries in 18 cases. Of 539 cases, there were 523 cases of closed fracture and 16 cases of open fracture. According to Arbeitsgemeinschaft fur Osteosynthesefragen (AO) standards of classification, there were 14 cases of A2 type, 22 of A3 type, 18 of B1 type, 24 of B2 type, 62 of B3 type, 91 of C1 type, 162 of C2 type and 146 of C3 type. The time from injury to operation was 1 - 16 days (mean 5 days). All patitents received open reduction and internal plate screw fixation. Forty-seven patients with bone defect were given 6 - 15 g autologous ilium and 75 cases were given 5 ml calcium sulphate artificial aggregate after reduction.

RESULTSAll incisions healed by first intention after operation. Patients were followed up for 15 to 32 months postoperatively (mean 22 months). The fractures healed within 10 - 18 weeks after operation (mean 12 weeks). During the last follow-up, the mean palmar tilt was (7.0 ± 0.9)° and the mean ulnar variance was (21.0 ± 4.2)°, showing significant difference when compared with preoperation ((-5.0 ± 1.2)° and (8.0 ± 3.8)°). The radial heights were not abbreviated. According to Gartland and Werley assessment system, the results were excellent in 314 cases, good in 163 cases, fair in 46 cases, and poor in 16 cases 12 weeks after operation, the excellent and good rate was 88.5%.

CONCLUSIONSThe clinical effect of distal radius fracture treated with open reduction and internal plate fixation was relatively satisfactory. Meticulous operation procedure and individual rehabilitation strategy contribute to the wrist joint functional recovery.

Adult ; Aged ; Bone Plates ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Middle Aged ; Radius Fractures ; surgery ; Retrospective Studies ; Treatment Outcome ; Young Adult

OBJECTIVETo study the changes of amino acids in cerebral spinal fluid (CSF) in children with spastic or athetotic cerebral palsy (CP) by examining CSF levels of glutamic acid (Glu), gamma-aminobutyric acid (GABA) and aspartate (ASP).

METHODSCSF samples were obtained from 13 children with spastic CP, from 14 children with athetotic CP, and from 10 children without central nervous system and infectious diseases (control group). CSF levels of Glu, GABA and ASP were determined by high-performance liquid chromatography.

RESULTSCSF levels of GABA, ASP and Glu in the control group were 13.04+/-2.19, 10.21+/-0.45 and 8.41+/-2.26 micromol/L, respectively. Compared with the control group, CSF GABA levels in the spastic and the athetotic CP groups (8.02+/-2.03 and 10.01+/-2.68 micromol/L respectively) significantly decreased (P<0.01), whereas CSF levels of Glu (20.99+/-8.15 and 28.77+/-17.62 micromol/L respectively) and Asp (13.53+/-3.93 and 14.02+/-2.88 micromol/L respectively) in the spastic and the athetotic CP groups significantly increased (P<0.01). There were statistical differences in the GABA level between the spastic and the athetotic CP groups (P<0.05). In children with spastic CPCSF Glu level was positively correlated to muscle tension.

CONCLUSIONSCSF excitatory amino acid levels increased, while CSF inhibitory amino acid levels decreased in children with CP. There were differences for CSF amino acid levels in different types of CP. The changes of amino acid levels may contribute to the pathogenesis of CP.

Amino Acids ; cerebrospinal fluid ; Cerebral Palsy ; cerebrospinal fluid ; physiopathology ; Child, Preschool ; Chromatography, High Pressure Liquid ; Female ; Humans ; Male ; Muscle Tonus