Calcaneus ; injuries ; surgery ; Fracture Fixation, Internal ; Fractures, Bone ; surgery ; Humans

OBJECTIVETo evaluate the functional outcomes of modified limited "L" incision beside the Achilles tendon with distraction bone block arthrodesis in treatment of subtalar osteoarthritis.

METHODSFrom March 2009 to September 2012, a total of 22 cases of old calcaneus fractures with subtalar osteoarthritis were treated with modified limited "L" incision and distraction bone block arthrodesis including 13 males and 9 females with a mean age of 35.3 years old (ranged 22 to 49). The mean time from calcaneal fracture was 21 months (ranged 11 to 32). According to the Stephens-Sanders classification, 16 cases were type II and 6 were type III. The modified-AOFAS ankle-hindfoot score was used for functional outcomes evaluation.

RESULTSThere was one incision necrosis and no infection, implant failure, bone-graft absorbed or talus necrosis was note at the follow-up time. A total of 21 cases were followed up for a mean time of 29 months (ranged from 18 to 46 months). All of the cases reached a bony union within 4 months postoperation. The mean modified-AOFAS ankle-hindfoot score was 82.6 points (ranged from 66 to 92 points),reached a significantly improvement in comparing with the mean preoperative score (50.8 points,ranged from 32 to 65 points, P < 0.01).

CONCLUSIONThe modified limited"L" incision beside the Achilles tendon with distraction bone block arthrodesis is an acceptable and alternative treatment method for subtalar osteoarthritis. This method is easy to use and with less complication. It can correct the main pathological changes and reach good functional outcomes.

Adult ; Arthrodesis ; methods ; Female ; Humans ; Male ; Middle Aged ; Osteoarthritis ; surgery ; Subtalar Joint ; surgery

OBJECTIVESTo provide a cumulative data about the complications of second or third generation ankle prostheses in the literature, and to provide a summary high-grade complications associated with implant failure.

METHODSA comprehensive search for all relevant articles published in English from January 1995 to December 2010 was conducted. Two reviewers evaluated each study to determine whether it was eligible for inclusion and collected the data of interest. Meta-analytic pooling of results across studies was performed for the complications and failure rate.

RESULTSThirty-five primary studies with 4395 implants were identified. The three highest complications of total ankle arthroplasty were aseptic loosening (12.51%), intra-operative bone fracture (11.97%) and bony impingement (11.27%). The three high-grade complications associated with implant failure were aseptic loosening (45.00%), infection (33.00%) and malalignment (29.00%). The pooled mean failure rate was 10.98% (95%CI: 8.80% - 13.16%), and the pooled mean failure rate of STAR implant was 14.20% (95%CI: 10.64% - 17.76%).

CONCLUSIONSIt is found that aseptic loosening, infection and malalignment are high-grade complications associated with implant failure in total ankle arthroplasty. The orthopaedic surgeons should be more careful in the operation, and the patients should coordinate with the post-operative rehabilitation plan.

Arthroplasty, Replacement, Ankle ; adverse effects ; Humans ; Joint Prosthesis ; Postoperative Complications ; Prosthesis Failure

Objective To investigate the pathogen spectrum and analyze the associated risk factors of pulmonary moniliasis in the patients with liver failure.Methods A retrospective analysis of pulmonary moniliasis complicating liver failure(n=150) was performed by case-control study on the data of patients admitted to PLA 302 Hospital from Jan.1986 to Nov.2007.A cohort of 154 patients with liver failure but without fungi infection(n=154) served as the control group.By analyzing the epidemiological and clinical data,the spectrum of fungi was identified,and the risk factors in pulmonary moniliasis pneumonia inpatients with liver failure were identified.Results The number of patients with acute on chronic liver failure(69/150,46.0%) were greater than patients with chronic liver failure(78/150,52.0%),while the number of patients suffering from moniliasis pneumonia was smaller than that of control group(20/154,13.0% and 129/154,83.8%,respectively,P

Calcaneus ; injuries ; Fracture Fixation ; methods ; Fractures, Bone ; surgery ; Humans

ObjectiveTo study the influence of Jiuqiang Naoliqing (JNQ) on the expression of calcitonin gene related peptide(CGRP)and Synapsin Ⅰ in brain of the spontaneous hypertension rats (SHR). MethodsThe rats were randomly divided into 4 groups: Wistar group, SHR group, lower dose of JNQ treated SHR group and higher dose of JNQ treated SHR group. The expression of CGRP and Synapsin Ⅰ in the dentate gyrus, CA1 subfield of hippocampus and cortex were determined by immunohistochemistry after treatment for 3 weeks. ResultsCompared with the Wistar group, the expression of CGRP and Synapsin Ⅰ in the dentate gyrus, CA1 subfield of hippocampus and cortex of SHR group significantly decreased. The treatment with lower dose of JNQ significantly enhanced the expression of CGRP in cortex(P<0.05 vs SHR).The treatment with higher dose of JNQ significantly enhanced not only the expression of CGRP in the dentate gyrus, CA1 subfield of hippocampus and cortex, but also that of Synapsin Ⅰ in the CA1 subfield of hippocampus selectively in comparison with SHR group. ConclusionJNQ may improve the micro circulation in brain by up regulating the expression of CGRP and enhance the modulating function of central nervous system by up regulating the expression of Synapsin Ⅰ in spontaneous hypertension rats.

Background Angiogenesis is an essential event for the growth and mobility of malignant tumors,but there is little literature about the effects of anoxia and angiogenesis-related factors on angiogenesis in choroidal melanoma.Objective The aim of this study was to investigate the expression of angiogeneic factors such as hypoxia inducible factor-1α(HIF-1α),inducible nitric oxide synthase(iNOS),cyclooxygenase-2(COX-2),and vascular endothelial growth factor(VEGF)in choroidal melanoma and their clinical significance.Methods The specimens from 44 cases of choroidal melanoma and 16 cases of eyelid nevi identified by pathology were collected.Immunohistochemistry SP was used to examine the expression of HIF-1α,iNOS,COX-2 and VEGF in the samples.The expression of HIF-1 α,iNOS,COX-2 and VEGF in tumors with different sizes,different pathological types and different growth patterns was evaluated.The correlations among these four proteins in tumor growth and development were assessed.Results The expression of HIF-1α,iNOS,COX-2 and VEGF in choroidal melanoma were significantly higher than those in the eyelid nevi group(x2 =6.58,4.105,8.350,13.240,P＜0.05).The expression of VEGF was associated with tumor size(x2 =9.389,P＜0.05),but not associated with pathological types(x2 =1.186,P＞0.05)and infiltration depth(x2 =5.398,P＞ 0.05).The expression of HIF-1α was associated with tumor size(x2=8.664,P＜0.05)and pathological type(x2=6.622,P ＜ 0.05),but not associated with infiltration depth(x2=4.914,P＞0.05).The expression of iNOS was associated with tumor size(x2 =8.609,P＜0.05),but was not associated withpathological type(x2 =4.789,P＞0.05)and infiltration depth(x2 =4.309,P＞0.05).The expression of COX-2 was associated with tumor size(x2 =7.320,P＜0.05),but was not associated with pathological type(x2 =2.772,P＞0.05)and infiltration depth(x2 =2.103,P＞0.05).The expression of HIF-1 α,iNOS,and COX-2 were significantly correlated with the expression of VEGF(r =0.943,1.000,0.986,P ＜ 0.05).The expression of COX-2 was significantly correlated with the expression of iNOS(r =0.986,P＜0.05).The expression of HIF-1 α was significantly associated with the expression of COX-2(r=0.986,P＜O.05).The expression of HIF-1α was significantly associated with the expression of iNOS(r=0.943,P＜0.05).Conclusions The expressions of the HIF-1 α,iNOS,COX-2 and VEGF protein are up-regulated in choroidal melanoma.They may play important roles in the angiogenesis of the choroidal melanoma.Assessment of the expression of HIF-1α,iNOS and COX-2 may be useful for the diagnosis and therapy of choroidal melanoma.

To introduce the application of Stata software to heterogeneity test in meta-analysis.A data set was set up according to the example in the study,and the corresponding commands of the methods in Stata 9 software were applied to test the example.The methods used were Q-test and Ⅰ2statistic attached to the fixed effect model forest plot,H statistic and Galbraith plot.The existence of the heterogeneity among studies could he detected hy Q-test and H statistic and the degree of the heterogeneity could be detected by,Ⅰ2 statistic.The outliers which were the sources of the heterogeneity could be spotted from the Galbraith plot.Heterogeneity test in Meta-analysis can be completed by the four methods in Stata software simply and quickly.H and Ⅰ2 statistics are more robust,and the outliers of the heterogeneity can be clearly seen in the Galbraith plot among the four methods.

OBJECTIVETo probe the feasibility and efficacy of damage control orthopedics (DCO) in treating severe multiple injuries.

METHODSA retrospective analysis was made on the clinical data of 41 patients (31 males and 10 females, aged 18-71 years, mean: 36.4) with multiple injuries admitted to our department and treated by DCO from January 1995 to December 2005.

RESULTSAs a first-stage therapy, devascularization of internal iliac arteries was performed in 29 patients with pelvic fractures combined with massive bleeding, including ligation of bilateral internal iliac arteries in 21 patients and embolization of bilateral internal iliac arteries in 8. And early external fixation of pelvis was performed in 10 patients. Ten patients with severe multiple injuries combined with femoral fractures were managed with primary debridement and temporal external fixation and 2 patients with spinal fractures combined with spinal cord compression received simple laminectomy. Thirty-one patients received definite internal fixation after resuscitation in intensive care unit. The overall mortality rate was 12.1% (5/41) with an average injury severity score of 41.4. The main causes of death were hemorrhagic shock and associated injuries. Complications occurred in 7 patients including acute respiratory distress syndrome in 3 cases, thrombosis of right common iliac artery in 1, subphernic abscess in 2 and infection of deep wound in lower extremity in 1. After treatment, all the patients got cured.

CONCLUSIONSPrompt diagnosis and integrated treatment are keys to higher survival rate in patients with severe multiple injuries. In this condition, DCO is an effective and safe option.

Adolescent ; Adult ; Aged ; Critical Care ; methods ; Female ; Humans ; Male ; Middle Aged ; Multiple Trauma ; mortality ; surgery ; Orthopedic Procedures ; methods ; Retrospective Studies

OBJECTIVETo discuss the diagnosis and treatment of multiple trauma with mainly thoracic and abdominal injuries.

METHODSA retrospective analysis was performed on data of multiple trauma cases with mainly thoracic and/or abdominal injuries.

RESULTSOf 1166 cases, 72.3% were found with shock. The operation rates of thoracic and abdominal injuries were 14.8% (119/804) and 83.5% (710/850) respectively (X(2) equal to 780.683, P less than 0.01). The operation rates of blunt and penetrating thoracic injuries was 6.8% (42/617) and 40.6% (76/187) respectively (X(2) equal to 131.701, P less than 0.01). The operation rates of blunt and penetrating abdominal injuries were 77.1% (434/563) and 96.1% (276/287) respectively (X(2) equal to 50.302, P less than 0.01). The operation rates of blunt thoracio-abdominal injuries were 6.8% (42/617) in thoracic region and 77.1% (434/563) in abdomen respectively (X(2) equal to 544.043, P less than 0.01). Among the cases of abdominal injuries, 41 received arteriography embolism, with the efficacy of 95.1% (39/41). Total mortality rate was 6.1%. The mortality rates of blunt and penetrating injuries were 7.3% (62/854) and 2.9% (9/312) (X(2) equal to 6.51, P less than 0.005). The deaths were mainly due to large volume of blood loss.

CONCLUSIONSWhen both thoracic and abdominal injuries exist, laparotomy is frequently required rather than thoracotomy. Laparotomy is seldomly used for blunt thoracic injuries, but usually used for penetrating thoracic and abdominal injuries. Mortality rate of penetrating thoracic and abdominal injuries is markedly lower than that of blunt injuries. Surgical operation is still important for those patients with penetrating thoracic or abdominal injuries.

Abdominal Injuries ; surgery ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Female ; Humans ; Male ; Middle Aged ; Multiple Trauma ; surgery ; Retrospective Studies ; Thoracic Injuries ; surgery ; Wounds, Nonpenetrating ; surgery ; Wounds, Penetrating ; surgery ; Young Adult