Objective To evaluate the efficacy of noninvasive positive-pressure ventilation (NPPV) on acute respiratory failure (ARF) in elderly patients with severe community-acquired pneumonia (CAP).Methods 321 CAP patients with ARF aged over 65 years [(75.6±12.2) years old in averag] were randomly treated with NPPV (n=162) and the standard oxygen therapy (n=159).Intubation rate,ARF control rate and total mortality were compared between the two groups,and the risk factors were analyzed.Results 90％ of 321 patients presented with hypoxemic respiratory failure.Compared with standard therapy group,the intubation rate was lower in NPPV group (46.9％ vs.64.2％,x2=9.652,P＜0.01).However,there were no differences in ARF control rate(77.9％ vs.72.3％,x2 =1.274,P＞0.05),overall 30-day mortality and 90-day survival between the two groups.The overall mortality in NPPV group was higher in treatment failure cases than in treatment success cases (48.7％ vs.11.6％,x2=26.900,P＜0.01).The independent risk factors for death were treatment failure in NPPV,higher simplified acute physiology score assessment,old age and mutilobar infiltrate.Conclusions NPPV can decrease the intubation rate in CAP patients with acute hypoxemic respiratory failure,but the overall efficacy is not significant.Delayed intubation should be avoided when NPPV is to be applicated.

0.05). After ventilation with 6ml/kg tidal volumes, the TNF-? in alveolar lavage fluid (1.58?0.56pg/ml) was significantly lower in b1 group compared with that in control group (1.73?0.81pg/ml, P

Objective To determine the prevalence of antibodies to cyclic citrullinated peptides (antiCCP) in patients with juvenile-onset systemic lupus erythematosus (JSLE) and its potential clinical significance. Methods Anti-CCP was measured in sera from patients with JSLE (n=47), juvenile idiopathic arthritis (JIA, n=54) and the sera from age-matched healthy children (n=40) using the third generation of anti-CCP ELISA commercial kit. The association of anti-CCP with other laboratory parameters and clinical features, especially arthritic symptoms in JSLE was also analyzed. T-test, Mann-Whitney U test, Chi-square and Fisher's exact test were used for statistical analysis. Results Out of the 47 JSLE patients, 6 (13%) were anti-CCP positive, which was significantly higher than that of the healthy controls( 13% vs 0, P＜0.05 ), but not different from that of the JIA group (26%, P=0.098). RF was more prevalent in JSLE patients with anti-CCP than patients without (83% vs 15%, P＜0.01 ), but there was no difference in other laboratory parameters and the clinical features ineluding the occurrence of arthritis (67% vs 51%, P＞0.05). As one of the initial symptoms, arthritis was observed in 25 of 47 JSLE patients and no one had developed deforming arthropathy.There was no statistical difference in anti-CCP positivity between JSLE patients with and without articular involvement ( 16% vs 9%, P＞0.05 ). Anti-CCP was not detected in any of the 3 patients with JSLE who had experienced joint pain and limited activity during 3 years follow-up. Conclusion Anti-CCP could be detected in patients with JSLE. It is noteworthy when differentiate from juvenile idiopathic arthritis, but the presence of anti-CCP does not relate with the occurrence of arthritis at presentation and persistence of arthritis in JSLE.

BACKGROUND: Chinese anatomical parameters of antedor atlantoaxial transarticular screw fixation have been rarely reported although the technique is a novel method out of China for patients with C1-C2 instability. OBJECTIVE: To provide Chinese anatomical data for anterior C1-C2 transarticular screw fixation. DESIGN, TIME AND SETTING: A measurement experiment was performed at the Department of Anatomy, Southern Medical University and Department of Orthopedics, Wuhan General Hospital, Guangzhou Command of Chinese PLA between September 2006 and April 2008. MATERIALS: A total of 50 sets of dried Chinese adult human C1 and C2 specimens, without regard to gender and age, but no abnormality and breakage, were measured with an electronic digital caliper (precision 0.01 mm) and a goniometer(precision 0.5°) made in China. METHODS: One proper screw was drilled through the atlantoaxial joint respectively in the direction to middle part of laterosuperior angle in the posterior of C1 lateral mass, and the screw point should not break through the superior facet articularsurface of the C1. In the procedure, the screw drilling point was at the junction of the lateral border of C2 body to 4 mm above the inferior border of C2 anterior arch. border of transverse foramen of C2 body and the median line of C2 body, and the distance between the inserting point and the medial border of transverse foramen of C2 body. RESULTS: The data from all specimens were involved in the result analysis. In the sagittal plane, the minimum lateral angulation of the screw tract was (10.80±2.10)°(left) and (10.76±2.40)°(right) respectively, and the maximum lateral angulation was (25.13±3.12)°(left) and (25.12±2.86)°(right), respectively. In the coronal plane, the minimum posterior angulation was (8.85±2.12)° (left) and (9.28±2.65)° (right) respectively, and the maximum posterior angulation was (26.96±3.09)°(left) and (27.49±2.51)°(right), respectively. The left screw tract length was from (17.48±2.10) mm to (25.41±2.59) ram, and the right was from (17.49±2.23) mm to (25.58±2.42) mm. The left distance between the inserting point and the median line of C2 body was (9.84±0.69) mm, and the right was (9.81±0.66) mm. The left distance between the median line of C2 body and medial border of transverse foramen of C2 body was (14.12±1.28) mm, and the right was (14.60±1.36) mm. The left distance between the inserting point and medial border of transverse foramen of C2 body was (6.28±1.38) mm, and the right was (6.79±1.39) mm. CONCLUSION: It is optimal for the anterior C1-C2 transarticular screw fixation to place the antedor screw with a length of 17 to 25 mm in lateral angulation ranging from 10° to 25° and the posterior angulation ranging from 9° to 27°. During the procedure, the dissecting distance from the middle of C2 body to lateral should not exceed 14 mm.

Objective To investigate the effect of cervical manual stratified anastomosis and anastomosis with tube stapler on the recent complications in thoracic laparoscopy combined with radical resection of esophageal cancer.Methods From February 2019 to April 2022,a total of 196 patients who underwent endoscopic surgery for esophageal cancer who met the study criteria were divided into the manual group(87 cases)and the tubulostomy group(109 cases)according to the different ways of gastro-esophageal cervical anastomosis.The incidence of cervical surgery time,total operation time,postoperative anastomotic fistula,anastomotic stenosis and other complications of the two groups were evaluated,and the differences in treatment effects between the two groups were compared.Results The preoperative basic conditions of patients in the manual group and the tube kiss group were comparable,and the cervical anastomosis time in the tube kiss group[(23±3.57)min]was shorter than that in the manual group[(31±4.5)min](P＜0.05),but there was no statistical significance in the overall operation time between the two groups(P＞0.05).The comparison of postoperative anastomotic fistula and anastomotic stenosis between the two groups showed that the manual group was significantly lower than the tube kiss group,and the difference was statistically significant(P＜0.05).Conclusion In thoracic laparoscopic combined with esophageal cancer surgery,cervical manual stratified anastomosis can reduce the incidence of postoperative anastomotic complications.

Objective To evaluate the clinical effect of mini-plate internal fixation via anterior elbow approach in treating coronoid process fractures.Methods A retrospective case series study was conducted on the clinical data of 43 cases of ulnar coronoid process fractures treated from December 2014 to December 2016.There were 29 males and 14 females,with an average age of 32.4 years (range,24-64 years).Twenty-four cases were injured on the right,and 19 on the left.There were 18 cases of simple coronoid process fractures,23 combined with ipsilateral capitulum radius fractures,and two combined with ipsilateral ulna olecranon fractures.According to the O'Driscoll classification,there were four cases of type Ⅰ,3 type Ⅱa,9 type Ⅱb,17 type Ⅱc,6 type Ⅲa,and 4 type Ⅲb.The elbow flexion and extension range was 40°-90°[(64 ± 18)°],and the rotation range 60°-130°[(83 ± 15)°].All the patients underwent mini-plate internal fixation via anterior elbow approach.The operation time,intraoperative blood loss,wound healing,fracture healing,and postoperative complications were recorded.Function of elbow joint was evaluated by Mayo elbow performance score (MEPS).Results All patients were followed up for 12-24 months (mean,15.7 months).The average operation time was 52 minutes (range,36-86 minutes).The average blood loss was 20 ml (range,10-50 ml).At the last follow-up,all were seen incision healing by first intention and clinical fracture healing.The index finger,and middle finger palmaris numbness occurred in one patient after surgery,and the patient recovered at 2 months of follow up.The elbow flexion and extension range was 86°-145° [(117 ± 114) °],and the rotation range of 114°-155° [(132 ± 17) °],showing significant difference in comparison with the preoperative measure (P ＜ 0.05).According to the MEPS one year after operation,14 cases were evaluated excellent,27 good,and four fair,with an excellent and good rate of 91％.Conclusion The mini-plate internal fixation via the anterior elbow approach is effective in treating ulnar coronoid process fractures,for the operation is simple,allows full exposure,reduction,or reconstruction under direct vision,and effectively restores the function of the elbow joint.

Objective:To investigate the clinical effect of treatment of valgus impacted proximal humeral fracture in elderly patients with locking plate internal fixation through deltoid approach.Methods:A retrospective case series study was carried out to analyze the clinical data of 25 elderly patients with valgus impacted proximal humeral fracture hospitalized in Central Theater General Hospital of PLA from September 2016 to March 2018, including 7 males and 18 females, aged 60-81 years [(67.9±9.1)years]. According to Neer classification, 21 patients were with three part proximal humeral fracture and 4 with four part fracture. All patients were treated by internal fixation with locking plate through deltoid approach. Rehabilitation exercise training was done after operation. Total length of incision, operation time, intraoperative bleeding volume and fracture healing were recorded. At the last follow-up, the range of motion and abductor muscle strength of the shoulder joint between the affected side and the healthy side were compared, joint function was evaluated using the Constant-Murley score, and the postoperative complications were observed.Results:All patients were followed up for 12-23 months [(14.6±3.2)months]. Total length of incision was 6.4-8.8 cm [(7.1±1.2)cm]. Operation time was 68-106 minutes[(84. 0±5.6)minutes]. Intraoperative bleeding volume was 55-95 ml [(62.5±16.4)ml]. All the fracture lines were well reduced and bony union was observed in all patients at popstoperative 6 months. At the last follow-up, there was no significant difference in flexion, abduction, pronation range and abductor muscle strength between the affected side and the healthy side ( P<0. 05). At the last follow-up, the Constant-Murley score of shoulder joint function was excellent in 9 patients, good in 13, fair in 3, with excellent and good rate of 88%. There was no subacromial impact, humeral head necrosis or other complications after operation. Conclusion:Locking plate through deltoid approach in treatment of valgus impacted proximal humeral fracture in the elderly has the advantages of less operative trauma, shorter operative time, less intraoperative bleeding, less postoperative complications, good reduction of fracture and good functional recovery of shoulder joint.

Objective:To evaluate the efficacy of lateral deltoid muscle approach in the treatment of valgus-impacted three- and four-part fractures of the proximal humerus.Methods:From January 2015 to December 2017, 36 patients were treated at Department of Orthopaedics, General Hospital of Central Military Theater for valgus-impacted three- and four-part fractures of the proximal humerus via the lateral deltoid muscle approach. They were 10 men and 26 women, aged from 38 to 85 years (mean, 65.6 years). The fracture had occurred at the left side in 20 cases and at the right side in 16. According to the Neer classification, 22 cases had a three-part fracture and 14 a four-part one. Their operation time and intraoperative bleeding were recorded. The efficacy was evaluated by their Constant-Murely scores and ranges of motion of the shoulder joint one year after operation.Results:This cohort was followed up for 12 to 36 months (mean, 21.7 months). Their operation time ranged from 55 to 120 min (mean, 75.9 min); their intraoperative bleeding ranged from 50 to 200 mL (mean, 109.7 mL). Their Constant-Murely scores of the affected shoulder one year after operation ranged from 79 to 90 points (mean, 84.1points). At one year after operation, their abduction ranged from 90° to 160° (mean, 120.6°), their uplift from 90° to 170° (mean, 128.1°), their backward extension from 20° to 60° (mean, 38.8°), their internal rotation from 20° to 45° (mean, 30.5°), and their external rotation from 30° to 45° (mean, 35.6°). All patients obtained bony union with no such complications as axillary nerve injury, deep infection, nonunion or ischemic necrosis of the humeral head.Conclusion:Treatment of valgus-impacted three- and four-part fractures of the proximal humerus via the lateral deltoid muscle approach is minimally invasive, simple, safe and effective.

Objective:To compare the effect of interlocking intramedullary nail and locking plate in the treatment of varus proximal humeral fractures in the elderly.Method:A retrospective case-control study was conducted to analyze the clinical data of 46 elderly patients with varus proximal humeral fractures treated in Central Theater General Hospital of PLA from June 2016 to January 2019, including 27 males and 19 females, at age of 60-84 years［（71.9±5.7）years］. All fractures were fresh. Overall 25 patients were treated with interlocking intramedullary nail（intramedullary nail group）, and 21 patients were treated with locking plate（bone plate group）. The incision length, operation time, intraoperative bleeding and fracture healing time were compared between the two groups. Visual analogue scale（VAS）was used to evaluate the degree of pain relief at 1 week and 1 month after operation, and Constant-Murley score was used to evaluate the recovery of shoulder function at 1 month, 3 months and 1 year after operation. The cervical trunk angle was recorded at 2 days and 1 year after operation to judge whether there was a loss of cervical trunk angle. Postoperative complications were observed.Results:All patients were followed up for 12-32 months［（19.7±6.6）months］. The incision length［（7.1±0.6）cm］, operation time［（60.8±5.2）minutes］, intraoperative bleeding［（64.4±8.4）ml］and fracture healing time［（10.0±1.0）weeks］in intramedullary nail group were significantly less than those in bone plate group［（13.6±0.9）cm,（80.2±8.1）minutes,（151.0±15.2）ml,（11.0±1.5）weeks］（ P<0.05）. In both groups, the VAS decreased significantly over time, and markedly increased Constant-Murley score was detected as well（ P<0.05）. The VAS in intramedullary nail group［（2.8±0.2）points,（1.1±0.2）points］was significantly lower than that in bone plate group［（4.0±0.2）points,（1.5±0.1）points］at 1 week and 1 month after operation（ P<0.05）. The Constant-Murley score in intramedullary nail group［（59.9±6.9）points,（79.1±6.8）points］was higher than that in bone plate group［（50.1±8.5）points,（73.6±8.4）points］at 1 month and 3 months after operation（ P<0.05）, but the score showed no significant difference between intramedullary nail group［（89.1±5.3）points］and bone plate group［（86.4±6.4）points］at 1 year after operation（ P>0.05）. According to Constant-Murley score, 10 patients were evaluated as excellent and 15 patients as good in intramedullary nail group at 1 year after operation, with the excellent and good rate of 100%, while 8 patients were evaluated as excellent, 11 patients as good and 2 patients as fair in bone plate group at 1 year after operation, with the excellent and good rate of 91%（ P>0.05）. The cervical trunk angle in intramedullary nail group［（140.2±2.9）°,（139.6±2.3）°］had significant difference from that in bone plate group［（139.6±3.2）°,（138.8±3.3）°］at 2 days and 1 year after operation（ P<0.05）. In both groups, the cervical trunk angle had slight lost at 1 year after operation compared with that at 2 days after operation, but the difference was not statistically significant（ P>0.05）. In intramedullary nail group, 1 patient had subacromial impact. In bone plate group, 1 patient had screw cutting, 2 patients subacromial impact, and 2 patients delayed fracture healing. The incidence of complications in intramedullary nail group was 4%（1/25）, lower than 24%（5/21）in bone plate group（ P<0.05）. Conclusion:Compared with locking nail plate, interlocking intramedullary nail in the treatment of senile varus proximal humeral fracture has the advantages of small trauma, early fracture healing, less pain, early function recovery and less complications.

Objective:To investigate the clinical effect of peroneal fracture line in the treatment of posterior Pilon fracture.Methods:The data of 26 patients treated with fibular fracture line from January 2017 to July 2019 were analyzed retrospectively, including 11 males and 15 females; the age ranged from 28 to 69 years, with an average of 42.2 years. There were 10 cases of falling injury, 9 cases of falling injury and 7 cases of traffic injury; all of them were fresh closed fibular fractures;According to Yu Guangrong's classification, there were 11 cases of type I, 8 cases of type II and 7 cases of type III; AGH was divided into 10 cases of type I, 5 cases of type IIa, 2 cases of type IIb, 5 cases of type IIIa and 4 cases of type IIIb. All cases were treated by opening the fibular fracture line through the posterolateral approach, the quality of fracture reduction was evaluated by Burwell Charnley radiological evaluation standard after operation; At the last follow-up, ankle function was evaluated by American Association of Foot and Ankle surgery (AOFAS) ankle and hindfoot scores.Results:All 26 patients were followed up for 12-23 months, with an average of 14.9 months; Bone healing was achieved in all fractures. The healing time was 3-6 months, with an average of 4.0 months. The quality of fracture reduction was evaluated according to the Burwell Charnley radiology evaluation standard after operation, including anatomical reduction in 23 cases and acceptable reduction in 3 cases. The anatomical reduction rate was 88% (23/26). At the last follow-up, AOFAS ankle and hindfoot scores ranged from 80 to 100, with an average of 89.9 points, of which 17 cases were excellent and 9 cases were good, and the excellent and good rate was 100%. At the last follow-up, no patient had complications such as reduction loss, skin necrosis, infection, internal fixation loosening or ankle stiffness.Conclusion:After the treatment of Pilon fractures via peroneal fracture line, the distal tibial articular surface and posterior ankle fracture gap can be fully exposed, which can be repositioned and fixed under direct vision, with high anatomical repositioning rate and good and safe clinical results.