BACKGROUND:There are many reports about clinical effect of femoral fractures with intramedul ary nail and distal femoral fractures with locking plate. However, there is less report about clinical effect of femoral and distal femoral fractures.
OBJECTIVE:To investigate the clinical effect of femoral and distal femoral fractures using intramedul ary nail combined with locking plate.
METHODEighteen patients with femoral and distal femoral fractures were treated by internal fixation with intramedul ary nail combined with locking plate. Among them, six cases had femoral and supracondylar fractures, seven cases had femoral and condylar fractures, and five cases had femoral and intercondylar fractures.
According to the AO classification, three cases were type 33A2, three cases were type 33A3, two cases were type 33B1, five cases were type 33B2, one case was type 33C1, three cases were type 33C2, and one case was type 33C3. The fractures union and complications were fol owed up and observed, and knee joint function was judged by HSS score.
RESULTS AND CONCLUSION:Al the 18 patients were fol owed up for 12-24 months. The time for fracture union ranged from 3 to 5 months, average 3.4 months. No infection and disunion, no fracture malunion, no internal fixation loosening and breaking, no refracture happened. The HSS score ranged from 68 to 96 points, average 86.8 points. There were 12 excellent cases, 5 good cases, and 1 common case. The excellent and good rate was 94.4%. The internal fixation using intramedul ary nail combined with locking plate is a good method for treatment of femoral and distal femoral fractures, due to less surgical trauma, simple and reliable fixation, high rate of fracture healing, low rate of complications, and excellent function.

AIM: The purpose of this study was to determine whether the signal transduction systems were activated at the molecular atrial tissue level in patients with atrial fibrillation (AF) and whether atrial expression of extracellular-signal regulated kinase (ERK) and protein phosphatases is altered. METHODS: Atrial tissue sample of 30 patients undergoing cardiac surgery were examined. 20 patients had AF, 10 patients had no history of AF. The mRNA expression of calcineurin B and MKP-1 were detected by semi-quantitative RT-PCR. ERK1 and phospho-ERK1 were analyzed at the protein level by Western blot. RESULTS: Western blot analysis showed that atrial fibrillation did not induce significant change in ERK1 expression level in the left atrium. In contrast , phospho-ERK1 content was increased in the patients with AF in comparison with those who had sinus rhythm (SR). The mRNA expression of calcineurin B and MKP-1 in the patients with AF were significantly higher than that in patients with SR. CONCLUSION: The activation of extracellular-signal regulated kinase and protein phosphatases may have correlation with the initiation or maintenance of atrial fibrillation.

The main acupoints ofZhongwan (CV 12), Tianshu (ST 25), Zusanli (ST 36), Shangjuxu (ST 37), Dachangshu (BL 25) and Shenque (CV 8), in combination with the corresponding acupoints based on the syndrome differentiation, were selected to treat 28 cases of chronic nonspecific ulcerative colitis, the result showed clinical cure in 18 cases, clinical effect in 15 cases, failure in 5 cases. The most treatment times were 46, and the least 25.

[Objective]To compare the clinical outcomes of fresh embryo transfer of the in vitro fertilization/intracytoplasmic sperm injection and embryo transfer(IVF/ICSI-ET)in different age groups as well as in different responders using gonadotropin-re-leasing hormone agonist(GnRH-a)long protocol or GnRH antagonist(GnRH-ant)protocol.[Methods]A retrospective analysis was performed on 737 IVF/ICSI cycles,including 386 cycles of GnRH-a long protocol(group A)and 351 cycles of GnRH-ant protocol (group B),from August 28,2015 to December 31,2016. Then all the cycles were divided into sub-groups by ages and retrieved oo-cyte numbers:group a1(<38 years),group a2(≥38 years);group b1(n≤5),group b2(6≤n≤15),group b3(n>15). The basic information of patients and clinical outcomes were compared.[Results](1)Comparable results were obtained from group A and group B in these following variables such as fertilization rate,normal fertilization rate,biochemical pregnancy rate and miscarriage rage. But the stimulation period,the total gonadotropin(Gn)dosage,estradiol(E2)level and endometrial thickness on the day of human chorionic gonadotropin(hCG)administration,number of oocytes retrieved and mature oocytes,ovarian hyperstimulation syn-drome(OHSS)rate,implantation rate and clinical pregnancy rate were significantly higher in group A than group B(P<0.05),and significantly higher cancellation rate of fresh embryo transfer was observed in group B(P<0.001).(2)When divided by ages,no mat-ter in sub-group a1 or sub-group a2,the implantation rate was slightly lower in GnRH-ant protocol than in GnRH-a long protocol, although they failed to reach significant difference(sub-group a1:32.6%vs 39.8%,P=0.067;sub-group a2:9.7%vs 17.9%,P=0.066). The clinical pregnancy rate was comparable using these two protocols in sub-group a1(54.8%vs 50.4%,P=0.429),but it was significantly lower by using GnRH-ant protocol than GnRH-a long protocol in sub-group a2(19.6%vs 39.1%,P=0.021).(3) When divided by numbers of oocytes retrieved,the implantation rate was significantly lower when using GnRH-ant protocol in sub-group b1(13.1%vs 26.0%,P=0.026),but we failed to observe significant differences in other two sub-groups. The clinical preg-nancy rates were comparable in all sub-groups ,whereas differed considerably in sub-group b1 (36.6% vs 19.3%,P = 0.056).[Conclusion]Overall,the implantation rate and clinical pregnancy rate were higher in GnRH-a long protocol than those in GnRH-ant protocol. Nevertheless,GnRH-ant protocol could reduce the dosage of Gn,shorten the treatment duration,and effectively reduce the occurrence of OHSS. There were similar pregnancy outcomes in two protocols for normal responders and high responders ,while for advanced patients or other poor responders,the implantation rate and clinical pregnancy rate were higher in GnRH-a protocol.

Objective Analyzing risk factors for gastrointestinal bleeding(GIB) after coronary artery bypass grafting(CABG). Methods 582 cases undergoing CABG from August 2001 to May 2005 were divided into two groups (GIB group ,n=6 ;control group,n=576) . Preoperative , operative and postoperative clinic data were com-pared. Results The ratio of over-aging(age greater than 70), hypertension, cerebrovascular disease, myocardial in-fraction,heart function (NYHA) over Ⅲ and postoperative low output syndrome (LOS) in GIB group were signifi-cantly higher than that in control group;age, blood transfusion and hospitalized time were significantly higher and left ventricular ejective fraction was significantly lower in GIB group than that in control group. Age over 70,history of myocardial infraction and heart function (NYHA) over Ⅲ were selected as risk factors of GIB after CABG by step-wise logistic regression analysis. Conclusions It is very useful for precaution, early diagnosis and early therapy of GIB after CABG to evaluate if patients have the risk factors of GIB after CABG before operations.

The levels of low-density lipoprotein(LDL)glycation from control group,diabetic HbA1C < 7.0%,and HbA1C>7.0% groups were(17.7±2.31),(34.29±5.73),and(48.79±7.82)Glycogroups/LDL by fluorimetry.The LDL binding to its receptor in three groups were(37.65±5.20),(27.36±4.34),and(15.07± 2.23)ng/mg cell protein measured by enzyme-linked immunoreceptor assay.The glycated levels in two diabetic groups were higher than that in control group,and higher in HbA1C>7.0% group than in HbA1C<7.0% group(all P< 0.01).The results of LDL binding capacity to its receptor were just the opposite.

Objective To evaluate the diagnostic and therapeutic role in bladder pain syndrome/interstitial cystitis (BPS/IC) of random bladder biopsy and hydrodistention with cystoscopy under anesthesia.Methods A retrospective review of cases in our BPS/IC center was performed from 2005 to 2010. One hundred and nineteen patients were included who are diagnosed as the bladder pain syndrome/interstitial cystitis (BPS/IC).There were 32 male patients,aged 47 to 64 years,and 56 years on average; 87 female cases,aged 23 to 67 years,49 years on average.Patients with bladder pain symptoms underwent a thorough evaluation which include voiding diary,pelvic pain、urgency and frequency questionnaire,urine culture,cytology,acid fast bacilli and upper tract imaging.Cystoscopy and random bladder biopsy had been undertaken with general anesthesia.Before and after hydrodistention with cystoscopy,the patients daily frequency of urination,the maximum urine volume,pain scores,symptom scores,QOL score were observed to understand whether there are significant improvement. Results One hundred and nineteen BPS/IC cases underwent random bladder biopsy and hydrodistention with cystoscopy under anesthesia,and finally 102 cases were confirmed of IC; 17 cases were not IC. Eight patients who were previously diagnosed as BPS/IC were found bladder transitional cell carcinoma as the cause of bladder pain symptoms( including 4 cases carcinoma in situ,1 case Low grade non-invasive bladder cancer,3 cases High grade invasive bladder cancers),and 4 of whom had no hematuria. Mean time from the occurrence of BPS to diagnosis of transitional cell carcinoma was 10.8 months. Three patients previously diagnosed as BPS/IC were found tuberculous cystitis as the cause of symptoms,and one eosinophilic cystitis,three chemical cystitis,two radiation cystitis were also detected.Before hydrodistention with cystoscopy under anesthesia,the daily frequency of urination in 102 cases diagnosed for IC patients was 42.1 ±5.6; the maximum urine volume was 141.0 ± 8.3 ml; pain score 7.6 ± 3.0; O'Leary-Sant questionnaire symptom score was 27.7 ± 4.2; QOL score was 7.6 ± 2.4.After hydrodistention with cystoscopy under anesthesia,the daily frequency of urination in 102 IC patients was 23.3 ± 3.4,and the maximum urine volume was 352.0 ± 1.7 ml ; pain score was 3.3 ± 4.3 ; O'Leary-Sant questionnaire symptom score was 12.5 ± 7.3 ; QOL score was 3.2 ± 5.1. Before and after hydrodistention with cystoscope under anesthesia,all of the daily frequency of urination,the maximum urine volume,pain scores,symptom scores,QOL score in 102 IC patients were significant improved (P ＜ 0.05 ). Conclusions BPS/IC remains a diagnosis of exclusion.Random bladder biopsy and hydrodistention with cystoscopy under anesthesia play an important diagnostic and therapeutic role in BPS/IC.

Objective To investigate the effects of intravenous fluid restriction on complications after biliary surgery.Methods The clinical data of 168 patients who received biliary surgery at the Nanjing General Hospital of Nanjing Military Command from October 2006 to March 2008 were prospectively analyzed.All patients were randomly divided into test group(85 patients received fluid restriction treatment)and control group(83 patients received conventional treatment)by the sealed envelope method.The difference in the fluid volume between the 2groups was observed.Differences in systemic complication rate,local complication rate,general complication rate,time to bowl movement,length of hospital stay and mortality between the 2 groups were compared.All data were analyzed using the chi-square test,t test,Fisher exact test,Results The median total volumes of fluid in test group and control group were 1450 ml and 2420 ml,respectively,with significant difference between the 2 groups (t=-5.067,P<0.05).The median volumes of erystalloid solution in the test group was 850 ml,which was significantly lower than 1500 ml of the control group(t=-15.190,P<0.05).The postoperative systemic complication rate and general complication rate of the test group were 9%(8/85)and 19%(16/85),which were lower than 22%(18/83)and 30%(25/83)of the control group.There was a significant difference in the postoperative systemic complication rate between the test group and the control group(x2=4.837,P<0.05).The time to bowl movement and length of hospital stay were 2 days and 9 days in the restriction fluid group,which were significantly shorter than4 days and 12 days in the control group(t=-8.102,-2.003,P<0.05).The mortalities of test group and control group were 2%(2/85)and 4%(3/83),respectively,with no significant difference between the 2 groups(P>0.05).Conclusion Fluid restriction reduces the complication rate,shortens the length of hospital stay and accelerates recovery after biliary operation.

OBJECTIVETo compare the efficacy difference in the treatment of functional dyspepsia between acupuncture at the acupoints selected by pattern/syndrome differentiation and domperidone.

METHODSSeventy cases were randomized into an acupuncture group (35 cases) and a western medication group (35 cases). In the acupuncture group, Zusanli (ST 36) and Neiguan (PC 6) were selected. Taichong (LR 3) and Neiting (ST 44) were added for excess syndrome while Gongsun (SP 4) and Yinlingquan (SP 9) were added for deficiency syndrome. A pair of electrodes was attached to one acupoint and an assistant point (2 mm next to the acupoint centripetally) and stimulated with disperse-dense wave at 2 Hz/100 Hz, once a day. In the western medication group, domperidone was prescribed for oral administration, 10 mg each time, three times a day. In the two groups, the treatment of 5 days made one session and 4 sessions were required totally. Nepean dyspepsia index (NDI) was compared after treatment, 1, 2, 3, 4 and 5 months after treatment between the two groups respectively.

RESULTSThe score of symptom and score of life quality in NDI after treatment and at each follow-up time point were improved obviously in the acupuncture group as compared with those before treatment (all P < 0.01). In the western mediation group, the score of symptom and the score of life quality in NDI after treatment and in follow-up of 1, 2 and 3 months were improved obviously as compared with those before treatment (all P < 0.01), but the differences were not significant in follow-up of 4 and 5 months (both P > 0.05). Compared with the western medication group, the symptom score of NDI was reduced obviously after treatment and in each time point of follow-up in the acupuncture group (P < 0.05, P < 0.01), and the score of life quality was increased obviously (P < 0.05, P < 0.01).

CONCLUSIONAcupuncture at the acupoints selected by pattern/syndrome differentiation and domperidone are effective in the treatment of functional dyspepsia. Domperidone is unsatisfactory in the long-term effect, but acupuncture achieves the positive short-term and long-term effects on functional dyspepsia.

Acupuncture Points ; Acupuncture Therapy ; Adult ; Aged ; Dyspepsia ; diagnosis ; psychology ; therapy ; Female ; Humans ; Male ; Middle Aged ; Quality of Life ; Time ; Treatment Outcome ; Young Adult

OBJECTIVETo explore the methods and therapeutic effects of trans-fibular anterior-lateral approach combined with external fixation in the treatment of Gustilo III distal tibiofibula fractures.

METHODSFrom 2007 to 2010,9 patients including 7 males and 2 females with the mean age of 40 years(ranging from 29 to 51 years). All patients received internal fixation of fibula after debridement on the first phase, external fixator were used to fix tibia across ankle joint, and removed after successful skin graft; The second phase tibia was used to fix through the lateral incision used in phase I. Early functional exercise was encouraged ,the union condition and functional results of the ankle joint was evealuated. The criteria of the AOFAS Foot and Ankle Surgery was used to evaluate the effects.

RESULTSAll patients were followed up,and the duration ranged for 8 to 37 months(averaged 21 months). Nine patients were achieved bony union, the average healing time was 24 weeks. No plate rupture or screw loosening was found. According to the AOFAS Foot and Ankle Surgery evaluation system, 3 cases got excellent results, 4 good cases and 2 fair.

CONCLUSIONTrans-fibular anterior-lateral approach combined with external fixation for Gustilo III distal tibiofibula fractures can receive satisfactory reset, debond ankle joint eralier and imporove the clinical effects.

Adult ; Female ; Fibula ; Fracture Fixation ; methods ; Fractures, Bone ; diagnostic imaging ; surgery ; Humans ; Male ; Middle Aged ; Radiography ; Tibia ; Treatment Outcome