BACKGROUND:Recently, the number of elder patients with femoral neck fracture increased. It is controversial if patients aged over 75 years should receive total hip replacement or hemiarthroplasty. To select a reasonable surgical manner is of great significance for increasing surgical safety, improving hip joint function, elevating quality of life, decreasing postoperative complications, and reducing revision rate.
OBJECTIVE:To retrospectively analyze data of patients aged over 75 years after hip replacement, to compare the advantages and disadvantages, and to find a precise indication.
METHODS:Case data of 171 patients undergoing total hip replacement (observation group) (n=51) or hemiarthroplasty (control group) (n=120) were included. Their differences were compared using basic diseases, operation time, bleeding amount, postoperative complications, postoperative hospitalization day, Harris score at 1 week and 3 months after operation.
RESULTS AND CONCLUSION:Patients in both groups were fol owed up for 3 to 39 months (averagely 23 months). No significant difference in basic diseases, average age, postoperative complications, postoperative hospitalization day, and Harris score at 1 week was detected between the two groups (P>0.05). Harris score and excellent and good rate at 3 months were better in the total hip replacement group than that in the hemiarthroplasty group (P<0.05). Results indicated that strict choice of indication achieved good short-period efficiency in two groups. Thus, hip function of elder patients was early recovered. Quality of life was obviously elevated. The recovery of hip function was relatively better at 3 months in observation group. The incidence of postoperative complications did not increase obviously. These results suggested that besides sufficient preparation, total hip replacement should be the first choice for elder patients.

In teaching of intra-arterial thrombolysis of ischemic stroke, introducing the method of problem-based learning ( PBL ) to improve the students' learning initiative and stimulate the students' interest in search of knowledge, and guide students to form scientific clinical thinking. Through further participation in surgery, promoting the combination of theory and practice. PBL can help to improve students' ability to analyze and solve problems related to intra-arterial thrombolysis of ischemic stroke.

According to the Implementing Regulations of Standard Examination for Schistosomiasis Control in Jiangxi Province and the Criteria for Control and Elimination of Schistosomiasis, the endemic situation of schistosomiasis in Nanchang City was assessed by listening reports, checking up data, field survey, ect. Results showed that the indexes of endemic situation for both human and cattle reached the criteria for schistosomiasis control.

Objective: To study the optimal combined ratio of baicalin, icariin and Astragalus saponin I from a Chinese herbal compound Biminne. Methods: Firstly, a mouse model of allergic rhinitis was established by intraperitoneal injection of ovalbumin (OVA) and aluminum hydroxide gel suspension, and the effective dose range of baicalin, icariin and Astragalus saponin I was detected by 2,3-bis(2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-carboxanilide inner salt method. Secondly, 10 groups of combinations of baicalin, icariin and Astragalus saponin I assembled by U*(10)(10(8)) form were employed to determine the optimal combination by means of analyzing of the inhibitory effect on the splenocyte proliferation. Finally, the effects of each effective ingredient and the optimal combination were compared by observing the splenocyte proliferation, the contents of interleukin-4 (IL-4), IL-5, interferon-gamma (IFN-gamma) in supernatant of the splenocyte cultures and the ratio of IL-4 to IFN-gamma in order to verify the result. Results: Baicalin or icariin at concentrations ranging from 2 to 10 mumol/L, and Astragalus saponin I from 1 to 10 mumol/L effectively suppressed the splenocyte proliferation. When the proportion of baicalin, icariin and Astragalus saponin I was 1:2.14:2.65, the inhibitory effect was most remarkable. Further research confirmed the rationality of the optimal combination. Conclusion: An optimal combination of the major effective ingredients from Chinese herbal compound Biminne most effectively suppresses the proliferation of splenocytes from sensitized mice and regulates the cytokine secreting.

Objective To promote the standardization of medical practice in China by comparing the discrepancies of diagnosis and medication strategies for benign prostatic hyperplasia (BPH) between urologists and geriatricians.Methods Departments of urology and geriatrics in general hospitals in China were selected through stratified sampling and 145 315 patients who went for the outpatient service in certain days during December 2011 to December 2012 were recruited by cluster.Questionnaires were completed by corresponding doctors and data of patient clinical characteristics as well as diagnostic and therapeutic pattern were collected.Results A total of 142 511 valid questionnaires were collected with 119 426 from urology and 23 085 from geriatrics.The average age of BPH patients was (68.34±8.61) years and the average IPSS was 17.93±4.73.The rates of diagnostic method were IPSS (99.2％),ultrasonic inspection (86.0％),digital rectal examination (DRE) (66.0％) and urine flow rate test (55.2％).The rate of ultrasonic application was lower while the rates of other methods were higher among urologists (P＜0.01) ; the rate of DRE among urologists was 2.2 times to that among geriatricians.For patients with moderate or severe symptoms,most urologists (72.1％ in moderate patients and 79.9％ in severe patients) applied drug-combination strategy and the rate was 2 times to that among geriatricians (P＜0.01).In contrast,most geriatricians (59.7％ in moderate patients and 56.1％ in severe patients) applied single drug to BPH patients.Urologists utilized α-receptor blockers,plant preparations and traditional Chinese medicine more frequently than geriatricians (P＜0.01).Conclusions Urologists performed more integrated diagnosis strategy compared with geriatricians.The urologists tended to use 5α-reductase inhibitor combined with α-receptor blocker to treat BPH patients with moderate or severe symptoms,while geriatricians preferred 5α-reductase inhibitor alone.

Objective To comparing the diagnostic and therapeutic strategies for patients with benign prostatic hyperplasia(BPH) between doctors in general hospitals and community hospitals,and to provide scientific clues for the standardization in medical practice.Methods General and community hospitals in urban China were selected via the stratified sampling.127,325 outpatients in these hospitals from December 2011 to December 2012 were randomly recruited.Results The average age of patients was(67.82±8.62) years.There were significant differences in I-PSS,prostate volume,urinary flow rate(UFR) and result of digital rectal examination(DRE) between patients in general and community hospitals.The rates of diagnostic applications were different between doctors in the two kinds of hospitals except I-PSS.Compared with community hospitals,DRE was more frequently applied while ultrasonic inspection and UFR test were less used in general hospitals in North China.A totally opposite situation was observed in East China as compared with the north.The application rates of DRE and UFR test were lower and ultrasonic inspection rate was higher in community hospitals than in general hospitals in South China.Pharmacotherapy was the most common treatment for BPH patients in both types of hospitals(97.53 ％).The rates of drug combinations were statistically different but both were close to 75％ in the two types of hospitals.In community hospitals,the percentage of patients receiving watchful waiting with severe symptoms and signs were lower than that of patients receiving watchful waiting with moderate symptoms and signs,but the percentage of patients receiving operation was not significantly increased.On the contrary,the percentage of patients receiving operation with severe symptoms and signs was higher than that of patients receiving operation with moderate symptoms and signs in general hospitals,but the percentage of patients receiving watchful waiting was not decreased.Conclusions Applications of diagnostic methods are significantly different between doctors in general hospitals and community hospitals and vary among regions.Therapeutic strategies are correlated with the severity of obstructive symptoms or signs.The medication strategy is similar between the two types of doctors.

BACKGROUND:Differences of knee anthropometry between individuals are significant, while preoperative templating is not accurate in predicting the prosthesis size.
OBJECTIVE:To improve the accuracy of pre-operative plan in predicting the prosthesis size in total knee arthroplasty using digital technologies.
METHODBetween January 2013 and May 2004, 50 patients (20 men and 30 women;aged 54-82 years;mean age, 67.8 years) received primary total knee arthroplasty for osteoarthritis and were retrospectively analyzed. According to the treatment, the patients were divided into two groups. The digital group, a series of 21 patients, underwent 64-row MDCT before total knee replacement. CT images were imported into Mimics, and three-dimensional models of femur and tibia were reconstructed. Then, computer-aided design files of different sizes of prostheses provided by the manufacturers were imported into Mimics, too. Surgical simulation of osteotomy and prostheses implantation were performed in Mimics, component size was determined by the contour of distal femur and proximal tibia. The control group, a series of 29 patients, underwent primary total knee arthroplasty using conventional approaches. The agreement between preoperative plan and the actual prosthesis size was assessed during the surgery. Postoperative X-ray of low limb was taken to evaluate the accuracy of sizing and the efficacy of digital technologies was assessed.
RESULTS AND CONCLUSION:The intraoperative and postoperative evaluation showed inaccurate sizing of femoral and tibial components in 1 case in digital group and in 11 cases in conventional group. The accuracy of prediction was 95%in digital group and 62%in conventional group, with significant differences between the two groups (P<0.05). Four overhanging and two notching cases were observed in conventional group, but none in digital group. The digital technologies provide an effective means for accurate prediction of prosthesis size and personalized surgical simulation.

OBJECTIVE: to explore the relationship between the maxillary sinus volume and the amount of alveolar bone, and the effect of molar loss upon the maxillary sinus was further analyzed,by measuring adult maxillary sinus volume, sinus ridge distance, and calculating the gasification coefficient of maxillary sinus. METHOD: One hundred and ninety cases (361 maxillary sinus) with CT examinations were collected, they were divided into group A and group B, 121 cases (242 maxillary sinus) of normal subjects served as group A, 42 cases (65 maxillary sinus) with molar part off were B group, in which 31 maxillary sinus with a molar loss were group B1,22 maxillary sinus with two molar loss were B2 group,12 maxillary sinus with three molar loss (one molar remains) were B3 group, 27 cases (54 maxillary sinus) with upper teeth off were C group. Bymeasureing the maxillary sinus volume, sinus ridge distance and the size of the maxillary sinus, calculating the gasification coefficient, we analyzed the relationship between maxillary volume and sinus ridge distance, and comparatively analyzed the differences among the three groups in the size, gasification coefficient, volume of maxillary sinus and sinus ridge distance. RESULT: In the normal group,the volume of maxillary sinus and sinus ridge distance had a correlation coefficient of -0. 63,(P< 0.05); Sinus ridge distance in group A was larger than the other two groups (P<0.05), and larger in B group than in C group (P<0. 05), anteroposterior maxillary sinus diameter and reft-right diameter in C group was greater than in A group and B group(P<0.05), group C gasification coeffiecent was less than A group and B group (P<0. 05). CONCLUSION The volume of maxillary sinus is negatively correlated with the amont of alveolar bone; Upper teeth's shedding promotes maxillary sinus deformation; Maxiuary sinus volume has a tendency to decrease.
Adult ; Humans ; Maxilla ; Maxillary Sinus ; anatomy & histology ; diagnostic imaging ; Molar ; Radiography ; Tooth Loss

Objective To investigate the influence of carotid artery stenting (CS)of asymptomatic critical internal carotid artery (ICA)stenosis patients on cognitive function .Methods One hundred and fifty‐six asymptomatic patients with internal carotid arter‐y stenosis(carotid stenosis severity≥70% )were enrolled ,in whom CS was attempted .Functional assessments including alzheimer disease assessment scale‐cognitive subtest (ADAS‐Cog) ,mini‐mental state examination (MMSE) ,and trail making test A(TMTa) and B(TMTb) were done prior to 1 weeks and 3 months after the procedure .Results Successful CS was achieved in all of patients (100% ) ,only 1 patient was lost to follow‐up .There were significant improvement in ADAS‐Cog score(pre 6 .60 ± 2 .04 vs .post 5 .16 ± 1 .63 ,P<0 .01) ,MMSE score (pre 26 .32 ± 1 .06 vs .post 27 .05 ± 1 .46 ,P< 0 .01) ,TMTa (pre 108 .94 ± 17 .42 vs .post 94 .70 ± 20 .27 ,P<0 .01) ,TMTb (pre 178 .65 ± 21 .77 vs .post 148 .92 ± 23 .65 ,P<0 .01) .There was new cerebral infarction dur‐ing 3 months after surgery .Conclusion Asymptomatic critical internal carotid artery (ICA)stenosis may be one reason of cognitive impairment ,and successful CS could improve cognitive function in asymptomatic ICA stenosis .

Objective To investigate the effect of the reduced nicotinamide adenine dinucleotide phosphate (NADPH) oxidase on Toll-like receptor 4 (TLR4)-mediated proinflammatory phenotype of cultured vascular smooth muscle cells (VSMCs) in mice.Methods NADPH oxidase agonist platelet-derived growth factorBB (PDGF-BB) and inhibitor apocynin were used respectively to treat cultured VSMCs from C57BL/6J and TLR4-/-mice.The fluorescent probe 2',7'-dichlorodihydrofluorescein diacetate was used to detect the reactive oxygen species (ROS) level in VSMCs.An enzyme-linked immunosorbent assay was used to detect the expressions of interleukin (IL)-6,IL-1β,and tumor necrosis factor-α (TNF-α) in VSMCs.Tetrazolium blue staining and Boyden chamber assay were used to detect the proliferation and migration of VSMC.Results The ROS levels were increased in VSMCs both from C57BL/6J and TLR4-/-mice after PDGF-BB treatment,and this could be inhibited by apocynin.PDGF-BB pretreatment significantly upregulated the expressions of IL-6 (52.69 ±3.49 ng/ml vs.35.04 ±2.74 ng/ml; P =0.001),IL-1β (79.68 ±2.33 ng/ml vs.62.38 ±0.54 ng/ml;P=0.000),and TNF-α (218.35± 5.42 ng/mlvs.124.74± 4.59 ng/ml; P=0.000) in VSMCs from C57BL/6J mice,and the abilities of proliferation (1.69 ± 0.53 vs.1.04 ± 0.40; P =0.000) and migration (42.11 ±4.05 vs.1.69 ± 0.53; P =0.000) were increased significantly; apocynin pretreatment significantly inhibit the expressions of IL-6 (42.11 ± 4.05 ng/ml vs.52.69 ± 3.49 ng/ml; P =0.010),IL-1β (67.57 ± 1.36 ng/ml vs.79.68 ±2.33 ng/ml; P =0.000) and TNF-α (156.18 ± 6.98 ng/ml vs.218.35 ± 5.42 ng/ml;P =0.000),as well as proliferation (1.23 ±0.42 vs.1.69 ±0.53; P =0.000) and migration (42.11 ±4.05 vs.52.69 ± 3.49; P =0.000).While there were no significant changes in the expressions of IL-6,IL-1β,and TNF-α in VSMCs from TLR4-/-mice after PDGF-BB and apocynin pretreatment.Conclusions NADPH oxidase-derived ROS involved in the TLR4-mediated VSMC inflammatory phenotype as well as proliferation and migration,which may be the important mechanisms of its influencing on the occurrence and development of atherosclerosis.