BACKGROUND: There are some reports about the relationship between atherosclerotic cerebral infarction and apolipoprotein E and B, but the results are still controversial. The relationship between apolipoprotein E and B and young adult atherosclerotic cerebral infarction has not been reported yet in China.OBJECTIVE: To investigate the relationship between the polymorphism of apolipoprotein E and B gene and young adults atherosclerotic cerebral infarction (ACI).DESIGN: A controlled case analysis of young adult atherosclerotic cerebral infarction patients.SETTING: Department of Neurology, Shengjing Hospital of Chinese Medical University.PARTICIPANTS: This study was conducted in the Department of Neurology, Shengjing Hospital of Chinese Medical University from January of 1998 to December of 2000. Thirty-six young adult patients with atherosclerotic cerebral infarction, including 30 males and 6 females, with the meaage of (41.6±6.54) years, and 100 healthy young adults, including 66 males and 34 females, with the mea age of (36.16±6.12) years were included in this study.METHODS: 8 Ml venous blood was collected after fasting for 12 hours to assay serum lipid and apolipoprotein. The gene polymorphism of apolipoprotein E and B were detected with PCR method. Enzymic method was used to detect total cholesterol, total triglycerides and high density lipoprotein-cholesterol (HDL-C). Apolipoprotein AI.B was measured with immunoturbidimetry method and lipoprotein (a) with ELISA method.Lipids, lipoprotein and apolipoprotein of six control blood samples couldn't be measured because of hematolysis.MAIN OUTCOME MEASURES: ① The distribution characteristics of genotypic frequency of apolipoprtein E and B in the two groups. ② The relationship between gene polymorphism of aoplipoprotein E and B and the level of blood lipids, lipoprotein and apolipoprotein. ③ The correlation intensity between genotypes of apolipoprotein E and B and onset of young adult atherosclerotic infarction.RESULTS: ① In ACI group, ε3/4 counted for 36.1% and ε2/4 for 27.7%, but was 12% and 7% in control group respectively. The gene frequency of ε4 was 0.320. All these values were higher than that in control group 0.95 (P ＜ 0.05). ② The levels of TG, TC, and LP (a) in ACI group were higher than that in control group. The level of HDL-C was much lower than the control group's (P ＜ 0.05-0.01). ③ ε4 allele caused the increase of the content of TG, TC, and LP (a) so as to induce the relative risk rates of decrease of HDL-C which were 8.23, 4.85, 29.9,4.39 (P ＜ 0.01-0.001) respectively. ④ AI content of the gene frequency of ApoB XbaⅠ X+X- was (1.01±0.30) g/L in ACI group, which was lower than (1.33±0.15) g/L in X-X- subgroup (t=2.55, P ＜ 0.05). The level of ApoA I in X+X group (244.3 mg/L) was remarkably different from that (183.0 mg/L)in control group (t=4.50, P ＜ 0.01). ⑤ Three cases had both ε3 and X+X-in ACI group, 10 had both ε3 and X-X-, 2 had both ε4 and X+X-, and 19 had both ε4 and X-X-. The risk of ACI was 2.85 with the linkage of allele ε4 and allele X-X- in ACI patients (x2=1.52, P ＞ 0.05).CONCLUSION: Allele ε4 is a genetic facilitated factor of young adults ACI. Xba Ⅰ X+X- is another probable genetic symbol. The correlation between atherosclerotic cerebral infarction of young patients during the combination of apolipoprotein E and B should be researched further.

Objective To assess the efficency and safety of non-peritoneal drain versus peritoneal drain after appendectomy of severe appendicitis. Methods Randomized controlled trials (RCTs) or quasi-randomize controlled trials(QRCTs) were searched and identified from CNKI (1994 to Oct 2008) ,CBM (1978 to Oct 2008), VIP (1989 to Oct 2008), Wanfang Data (1997 to Oct 2008), MEDI.INE (1966 to Oct 2008), EMBASE (1974 to Oct 2008),The Cochrane Library (issue3, 2008) and SCI (1974 to Oct 2008), and related journals were also scanned. We evaluated the quality of the included studies by Jadad scale and analyzed the data by Cochrane Collaboration' s RevMan 5. 0. Results We included 15 randomized controlled trials or quais-randomized controlled trials (n = 2809). Meta analysis showed that there were statisticly differences between two groups on the incidence of wound infection [OR = 0.43,95%CI (0.29,0.65)], postoperative intestinal adhesion [OR = 0.26,95%CI(0. 18,0.37)]and the duration of hospital stay [WMD = - 0.38,95%CI(- 4.96, - 1.20)], but no difference was found on the incidence of abscesses [OR = 0. 77,95% CI(0. 39, 1. 51)]. Conclusions The current evidences show that contrast with peritoneal drain, the non-peritoneal drain can significantly reduce the incidence of wound infection and intestinal adhesion, and shorten the duration of hosipital stay. Before draw the conclution into clinical practice, further high-quality, large scale, double-blind randomized controlled trials are still needed.

Objective To study the effect of clinical pharmacist interventions on the rational use of antibiot-ics.Methods 1 000 hospitalized patients before the implementation of intervention in April 2012 to April 2013 (control group)and the other 1 000 cases of hospitalized patients in May 2013 to May 2014 after the implementation of the intervention (study group)were selected,the antibiotics use rate,hospitalization time and cost,cost of using antibacterial drugs were compared between the two groups.Results The antibiotics use rate of the study group was 56.0%(560/1 000),significantly lower than 78%(780/1 000)of the control group,with significant differences between the two groups(χ2 =11.089,P=0.032),the hospitalization time,cost of using antibacterial drugs of the study group were (12.6 ±0.8)days,(912.2 ±13.2)yuan,significantly better than (16.9 ±0.7)days,(1 528.1 ± 32.5)yuan of the control group,with significant differences between the two groups (t=9.892,10.142,P=0.028, 0.014);The two groups of hospitalization expenses showed no statistical significance (t =4.984,P =0.072 ). Conclusion Clinical pharmacist intervention has a positive effect on the application of antibacterial drugs,which can significantly reduce the use of antimicrobial drugs and reduce the hospitalization days.

Objective To evaluate feasibility of totally laparoscopic surgical treatment of congenital choledochal cysts(CCC) in adult patients.Methods The clinical data of 36 adult CCC patients were analyzed retrospectively.In this study there were 31 type Ⅰ cases and 5 type Ⅳ cases,divided into laparoscopic operation group (n =18) and open operation group (n =18).Results There were no death cases in perioperative period and all patients were followed up.The total operative time of laparoscopy group compared with open group respectively was (212 ± 43) min and (135 ± 20) min (P ＜ 0.05),the volume of blood loss during operation was (75 ± 20) ml and (150 ± 49) ml,(respectively t =6.875,6.000,P ＜0.05).Postoperative recovery time of intestinal function was (65 ± 15) h vs (94 ± 12) h,celiac drainage tube indwelling time was (72 ± 20) h vs (89 ± 26) h,postoperative hospital stay was (5.8 ± 1.4) d vs (8.9 ± 0.9) d,(respectively t =6.444,2.199,7.908,P ＜ 0.05).One case suffered from reflux cholangitis in the laparoscopic group,1 case of choledochojejunostomy stricture and recurrence of intrahepatic calculi in the open group.Conclusion Laparoscopic cystectomy and cholangiojejunostomy for congenital choledochal cyst in adults is safe and feasible.

Objective:To analyze the lipid levels, adverse perinatal outcome and their correlation in Tibetan pregnant women in high altitudes in late pregnancy.Methods:Retrospective analysis was performed on clinical and laboratory data of 523 Tibetan singleton pregnant women who delivered after 28 weeks at the Department of Obstetrics and Gynecology, Chaya People's Hospital, Changdu City. The subjects were divided into three groups according to the altitude of their long-term residence, including altitude<3 500 m (Group A, n=161), altitude ≥3 500 m and <4 000 m (Group B, n=203) and altitude≥4 000 m (Group C, n=159). In addition, the subjects were also grouped into high TG group (TG≥3.23 mmol/L, n=80) and control group (TG<3.23 mmol/L, n=443). The baseline information, levels of lipid and perinatal outcome were compared among Group A,B and C, and also between the high TG and control group, respectively, using Mann-whitney U test, Kruskal-Wallis H test, LSD- t, Chi-square test, or Fisher exact test. Multivariate logistic regression analysis was also applied to analyze the correlation between hypertriglyceridemia and adverse perinatal outcome. Results:The maternal age, gravidity and parity, body mess index, blood pressure on admission and total cholesterol (TC), TG, high density lipoprotein-cholesterol (HDL-C), low density lipoprotein-cholesterol (LDL-C), TG/HDL-C ratio and LDL-C/HDL-C ratio in late pregnancy and the occurrence of adverse perinatal outcome did not show any significant differences among Group A, B and C (all P>0.05). However, the hemoglobin (Hb) level increased with the elevation of altitude as expected, and that in Group C was higher than that in Group A and B [121.0 g/L (108.0-132.0 g/L) vs 115.0 g/L (103.5-128.0 g/L) and 117.0 g/L (101.0-127.0 g/L), H=2.37 and 1.97, both P<0.05]. The proportion of women with hypertriglyceridemia, the high TG group, in late pregnancy was 15.3% (80/523), and no significant difference was found in HDL-C or Hb levels between the high TG and control group [1.7 mmol/L (1.5-2.0 mmol/L) vs 1.8 mmol/L (1.5-2.1 mmol/L), Z=－1.51;123.5 g/L (110.0-131.8 g/L) vs 117.0 g/L (104.0-128.0 g/L), Z=1.69; both P>0.05]. Higher rates of cesarean section [13.8% (11/80) vs 6.6% (29/443), χ2＝4.98], hypertensive disorders of pregnancy (HDP) [16.3% (13/80) vs 7.5% (33/443), χ2＝6.54], preeclampsia (PE) [8.8% (7/80) vs 1.6% (7/443), χ2＝13.37], hyperglycemia during pregnancy [11.3%( 9/80) vs 3.6% (16/443), χ2＝8.69], preterm birth (PB) [7.5% (6/80) vs 2.0% (9/443), χ2＝7.27], microsomia [5.0% (4/80) vs 0.9% (4/443), Fisher exact test] and neonatal asphyxia [8.8%(7/80) vs 2.5% (11/443), χ2＝8.01] were observed in the high TG group than in the control group (all P<0.05). Regarding the pregnant women at different altitude, TG was negatively correlated with Hb ( r=－0.17, P=0.037) only in Group C .Multivariate logistic regression analysis revealed higher risk of HDP ( OR=2.42,95% CI:1.17-5.00), PE ( OR=5.25, 95% CI:1.73-16.00), hyperglycemia during pregnancy ( OR=3.77, 95% CI:1.56-9.09), PB ( OR=4.33, 95% CI:1.42-13.22), microsomia ( OR=4.33, 95% CI:1.42-13.22), neonatal asphyxia ( OR=3.45, 95% CI:1.27-9.35) and fetal demise ( OR=4.94, 95% CI:1.01-24.21) in women with high TG level in late pregnancy (all P<0.05). Conclusions:There were no differences in adverse perinatal outcomes or serum lipid levels in late pregnancy among women living at different high altitudes. However, hypertriglyceridemia at the third trimester is closely associated with the incidence of HDP, PE, hyperglycemia during pregnancy, PB, microsomia, neonatal asphyxia and fetal demise in this group of women.

Objective:To compare the clinical efficacy between 3D printing-assisted percutaneous balloon dilatation calcaneal plasty (3D-PCP) and conventional open reduction and internal fixation (ORIF) via the extended lateral L-shaped approach in the treatment of osteoporotic calcaneal fractures of Sanders type Ⅱ or Ⅲ in the elderly patients.Methods:Retrospectively analyzed were the data of 36 elderly patients with osteoporotic calcaneal fracture of Sanders type Ⅱ or Ⅲ who had been surgically treated at Department of Orthopaedics, Yixing People's Hospital from June 2012 to June 2018. According to their treatment methods, the patients were divided into a 3D-PCP group [16 cases, 9 males and 7 females with an age of (73.0 ± 3.4) years] and an ORIF group [20 cases, 8 females and 12 females with an age of (71.4 ± 2.6) years]. The 2 groups were compared in terms of hospital stay, operation time, intraoperative fluoroscopy frequency, suture removal time, weight bearing time, fracture healing time, visual analogue scale (VAS) for the surgical site 2 days and one year after surgery, American Foot and Ankle Surgery Association (AOFAS) ankle-hindfoot score, calcaneal imaging parameters (B?hler angle, Gissane angle, and length, width and height of the calcaneus axis) at 2 days and one year after surgery, and postoperative complications.Results:There was no significant difference in the preoperative general data between the 2 groups, showing comparability ( P > 0.05). All patients were followed up for 14 to 18 months (mean, 15.6 months). Compared with the ORIF group, the 3D-PCP group had significantly shorter hospital stay, significantly shorter operation time, significantly earlier suture removal, significantly earlier weight-bearing, significantly lower VAS scores at 2 days after surgery, significantly higher AOFAS ankle-hindfoot scores at one month after surgery, but significantly more times of intraoperative fluoroscopy (all P < 0.05). In all patients, the VAS scores at 2 days after surgery were significantly lower than those before surgery, and those at one year after surgery significantly lower than those at 2 days after surgery ( P < 0.05). In all patients, the AOFAS ankle-hindfoot scores at one month after surgery were significantly higher than those before surgery ( P < 0.001). In the ORIF group, the AOFAS ankle-hindfoot scores at one year after surgery were significantly higher than those at one month after surgery ( P < 0.05), but in the 3D-PCP group there was no such a significant difference between one year and one month after surgery ( P > 0.05). There was no significant difference in VAS score, AOFAS score, fracture healing time or postoperative imaging parameters between the 2 groups at one year after surgery ( P > 0.05). There was no significant difference either in the incidence of complications between the 2 groups ( P > 0.05). Conclusion:In the treatment of osteoporotic calcaneal fractures of Sanders type Ⅱ or Ⅲ in the elderly patients, compared with conventional ORIF, 3D-PCP shows advantages of shorter operation time, minimal invasion, quicker incision healing, shorter hospital stay, earlier weight-bearing exercise, and better functional recovery but a disadvantage of increased times of intraoperative fluoroscopy.

Objective:To evaluate the efficacy and safety of perioperative rehabilitation approaches based on the concept of Enhanced Recovery After Surgery (ERAS) for pelvic fractures.Methods:A prospective randomized control trial was conducted to include 114 emergency patients who had been admitted to Department of Orthopaedic Trauma, Beijing Jishuitan Hospital for surgical treatment of pelvic fractures from June 2019 to December 2020. Of them, 57 were assigned into an intervention group according to a random digits table. They were 42 males and 15 females, aged from 18 to 77 years and subjected to management of pelvic fractures with tentative perioperative ERAS approaches which were adjusted at different stages. The other random 57 patients were assigned into a control group. They were 40 males and 17 females, aged from 17 to 70 years and subjected to management of pelvic fractures with conventional rehabilitation approaches which included postoperative in-hospital consultation and guidance by rehabilitation physicians. The 2 groups were compared in terms of Majeed pelvis scores and Barthel indexes at postoperative 2, 6, 12 and 24 weeks, and visual analogue scale (VAS) pain scores and SF36 scores at postoperative 12 and 24 weeks.Results:A total of 105 patients (55 in the intervention group and 50 in the control group) were completely followed up for 151 to 254 d (mean, 177 d). The 2 groups were comparable due to no significant difference between them in the preoperative general data ( P>0.05). The Majeed scores (44±13, 67±16, 86±14 and 98±7) and Barthel indexes (57±13, 79±16, 95±8 and 100±2) at postoperative 2, 6, 12 and 24 weeks in the intervention group were significantly higher than those in the control group [(35±16, 51±16, 73±14 and 91±12) and (45±19, 67±18, 86±12 and 98±4)] (all P<0.05). At postoperative 12 and 24 weeks, the SF-36 scores (129±15 and 141±6) in the intervention group were significantly higher than those in the control group (114±15 and 131±12) ( P<0.05). There was no significant difference in the pain degree between the 2 groups ( P>0.05). Conclusion:In management of pelvic fractures, compared with conventional perioperative rehabilitation approaches, the perioperative ERAS rehabilitation approaches may improve early functional outcomes and thus help the patients restore their activities of daily living earlier.

ObjectiveTo evaluate the efficacy and safety of a perioperative rehabilitation clinical pathway of acetabular fracture in light of orthopedics rehabilitation team approach. MethodsA prospective randomized control trial was conducted in 82 patients with acetabular fractures who had been admitted from the Emergency Department of Orthopaedic Trauma, Beijing Jishuitan Hospital from June, 2019 to January, 2021. The patients were randomly divided into control group (n = 41) and intervention group (n = 41). The control group was managed routinely, while the intervention group received the rehabilitation clinical pathway, for 24 weeks. The Visual Analogue Score (VAS) of pain, the Barthel Index (BI) and Majeed Pelvic Score were compared. ResultsFinally, 76 patients completed the trial. There was no statistical difference in VAS score between two groups in all periods (|Z| < 1.926, P > 0.05). The BI score was higher in the intervention group than in the control group at discharge, two weeks, six weeks and twelve weeks after operation (|Z| > 2.121, P < 0.05); and no significant difference was found before operation and 24 weeks after operation (|Z| < 1.862, P > 0.05). Majeed Pelvic Score was higher in the intervention group than in the control group two weeks, six weeks, twelve weeks and 24 weeks after operation (|Z| > 2.428, P < 0.05). Six, twelve and 24 weeks after operation, the excellent rate of Majeed Pelvic Score was higher in the intervention group than in the control group (χ² > 6.136, P < 0.05). ConclusionIn comparison with traditional protocol in acetabular fracture, the perioperative rehabilitation clinical pathway was proved effective and of great safety in the light of the integration of orthopedics and rehabilitation mode for improving the function and activities of daily living of patients.