Objective To discuss the clinical effects of open reduction and internal fixation with locking compression plate(LCP)to treat elderly women with comminuted distal radius fracture.Methods 32 elderly women(35 sides)with comminuted distal radius fractures were treated by open reduction and internal fixation with LCP from March 2002 to October 2004 in our department.Their mean age was 65 years old.According to AO classification,11 sides were type A3,15 sides type C2 and nine sides type C3.Volar approach was used in 32 sides and dorsal approach in three sides.Bone graft was applied for five sides.Results The follow-up period was 10 to 41 months(mean 21.5 months)and the union period was three to five months.According to Dienst criteria of joint functions,the result s showed that 13 sides were excellent,19 sides good,two sides fair and one side poor.Complications included wound dehiscence and superficial infection in five sides and median nerve injury in two sides.Conclusion The LCP method in this study is one of the good options to treat elder women with comminuted distal radius fractures.

Objective To explore the effect of 12 weeks of aerobic exercise combined with resistance training on the cardiovascular risk factors of obese adolescent men. Methods Thirty-six obese male adolescents ( the obese group) and 36 age-matched normal-weight adolescent men ( the control group) were recruited. Those in both groups maintained their routine eating habits. The obese group participated in a 12-week combined aerobic ex-ercise and resistance training program. Markers of inflammation, blood lipids, insulin sensitivity, vascular endothe-lium function and body composition were measured before and after the intervention. Results Some in the obese group lost visceral fat mass ( VFM) and some gained it. Before the intervention the average levels of serum interleu-kin-1 receptor antagonist ( IL-1Ra) , tumor necrosis factor-α, leptin, insulin, insulin resistance index ( HOMA-IRI) , high-sensitivity C-reactive protein, triglycerides, adiponectin and high-density lipoprotein cholesterol of the obese group were all significantly higher than those of the control group. After the intervention there had been signif-icant decreases in the average levels of IL-1Ra, IFN-γ-inducible protein 10, insulin and HOMA-IRI, but no signif-icant change in average body weight in the obese group as a whole. The group which lost VFM, however, showed greater improvement in triglycerides and insulin resistance than those who gained. Conclusions Twelve weeks of aerobic exercise combined with resistance training can reduce the inflammatory response and insulin resistance of obese adolescent men. The participants who lost more VFM after exercise improved their lipid profile and insulin sensitivity the most.

Objective To study the clinical results of early surgery for acute cervical spinal cord injury. Methods 24 cases of acute cervical spinal cord injury were treated with early surgery in our hospital from 1999 to 2002. The average interval from injury to surgery was 67 hours. The injured cervical segments were reduced, decompressed and fixed through anterior approach, posterior approach or anterior posterior approach. Results 22 cases got follow ups of 12 to 38 months (mean 18 months), but 2 cases were lost. 2 cases of the 11 patients of ASIA Grade A did not experience any restoration, but all the other patients got significant restoration and an average improvement of 1.8 ASIA grades. Conclusion Operation should be performed as soon as possible for acute cervical spinal cord injury, for good results can be achieved by early surgery.

10?) and delayed union of tibia in 4 sides. Conclusion Many factors can affect the prognosis of tibial Pilon fracture, but the key points for a successful operation are right procedure and timing of surgery.

Objective To investigate the operative indications and operation techniques for augmentative plate fixation in treatment of femoral shaft atrophic nonunions subsequent to intramedullary fixation. Methods Twelve femoral nonunions after internal fixation with intramedullary nailing were treated with augmentative plate internal fixation and bone graft from June 1999 to June 2008. All femoral nonunions were caused by insecure fixation of the intramedullary nailing, in which a rotational instability of the fracture site was verified in all the patients during operation. Minimally invasive removal of the granulation tissue at fracture site and the sclerotic bone was dccorticated. The adequate lilac bone was tiled longitudinally on the nonunion gap and the cortical bone bed. The fixation involved the limited-contact dynamic titanium plate with 5-6 holes, 3.0 mm Kirschner wire and 4-6 double cortex cortical screw fixation.Protective weight-bearing was given after surgery and the tunction was evaluated at 1,3, 6 and 12 months with imaging. Results All patients were followed up for 7-26 months ( average 17.4 months), which showed radiological solid union (7-12 months, average 9.4 months) and clinical union (5-9 months, average 7.1 months ). The operation lasted for 50-120 minutes ( average 77.5 minutes), with blood volume of 150-350 ml ( average 252 ml). There were nine patients with bone pain, of whom the pain was relieved within one month in seven patients and three months in two. No infection, hardware loosening or breaking were found. Conclusion The plate augmentation and cancellous bone grafting leaving the nail in situ can be an effective solution for nonisthmal femoral nonunion, bone defect and failed exchange nailing.

ObjectiveTo compare the outcomes and indications between exchange nailing (EN) and augmentation plating (AP) with a nail left in situ for femoral shaft hypertrophic nonunion after femoral nailing. MethodsFrom April 1998 to June 2009, 20 patients with femoral shaft hypertrophic nonunions after femoral nailing were treated with EN (11 patients) and AP (9 patients) respectively. There were no significant differences between the two groups with respect to the patient's age, gender, associated injuries, anatomical location and type of femoral fracture. Patients were evaluated by imaging and clinical function at 1, 2, 3, 4,6, and 12 months after surgery, and then every year postoperatively, to observe the callus and the recovery condition of the affected limb function. Fisher exact test and t'-test were performed to compare the outcome and complications respectively. ResultsAn unpaired t'-test showed no significant differences with respect to follow-up time, operating time, intraoperative blood loss, postoperative drainage, length of stay, time to radiographic union, time to clinical union, and AAOS score between the two groups. The cost of hospitalizations in the EN group was higher than in the AP group(t'=16.4, P=0.013). Four nonunions in the EN group failed to achieve union, which 3 patients were subsequently treated with AP and simultaneous autogenous bone grafting and 1 patient was treated with nail dynamization. All 9 hypertrophic nonunions in the AP group obtained osseous union. Fisher exact test showed a higher nonunion rate of EN compared with AP (χ2=6.01 ,P=0.008). ConclusionEN has been an excellent choice for aseptic isthmal femoral nonunion without a large bone defect subsequent to intramedullary fracture fixation, and AP can be an effective solution in cases of nonisthmal femoral nonunion and bone defect and failed exchange nailing.

Objective:To evaluate the efficacy and safety of intermittent aerobic exercise of different intensities in the cardiac rehabilitation of patients with acute coronary syndrome so as to provide a reference for making the best exercise prescription.Methods:Sixty-four acute coronary syndrome patients were randomly divided into a maximum-intensity and a high-intensity intermittent aerobic exercise group, each of 32. Both groups underwent 2 weeks of adaptive training, followed by 4 weeks of intermittent aerobic exercise (3d/week) at either 95-100% or 85% of their heart rate reserve. The maximum oxygen uptake (VO 2max) was measured before and after the intervention, and any exercise-related adverse reactions were recorded. Results:Both groups completed the 671.6-hour exercise plan without any cardiovascular or musculoskeletal complications. After the intervention, the average VO 2max of the maximum-intensity group had increased by 31.2%, versus 17.2% for the high-intensity group, a significant difference. Conclusion:Maximum-intensity aerobic exercise is more effective than high-intensity in improving cardiopulmonary function among patients with acute coronary syndrome. With strict monitoring, both intensities are safe.

Objective:To observe the effect of a modified version of high-intensity interval training (HIIT) on the rehabilitation of persons with coronary artery disease (CAD), and to evaluate its safety and patient compliance.Methods:Sixty CAD patients were randomly divided into an exercise group and a control group, each of 30. Both groups were given conventional cardiac rehabilitation (including controlled nutrition, psychological counseling and low-intensity aerobic exercise). The exercise group additionally completed a session of HIIT twice a week for 6 weeks. Each session involved 30s of cycling at 85-90% of the patient′s maximum heart rate followed by 30s rest, repeated 15 times. The cardiorespiratory fitness, blood pressure, vascular function and body composition of both groups were documented before and after the 6 weeks. Compliance was recorded and the safety of the modified HIIT program was evaluated.Results:A significant improvement was observed in the maximum oxygen uptake and workload in a graded exercise test among the exercise group. The average blood pressure and body composition improved significantly, as did the average positive mood score and enjoyment of training. There was a significant decrease in negative mood and anxiety scores among the exercise group. No significant differences were observed in the control group. Compliance with the HIIT training program of the exercise group (97.4%) was significantly better than the control group′s compliance (88.7%) with its less strenuous regimen. There were no serious adverse reactions or cardiovascular events during the experiment.Conclusion:Modified HIIT is an effective form of cardiac rehabilitation training for CAD. It is safe, and compliance is good.

OBJECTIVETo establish a clinical classification of pulmonary embolism (PE), and to evaluate the optional treatment strategies for different types of PE.

METHODSFrom December 1995 to July 2001, 45 patients with acute PE were hospitalized, of which 33 received intravenous thrombolytic therapy or interventional treatment.

RESULTSMisdiagnostic rate in the 45 patients with acute PE during first visit was 62.2% and mortality rate was 28.9%. Misdiagnostic rate in acute PE patients who had undergone surgery was 82% and mortality rate was 73%. The effective rate of thrombolytic therapy was 77.7%. Clinical symptoms rapidly disappeared in massive PE patients treated with interventional therapies.

CONCLUSIONSIntravenous thrombolytic therapy is one of the most effective methods for treating acute PE. Application of interventional therapy for severe acute PE is also promising.

Acute Disease ; Adolescent ; Adult ; Aged ; Anticoagulants ; therapeutic use ; Diagnostic Errors ; Humans ; Middle Aged ; Pulmonary Embolism ; diagnosis ; therapy ; Thrombolytic Therapy

Background Vascular endothelial damage associated with endothelial progenitor cell dysfunction is considered as an initiating step of hypertension and target organ damage, in which oxidative stress plays a key role. High-intensity intermittent exercise is an effective prevention and treatment method of various chronic diseases; however, little attention has been paid to its effects and mechanisms on endothelial progenitor cells. Objective To observe the effect of high-intensity intermittent exercise on the function of endothelial progenitor cells in patients with hypertension and explore the mechanism of oxidative stress. Methods A total of 60 patients with essential hypertension were randomly divided into a control group and an exercise group. The control group received conventional drug treatment (including diuretics, calcium blockers, and beta-blockers), and the exercise group performed high-intensity intermittent exercise for 8 weeks (3 times·week⁻¹) in addition to the treatment plan of the control group. Before and after intervention, brachial artery flow-mediated vasodilation (FMD) was used to evaluate vascular endothelial function; venous blood was sampled to perfrom circulating endothelial progenitor cell counts; endothelial progenitor cells were cultured in vitro, and the modified Boyden chamber assay and Matrigel lumen formation assay were used to detect their migration and tube formation ability, superoxide fluorescent anion probe method to detect reactive oxygen species levels, terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) staining method to detect cell apoptosis, Western blotting to determine protein expression of reduced nicotinamide adenine dinucleotide phosphate (NADPH) oxidase 2, NADPH oxidase 4, and superoxide dismutase. Results Four patients (13.3%) in the control group and 2 patients (6.7%) in the exercise group dropped out; the completion rate of the exercise group's training plan was 94.9%. Compared with the before-intervention indicators, blood pressure decreased, brachial artery FMD increased, number of circulating endothelial progenitor cells increased, their migration and tube formation ability were enhanced, reactive oxygen species levels and cell apoptosis rate were reduced, NADPH oxidase 2 and NADPH oxidase 4 protein expressions were down-regulated, and superoxide dismutase protein expression was up-regulated in the after-intervention exercise group, and the differences were all statistically significant (P < 0.05). There was no significant difference in the above indicators in the control group between before and after intervention (P > 0.05). Conclusion High-intensity intermittent exercise regulates oxidative stress mediated by NADPH oxidase, improves endothelial progenitor cell function, and restores vascular endothelial disorders in patients with essential hypertension.