Fracture Fixation ; methods ; trends ; Fractures, Bone ; surgery ; Humans ; Pelvic Bones ; injuries ; surgery

Objective To investigate the clinical effects of posterior reduction and interbody fusion in the treatment of thoracolumbar fractures and dislocations ,and its impact on the neural function .Methods 12 cases with thoracolumbar fractures and dislocations were treated with posterior reduction and interbody fusion .After treatment , flange height ,Cobb angle ,nerve function ,complications of internal fixation were observed ,and the clinical efficacy was evaluated.Results The anterior height of fractured vertebrae was significantly increased from (56.7 ±7.9)% to (90.4 ±9.8)% in 12 patients(t=9.3,P<0.05);Cobb angle was significantly reduced from (28.4 ±3.8)°to (7.9 ±2.9)°(t=14.9,P<0.05);The grade of neural function was obviously improved (from 2 cases A,5 cases B, 4 cases C and 1 case D to 1 case A,1 case B,2 cases C,6 cases D and 2 cases E),and there were no serious compli-cations.Conclusion The clinical effect of posterior reduction and interbody fusion in the treatment of thoracolumbar fractures and dislocations was good ,which is worthy of clinical application .

To introduction the biological function of vascular endothelial growth factor and to explore the role of vascular endothelial growth factor(VEGF)and in the pathogenesis of endotoxin,ischemia-reperfusion,hyperoxia,ventilator-induced lung injury(ALI)/acute respiratory distress(ARDS).

Objective To explore the efficacy of different modes of fluid resuscitation (early or delayed use of norepinephrine) on lung injury of septic shock rat induced by LPS.Methods A total of 60 male Wistar rats were randomly (random number) divided into 4 groups:the normal control group (group A,n =15),septic shock control group (group B,n =15),conventional fluid resuscitation group (group C,n =15),fluid resuscitation with early using of norepinephrine group (group D,n =15).All rats were mechanically ventilated with the same parameters.In the group C,norepinephrine was used 30 min after fluid resuscitation.In the group D,norepinephrine was used at the beginning of fluid resuscitation.Vital signs,volume of fluid infused and dosage of norepinephrine were recorded.Rats were sacrificed 2 h later and blood samples were collected for blood gas analysis.The lung tissues and BALF were collected.Pathological changes of the lung tissues were observed under light microscope.The levels of MPO,SOD and MDA were detected.The levels of IL-6,IL-8 and TNF-α in BALF and in serum were detected by using ELISA.Results Compared with group C,the mean volume of fluid infusion to achieve target blood pressure was decreased,oxygenation index was improved and the level of blood lactic acid were decreased in group D (P ＜ 0.05).HE staining indicated that inflammatory cells were decreased,pulmonary edema and alveolar walls hyperemia were alleviated in group D in comparison with group C.Inflammatory cytokines (IL-6,IL-8 and TNF-α) in BALF and in serum were significantly decreased in group D compared with group C (P ＜0.05).Levels of MPO were decreased in group D compared with group B and group C.However,early using of norepinephrine had limited effect on the levels of SOD and MDA.Conclusions The current study demonstrated that fluid resuscitation with early use of norepinephrine exhibited a protective effect on lung injuries induced by LPS.

Compared with hip replacement, internal fixation in the treatment of the elderly femoral neck fracture, especially the application of cannulated screws, is minimally invasive, easy to operate and economical. In recent years, it becomes the research focus in the field of orthopedic clinical research. However, configuration of cannulated screws is still controversial. Most clinicians believe that three cannulated screws being placed in parallel in an inverted triangle configuration is better than that in a triangular configuration in biomechanics and clinical effect. Nonparallel strong oblique nailing technique allows the screws to share more weight to reduce postoperative complications, so that it is more suitable for elderly patients with osteoporosis. However, the related complications of internal fixation such as nonunion, femoral neck shortening and other problems are still the focus of domestic and foreign scholars. Issues about how to control the indication of internal fixation surgery, understand related factors of the complications, and prevent complications are required to be further explored.
Aged ; Bone Nails ; Femoral Neck Fractures ; surgery ; Fracture Fixation, Internal ; adverse effects ; methods ; Humans ; Internal Fixators

Objective To investigate the joint value of early peak temperature and 48 h-△sequential organ failure assessment (SOFA) score in predicting the prognosis for patients with sepsis in emergency department.Methods Two hundred and thirty-one patients with sepsis admitted from January 2013 to January 2015 in Emergency Intensive Care Unit of the First Affiliated Hospital of China Medical University were enrolled.Clinical features,early peak temperature,SOFA scores,the length of stay in EICU and the mortality in 28 days were studied.The patients were divided into two groups according to the 48 h-△SOFA.Each group were divided into three subgroups according to the early peak temperature.For example,hypothermia subgroup had temperature below 36 ℃,normothermia subgroup had temperature between 36 ℃ and 38 ℃,and hyperthermia subgroup had temperature above 38 ℃.The relationship between peak temperature plus 48 h-△SOFA and the length of stay in EICU as well as mortality were analyzed.Results Of 231 patients,in 48 h-△SOFA＞0 group (n =142) 27 (19.0％) patients died,and in 48 h-△SOFA≤0 group (n =89) 33 (37.1％) patients died (P ＜ 0.05).Hypothermia subgroup had a higher odds ratio value in predicting nonsurvival in 48 h-△SOFA≤0 group (OR =4.51,95％CI:1.33-2.17,P =0.01).Hyperthermia subgroup had a longer stay in EICU than hypothermia subgroup and normothermia subgroup (P ＜ 0.05).Conclusion The combination of the early peak temperature and 48h-△SOFA score is an effective indicator to evaluate the prognosis and to stratify patients with sepsis in emergency department.More attention should be paid to the patients with an early peak temperature ＜ 36 ℃ and 48 h-△SOFA ≤0 because of higher mortality.The condition of patients should be reassessed and try to make a more rational treatment for the patients with an early peak temperature ＞38 ℃ and 48 h-△SOFA ＞0 because of its longer stay in EICU.

Objective To determine the clinical indicators of early death (within 72 hours) in patients with acute paraquat poisoning.Methods The data of 93 acute paraquat poisoning patients admitted to emergency intensive care unit (EICU) of the First Hospital of China Medical University were retrospectively analyzed.The patients were divided into two groups according to whether they died within 72 hours or not.The gender,age,poison dose,paraquat concentration in urine,reduction of paraquat amount in urine after each hemoperfusion,and the worst value of white blood cell (WBC) count,lymphocytes count,arterial blood gas analysis,blood K +,Na+,Cl-,and serum amylase,serum lipase,serum total bilirubin,troponin Ⅰ,creatine kinase (CK),blood urea nitrogen,serum creatinine within 24 hours after poisoning were compared.Spearman correlation analysis was used to analyze the correlation between paraquat concentration in urine and the dose of paraquat.The predictive value of each indicator at death in early stage of poisoning was analyzed with receiver operating characteristic curve (ROC curve).Results Nineteen patients in the group of those died in early stage of poisoning (within 72 hours) resulted in a mortality rate of 20.4％.Compared with non-early death group,in early death group,the value of poison dose (mL:133.4 ± 108.8 vs.58.6 ± 40.0,t=3.145,P=0.002),paraquat concentration in urine [mg/L:16.34 (11.87,96.76) vs.4.46 (1.21,12.78),Z=-3.422,P=0.001],WBC (× 109/L:22.63 ±9.72 vs.14.95 ±8.39,t=3.446,P=0.001),blood lactate [Lac (mmol/L):6.7 (2.2,12.1) vs.1.9 (1.1,3.4),Z=-3.294,P=0.001] were significantly higher,and the reduction rate of paraquat concentration in urine after first perfusion [(38.4 ± 15.63)％ vs.(67.59 ± 27.87)％,t=2.945,P=0.004] and arterial partial pressure of carbon dioxide [PaCO2 (mmHg,1 mmHg=0.133 kPa):28.7 ± 9.3 vs.34.8 ± 6.7,t=-3.245,P=0.002] were significantly lowered.There was no significant difference between two groups in other indexes.Poison dose and paraquat concentration in urine showed significantly positive correlation (r=0.450,P＜0.001).ROC curve showed that the predictive value of paraquat concentration in urine,WBC,and Lac in early death were significant [area under the ROC curve (AUC) of paraquat concentrations in urine was 0.806,95％ confidence interval (95％CI) 0.699-0.913,the cut-off value was 11.64 mg/L,with sensitivity 84.6％,specificity 71.4％; AUC of WBC was 0.734,95％CI 0.569-0.899,the cut-off value was 15.94 × 109/L with sensitivity 69.2％,specificity 76.8％ ; AUC of Lac was 0.729,95％CI 0.568-0.891,the cut-off value was 1.95 mmol/L with sensitivity 84.6％,specificity 42.9％].Conclusions Paraquat concentrations in urine,WBC,Lac,poison dose and PaCO2 were the risk factors of the early death of the acute paraquat poisoning.The research suggests that paraquat concentration in urine,WBC and Lac are valuable in predicting early death of the patients.

Objective To explore the measurement of femoral neck shortening (FNS) after cannulated screwing for elderly femoral neck fractures and the effect of FNS on hip functional outcome.Methods Totally 214 elderly patients with femoral neck fracture were included in this study who had been treated by fixation with cannulated screws from June 2007 to October 2013.They were 71 males and 143 females,with an average age of 77.2 years.According to Garden classification system,65 cases were types Ⅰ and Ⅱ (undisplaced fractures),and 149 types Ⅲ and Ⅳ (displaced fractures).The postoperative X-ray and follow-up X-ray films were compared to observe whether the trailing end of screw shaft was exposed to the outer cortex of the proximal femur.We chose the screw which had the longest exposure of trailing end to measure the length of the exposed screw shaft as the length of FNS.FNS indexes were defined according to the ratio of the length of exposed screw shaft to the thickness of screw head.FNS degree 1:＜ 1 screw head; FNS degree 2:1 to 2 screw heads; FNS degree 3:＞ 2 screw heads.The relationships of the FNS length respectively with thefemur length decrease and Harris scores of hip functional outcome were analyzed statistically.Results FNS occurred in 78 cases,giving an incidence of FNS of 36.4％ (78/214).Of them,12 cases (15.4％)were defined as degree 1,24 cases (30.8％) as degree 2,and 42 cases (53.8％) as degree 3.There was a significant positive correlation between the FNS length and the femur length decrease(r =0.919,P =0.000).The average Harris score at 12 months postoperation for 180 cases was 77.3 points (ranging from 32 to 98 points).The average Harris score for those with FNS was significantly lower than that for those without FNS (t =9.904,P =0.000).There was a significant negative correlation between the FNS length and Harris scores (r =-0.707,P =0.000).Conclusions Our measurement of FNS and FNS indexes are easy to be used in clinic.Severe FNS can influence the function of hip joint.

Objective To investigate the expressions of heat shock protein(HSP)90α and HSP90β in peripheral blood mononuclear cells (PBMC) in myasthenia gravis (MG) children before and after glucocorticoid (GC) treatment,and normal control groups.Methods Fresh bloods were collected from 20 cases of children with MG before and after treatment and 19 healthy children.PBMCs were isolated,followed by measurement of the expression levels of HSP90α and β by immunocytochemistry,and HSP90α and β mRNAs by reverse transcription and polymerase chain reaction (RT-PCR).Results The positive cell ratio of HSP90α andβ of MG children before and after of GC treatment was significantly higher than control groups (P ＜ 0.05),and their mRNA expression levels was higher than control groups (P ＜ 0.05).HSP90β in MG children after GC treatment was mainly expressed in the nucleus(P ＜ 0.05).Conclusions HSP90α and β in PBMC of MG children before and after GC treatment were significantly higher than those of normal control groups.HSP90β in MG Children after GC treatment was significantly increased.The present results suggest HSP90β promote GC receptor binding and enhance GC transportation,which promotes and strengthens the physiological and pharmacological effects of GC to improve the clinical symptom of MG children.

Objective　To establish the normal growth velocity of fetal liver length and compare them with those of intrauterine growth retardation, pregnant diabetes and maternal-fetal blood types imcopatible. Method　Three hundred and five normal pregnant women and 24, 10, 16 pathological pregnant women of intrauterine growth retardation (IUGR), gestational diabetes and maternal-fetal blood types incompatible respectively had ultrasonographic measurement of fetal liver length at 18 to 42 weeks′ gestation. Results　Normal fetal liver length has a linear relation to gestational age, and showed a significantly rapid increase after 28th week with a growth rate of 1.76 mm per week, and 1.00 mm per week before 28th week (P<0.05). The growth rate of IUGR group before and after therapy were 1.19 mm and 1.23 mm per week, significantly lower than those of normal group (P<0.05). The growth rate of pregnant diabetes group before and after therapy were 1.63 mm and 1.63 mm per week, no statistical significance with normal group (P>0.05). The growth rate of maternal-fetal blood types incompatible group before therapy was 1.98 mm, showed no difference with normal group (P>0.05), but after therapy, the growth rate of fetal liver was 1.38 mm per week, significantly lower than normal group (P<0.05). Conclusion　Dynamic measurement of fetal liver length can help us to understand whether the fetus grow well in uterus and whether the treatments are effective.