Objective To evaluate the clinical effects in treating periprosthetic femoral fractures classified Vancouver B2 with a cementless modular revision femoral prosthesis.Methods Twenty-six patients (7 males and 19 females with mean age of 66.5 years,range 60-69 years) who suffered from periprosthetic femoral fractures classified Vancouver B2 were treated with a cementless modular revision femoral prosthesis in hip revision and open reduction and internal fixation with cables or plates from March 2007 to February 2014.The previous femoral prostheses included 21 cementless and 5 cemented hip stems.The period from former procedures to fractures was 16 months,range from 7 to 32 months.Harris hip scores and numerical rating scales were analyzed statistically.Time of leaving bed,discharging,fracture union postoperative complications and radiographic imaging were also recorded.Results The operation duration were 143 (range 105-165) minutes.Blood loss volume was 450 (range 270-780) ml.Blood transfusion volume were 330 (range 0-800) ml.All patients were followed up at least two years,averagely 3.5 years after surgeries.All fractures healed at 6.5 (range 3-12) months averagely after surgeries.Harris hip scores improved significantly from 11.8±2.5 before surgeries to 80.3±5.3 one month and to 91.4±7.3 six months after surgeries separately (F=0.715,P=0.001).Numerical rating scales were 9.6±0.3,9.4±0.4 and 9.1±0.7 points averagely in aspect of information acquisition,postoperative pain control and function recovery respectively one month after surgeries.Average time of leaving bed and discharging from surgeries was 68.3 (range 51-75) hours and 6.5 (range 5-9) days respectively.No postoperative complications was found except dislocation in 1 hip,lower limb discrepancy in 1 hip,DVT in 1 hip,and heterotopic ossification in 3 hips.Conclusion Due to achieving prosthetic stability and fracture union,periprosthetic femoral fractures classified Vancouver B2 treated with a cementless modular revision femoral prosthesis combined with open reduction and internal fixation with cables or plates can reach good clinical outcomes.

Objective To investigate how vascular endothelial growth factor(VEGF) up-regulates intercellular adhesion molecule-1 via protein kinase C(PKC)/ nitric oxide(NO) pathway in the retina of diabetic rats.Methods All the rats were divided into 4 groups: normal,diabetes,diabetes+PKCI and control groups.Diabetes was induced by an intraperitoneal injection of STZ.PKC inhibitor GF109203X was injected intravitreally after 5 months of streptozotocin induced diabetes.NO was determined by nitrate reductase method.VEGF and intercellular adhesion molecule-1(ICAM-1) were measured by Western blot.Results VEGF and NO expressions increased obviously in the retina of diabetic rats compared with those in the normal group(P

OBJECTIVETo study the scientific evidence of the traditional preparation of Dachengqi: "Boiling Aurantii Immaturus and Magnoliae Officinalis first, and then adding Rhei to decoct together. Discarding the dregs, adding Natrii Sulfas into the decoction and drinking the upper solution when the Natrii Sulfas has dissolved completely".

METHODThe concentrations of free and combined anthraquinonoids(emodin, rhein, chrysophanol, physcion) in different decoctions were determined with HPLC method respectively.

RESULTWhen Natrii Sulfas, Aurantii Immaturus and Magnolias Officinalis are decocted with Rhei in different schemes, the concentrations of anthraquinonoids were changed regularly.

CONCLUSIONThe scientific evidence of traditional preparation method greatly increased the concentrations of the active components in Dachengqi.

Anthraquinones ; analysis ; Citrus ; chemistry ; Drug Combinations ; Drugs, Chinese Herbal ; chemistry ; Emodin ; analogs & derivatives ; analysis ; Hot Temperature ; Magnolia ; chemistry ; Materia Medica ; chemistry ; Plant Extracts ; chemistry ; Plants, Medicinal ; chemistry ; Rheum ; chemistry ; Sulfates ; Time Factors

Acute Kidney Injury ; diagnosis ; etiology ; Biomarkers ; Early Diagnosis ; Humans ; Liver Cirrhosis ; complications ; diagnosis

Objective To explore the appropriate treatment according to the grading system of adolescent idiopathic cervical kyphosis.Methods A retrospective study was performed in 115 adolescent patients with idiopathic cervical kyphosis.The patients were divided into 4 groups according to the magnitude of kyphosis.The initial Cobb angle of 4 groups were 12.7°±1.4° 25.4°±4.8°,47.2°±4.4° and 62.6°±5.7° respectively.The patients in group I were treated with the collar support for 4-8 weeks.The patients in group Ⅱ were treated with skull traction (3-5 kg) and then fixed by cranio-cervical-thoracic plaster.According to the angles between the tangents of posterior vertebral body at each level on lateral cervical radiograph in extension,the anterior fusion levels of the group Ⅲ and angles and range of osteotomy in the group Ⅳ were decided.In group Ⅳ,the patients were treated by two steps.The anterior release and posterior osteotomy were performed firstly.Then skull traction (1/10 body weight) was maintained in order to correct the deformity for 7-10 days,fusion and anterior fusion with autologous bone graft and internal fixation was completed.Results Post-operative radiograph showed that Cobb angle were -5.5°±2.0°,-8.2°±6.1°,-4.5°±6.6° and -2.9°±7.9° in Ⅰ-Ⅳ group after treatment.The deformed appearance of the patients improved significantly.A improvement neck pain and neurologic function were found in all patients.Post-operative MRI showed that physiological curve of the cervical spine was restored,and the cerebrospinal fluid line was clear in the previous kyphosis area.Conclusion Adolescent idiopathic cervical kyphosis has specific characteristics.Surgical strategy is determined by the severity of deformity.

Objective To investigate the anti-apoptotic effect of gene A20 in treatment of trau-matic brain injury (TBI). Methods Thirty-five Sprague-Dawley rats were made severe TBI models and assigned randomly to experimental group and control group (35 rats in each group). After severe TBI, the rats in experimental group were injected with liposome-pcDNA3.1-A20 and those in control group injected with liposome pcDNA3.1-A20 at 30 minutes after severe TBI. The animals in both groups were sacrificed to remove the brain of five rats from each group at 12, 24, 48, 72 and 168 hours for sec-tioning. The expression of A20 and neurocyte apoptosis were defined by immunohistological method and TUNEL accordingly. The other ten rats were testified for neurological function at 1,2, 3 and 4 weeks af-ter TBI. Results The expression of A20 in experimental group was higher than that in control group, with statistical differences (P < 0. 01). The peak neurocyte apoptosis was found at 72 hours after TBI. The number of apoptosis cells in experimental group was lower than that in control group at 12, 24, 48 and 72 hours afte TBI (P < 0.01 or 0.05). At the 4th week after TBI, the neurological function in exper-imental group was better than that in control group (P < 0.05). Conclusion Gene therapy with A20 may have anti-apoptosis effect and exert neuroprotective effect on severe TBI.

Objective To analyse the causes of perinatal death and explore the preventive measures to reduce the perinatal mortality.Methods The cases with perinatal death in this hospital from January 2005 to December 2006 were reviewed to analyse the causes of death by categorization and sum-up.Results There were 166 cases with perinatal death and the mortality rate was 27.08‰,including 126 cases with fatal death,which accounted for 75.90%.In the analysis of dead causes,the first one was birth defects,which suffered 69 cases,41.57% of all,and mostly were with fetus edema syndrome.The cord factors had been elevated to the second cause,which suffered 51 cases,30.72% of all.Conclusion Improving the consciousness of gestational monitoring and self-care,strengthening the prenatal diagnosis and genetic counseling,controlling the perinatal birth defects,monitoring mother and fetus by poly-parameter and stopping the pregnancy in time can reduce perinatal death effectively.

Objective To evaluate the clinical efficacy of multiple stents placement in the management of hilar cholangiocarcinoma,especially in the complex cases of which the hepatic ducts are invaded.Methods Forty-five consecutive patients with hilar cholangiocarcinoma were treated with percutaneous transhepatic placement of two or three self-expandable metallic endoprostheses.The cause of hilar obstructions in these patients were all cholangiocarcinoma,including Bismuth classification type Ⅱ(n 12 ),Ⅲa(n 17),Ⅲb(n 10),and Ⅳ(n 6).Two or 3 stents were placed in the configuration of T,Y or X over the strictures.Results Stent placement with 2 or 3 endoprostheses was successful in all patients.All patients showed significant decrease in serum bilirubin level.The mortality rate within 30 days of stent placement was 2.2%(1/45).The mean survival and stent patency times were 215.3 d(26— 516 d)and 181.5 d(26—473 d),respectively.Conclusion Deploying of multiple metallic stents is an effective method to treat complex hilar cholangiocarcinoma,especially for the cases of which hepatic ducts are invaded:the henatic ducts should be drained as much as nossible.

ObjectiveTo compare the incidence of C5 nerve palsy after laminoplasty and laminectomy with internal fixation for treating multilevel cervical spondylotic myelopathy (MCSM).MethodsFrom January 2005 to June 2010,68 patients with MCSM were treated with laminoplasty (27 patients,group A) or laminectomy with internal fixation(41 patients,group B).There were 21 males and 6 females in group A,aged 33-80 years(average,60.4 years),31 males and 10 females in group B,aged 22-77 years (average,58.7 years).All the patients were followed up for 12-48 months (average,22 months).In both groups,Cobb's method was applied to measure cervical lordotic angle,and Ishihara's method was conducted to measure cervical curvature index(CCI) before and after operation.The incidence of C5 nerve palsy was recorded and compared.Then we further compared preoperative and postoperative the cervical lordosis angle and CCI of 9 patients with C5 nerve palsy (group B1) and 32 patients without C5 nerve palsy (group B2) in group B.ResultsThe incidence of C5 nerve palsy in group A was 3.7％(1/27),while 22.0％(9/41) in group B (x2=4.32,P＜0.05).For all ten patients with C5 nerve palsy,the muscle strengths of paralyzed muscles were recovered to grade 4 or better after being treated with conservative treatment for an average of 14 months.The change rate of preoperative and postoperative CCI in group B1 was 38.07％±18.03％,while 22.81％±12.71％ in group B2.There was a statistical difference between group B1 and group B2 (t=2.88,P＜0.05).Conclusion Compared with laminoplasty,laminectomy with internal fixation has a higher incidence of C5 nerve palsy.The C5 nerve palsy may be associated with postoperative increase of cervical lordosis angle.Moreover,tethering of the C5 root may be one of its important pathomechanisms.

ObjectiveTo investigate the effect of total disc replacement (TDR) in the treatment of cervical spondylotic myelopathy(CSM) with sympathetic symptoms.MethodsTwenty-seven patients (15 males and 12 females) with CSM at single level accompanied by sympathetic symptoms,who underwent TDR surgery(Prestige or Discover prosthesis) with the posterior longitudinal ligament (PLL) resected at the area of decompression between October 2008 and May 2011,were retrospectively analyzed.All patients were followed up for at least 6 months (average,15.1 months).Clinical and radiologic evaluations were obtained preoperatively,1 week postoperatively,and at the final follow-up.The sympathetic symptoms were scored by our original 20-point system.The clinical outcomes were assessed by Japanese Orthopedic Association (JOA) scoring system and the Short Form-36 Health Survey (SF-36).ResultsThe sympathetic symptoms were improved in all patients and the score was significantly improved after surgery.The sympathetic symptoms scores were (8.5±2.5) points preoperatively,(1.6±1.4) points 1 week postoperatively,and (2.3±1.1) points at the final follow-up.The patient's subjective satisfaction was excellent in 15 patients,good in 8,fair in 4,with an excellent and good rate of 85.2％.The corresponding JOA scores were(10.8±2.4) poiuts, (11.1±2.5) points,and (14.9±1.4) points,respectively.The SF-36 scores showed statistical improvements from preoperative (102.7±8.7) points to postoperative (129.8±5.5) points.Based on X-ray examination,the range of motion of the treated segment were reserved.During the follow-up period,there was no prosthesis subsidence or excursion.ConclusionThe CSM patients with sympathetic symptoms could be managed successfully with TDR.And thoroughly resection of the PLL may be the key factor for good prognosis.