Objective:To observe and compare the efficacy,safety and turnover of plasma exchange and hemoperfusion in treating patients of chronic hepatitis with hyperbilirubinemia.Methods:This is a retrospective study.85 patients with hyperbilirubinemia were treated with plasma exchange and 68 patients with hyperbilirubinemia were treated with hemoperfusion.The clinical symptoms,liver function,bilirubin and prothrombin time activity were compared before and after the treatment in one group,and between the two treatment groups,were examined.Adverse effects were observed in the same time.Results:After plasma exchange,bilirubin decreased significantly;prothrombin time activity and albumin increased significantly(541.68?186.94 VS 337.65?130.52,40.50?19.32 VS 55.29?19.45,30.12?4.24 VS 34.57?3.17).After hemoperfusion,bilirubin decreased;prothrombin time activity and albumin decreased but not significantly(482.69?189.36 VS 473.58?183.57,41.63?19.85 VS 43.03?20.85,30.86?4.31 VS 30.26?3.48).Compared with hemoperfusion,bilirubin,prothrombin time activity and albumin in plasma exchange had more significant change(204.03?102.04 VS 9.11?87.46,-14.79?16.20 VS -1.40?12.78,-1.45?20.83 VS 0.60?3.58,P

Many primary reports featured applications of new techniques and long term results of popularized techniques in 2nd National Congress of Chinese Orthopaedic Trauma Association. The numbers of contributions and participants exceeded those in the last Congress. It was widely recognized that further comparison studies should be done between new techniques and conventional ones in clinical application. The congress was as successful as the last one.

The 2002National Annual Meeting org anized by the newly founded Chinese Orthopedic Trauma Association was held in Shenzhen in J une,with attendance of 180surgeons.Leaders of Chinese Orthopedic Society and many senior professors from the o rthopedic field also attended the me eting.The major topics of this 3-day meeting were“pelvic &acetabular fractures”and“open fractures”.5orthopedic trauma experts coming from Germany and US were invited to give pr esentations at the first day symposium,with the topics about radiologic al diagnosis,surgical approach and su rgical techniques of pelvic &acetab ular fractures.Precious experiences were exchanged in trauma resuscitation,management of open fractures and man agement of infection of bone and join t.225articles were received for this m eeting,with the contents covering e very part of the skeletal system.Clinically,the treatments reported at the meeting involved modern orthopedic surgical techniques and experiences in non -operative management.As for the basic research,application of tissue e ngineering in the orthopedic field w as discussed.45articles selected for oral presentation covered the management of pelvic &acetabular fractur es,choice of internal or external fixation in treatment of proximal femoral fractures,soft tissue management i n bone and joint infections,and clinical tria ls in the treatment of scapular fractures,proximal humeral fractures,d istal radial fractures and calcaneal fractures.The articles received also revealed that the methods adopted in clinical research should be improved and standardized in China so as to promote better natio nal comparison and exchange.[

Objective To assess the methods used to analyze the clinical outcomes in recent 180c linical reports in orthopaedic trauma in Chi na.Methods Statistical analysis was done with t he collection of the papers of2002Symposium of Chinese Orthopedi c Trauma Association in the aspects o f their research scope,object,case number,fracture classification,c riterion of follow -up and application of statistics.Results Of the total 225papers received by the symposium,180were clinical reports which reported more than ten thousand cases.The s cope of reports was wide and included majo r current methods of fracture treatm ent.The papers with statistical analysis were only 6.1%.Fracture classifica tions and criteria of follow up were v aried without a standard.No prospec tive report was found.Conclusion Current methods in clinical study on orthopaedic trauma should be improv ed.[

BAFF is an essential ligand essential for survival and differentiation of peripheral B cells. By interacting with three receptors, BAFF can promote B cell maturation and class switching, enhance humoral immunity and T cell co-stimulation. Over-expression of BAFF leads to autoimmune diseases such as systemic lupus erythematosus (SLE) in mouse model. Treating the mice model with BAFF antagonists can slow-down disease progression and enhance survival rate. Moreover, in some SLE patients serum level of BAFF is elevated and correlated with serum anti-dsDNA titer. The preliminary clinical trial of anti-BAFF monoclonal antibody has shown to be safe and effective. BAFF antagonists are promising therapeutic drugs for SLE.

Objective To explore the clinical efficacy of radial head replacement with titanic prosthesis for comminuted fractures of the radial head associated with elbow instability. Methods From 2000 to 2003, a total of 18 patients, 13 men and 8 women (mean age, 34.8 years, range, 24-47 years) underwent radial head replacement with titanic prosthesis for comminuted fractures associated with elbow instability. All were the close fractures, left elbow in 8 and right elbow in 10 cases. 3 patients suffered multiple fractures in ipsilateral elbow, including proximal comminuted fracture of radius in 1, fracture of coronoid process in 2. 4 patients suffered simultaneous fracture in ipsilateral upper extremity, including distal fracture of radius in 3, fracture of surgical neck of humerus in 1. According to Mason classification, 10 fractures were of type Ⅲ, 7 of type Ⅳ, and 1 with Essex-Lopresti injury. 4 cases were old fractures and dislocations, the other 14 were of fresh injuries within 2 weeks. Operations were undertaken averagely in 9 days after injury (range, 4-26 days). Results Patients were followed from 12 to 44 months (average, 29 months). According to Broberg and Morrey scoring system, 8 patients (44.4%) were rated as excellent, 8 (44.4%) as good, 1 (5.6%) as fair, and 1 (5.6%) as poor. The rate of excellent and good results was 88.9%. No cases of infection, neural injury, foreign body reaction, exacerbation of cubitus valgus or deformity of wrist was found. On X-ray films, all of the titanic radial head prosthesis were stable, no shortening or proximal migration of radius, or subluxation of distal radioulnar joint was found. No sign of inflammatory reaction was noted. Mild heterotopic ossification was found in 6 elbows, but no distinct resulted limitation of locomotion. Conclusion The radial head replacement with titanic prosthesis provides an effective method for the treatment of comminuted fractures of the radial head associated with elbow instability.

Objective To analyze factors influencing the incidence of deep venous thrombosis (DVT) and discuss the prevention and treatment of DVT in hip fracture patients. Methods The present study enrolled 531 patients who received surgery between June, 2008 to June, 2010 for hip fractures. They were 242 men with a mean age of 56. 2 years and 289 women with a mean age of 65.2 years. There were 336 femoral neck fractures, 183 femoral intertrochanteric fractures, and 12 femoral subtrochanteric fractures. The associations between DVT incidence and fracture type, plasma D-Dimer, sex, age and preoperative duration of immobilization were statistically analyzed. Inferior yens cava filters were used for patients who suffered DVT while surgery was performed. Results The total incidence of DVT was 10. 4% in this series. DVT occurred in 21 cases of femoral neck fracture, 34 cases of femoral intertrochanteric fracture and 0 case of femoral subtrochanteric fracture. All DVT events happened before surgery. DVT incidence had no significant associations with age or sex (P =0. 347 and 0. 376, respectively), but did with plasma D-Dimer, fracture type and preoperative duration of immobilization (P = 0. 002, 0. 017 and 0. 037, respectively). All the 55 DVT patients underwent a successful surgery. Conclusions The DVT incidence in hip fracture patients may have no significant associations with age or sex, but may do with plasma D-Dimer, fracture type and preoperative duration of immobilization. Inferior vena cava filters can ensure a successful internal fixation of the fracture and an uneventful postoperative rehabilitation.

Objective To explore factors influencing the restdts of operative treatment of unstable scapular neck fractures. Methods We reviewed 15 patients who had been diagnosed as the unstable scapular neck fracture and received operation from June 2001 to November 2007 in our department. Of them, 13 had full follow-up data, with a mean follow-up time of 45.1 (10 to 90) months. There were 8 cases of anatomic scapular neck fracture and 5 cases of surgical scapular neck fracture combined with injury to the superior shoulder suspensory complex. The shoulder posterior approach was adopted, exposing the fracture site between the in-fraspinatus and teres minors interval, to fix the scapular neck fracture along the scapular lateral border and si-multaneously fix the combined clavicle fracture, dislocation of the acromioclavicular joint and acromial process fracture. The results were evaluated by the absolute value of Constant-Murley rating system. Results The average absolute Constant-Murley score was 81.2 (40-98) points. Nine cases were evaluated as excellent and good, 2 cases as fair, and 2 cases as poor. The average forward elevation was 147.7°. Conclusions The degree of displacement is the main factor affecting the prognosis of the scapular neck fracture. Reduction and fixation of the displaced scapular neck fracture is the key to achieving good results.

Objective To compare the phenotypes of abnormal CD4+CD25-Foxp3+ T cells with traditional regulatory T cells (CD4+CD25+Foxp3+) in patients with untreated new-onset lupus (UNoL) and investigate their clinical relevance. Methods The expressions of surface markers (CD25, CD127, CCR4, GITR, CTLA-4) and intracellular marker(Foxp3) on the peripheral blood mononuclear cells from twenty-two UNoL patients were analyzed by flow cytometry analysis, and their clinical relevance were assessed. Results There were no significant differences between CD4+CD25-Foxp3+ and CD4+CD25+Foxp3- T cells in the expressions of GITR, CTLA--4 and CCR4 (P>0.05), but they were significantly lower than those of CD4+CD25+ Foxp3+ T cells in UNoL patients (P<0.01). The percentages of CD127low- in CD4+Foxp3+CD25high,CD4+Foxp3+ CD25low and CD4+Foxp3+CD25+ T cells were (93.8±3.5 )%, (93.7±2.3)% and (92.0±2.1)% respectively (P> 0.05), whereas the expressions of Foxp3 on CD4+CD127low- T subpopulations showed significant differences in CD4+CDI27low-CD25high (91.4±2.6)%, CD4+CD127low-CD25low (71.9±3.3)% and CD4+CD127low-CD25- (9.0± 2.2)% T cells(P<0.01 ). The frequency of CD+CCR4+CD25high T cells correlated negatively with SLEDAI (r=-0.695,P<0.001).and it was significantly lower in lupus nephritis patients(1.10±0.17)%compared with SLE patients without nephritis [(1.61±0.23)%,P<0.01]and healthy controls [(1.75±0.10)%,P<0.01], furthermore,the frequency of CD4+CCR4+CD25low-T cells in lupus nephritis was significantly higher than that in healthy controls[(11.5±2.3)%vs (8.0±1.0)%,P<0.01].Conclusion The increased CD4+CD25-Foxp3+ T cells in the Untreated Newonset Lupus(UNoL)patients mimic activated T effector cells.CD4+CD25high-CD127low-T cells can be used to isolate live CD4+CD25highFoxp3+regulatory T cells.CCR4+regulatory T cells may be involved in the pathogenesis of lupus nephritis.

OBJECTIVE:To systematically review the efficacy and safety of intrathecal injection of vancomycin combined with dexamethasone in the treatment of intracranial infection,and to provide evidence-based reference in the clinic. METHODS:Re-trieved from PubMed,Medline,CJFD,VIP,Wanfang databases,randomized controlled trials(RCTs)about intrathecal injection of vancomycin combined with dexamethasone in the treatment of intracranial infection were collected. Two reviewers independently screened literature,extracted data and assessed the risk of bias of included studies according to Cochrane system review manual 5.0.1. Then Meta-analysis was conducted by Rev Man 5.2 statistical software. RESULTS:Total of 8 RCTs were included,involv-ing 543 patients. Meta-analysis showed that,compared with intravenous dripping of ceftriaxone or vancomycin,intrathecal injec-tion of vancomycin combined with dexamethasone could significantly increase response rate [RR=1.18,95%CI(1.11,1.26),P<0.001] and bacterial clearance rate of CSF[RR=1.13,95%CI(1.01,1.27),P<0.001] of intracranial infection patients,shortened treatment time [SMD=-1.60,95%CI(-1.89,-1.30),P<0.001],reduce the incidence of ADR [RR=0.48,95%CI(0.32,0.73), P<0.001]. At the same time,it also could improve changes of intracranial pressure[SMD=-1.78,95% CI(-2.10,-1.47),P<0.001],changes of protein quantitation of CSF[SMD=-0.18,95%CI(-0.25,-0.11),P<0.001] and changes of glucose quantita-tion of CSF[SMD=1.77,95%CI(0.91,2.63),P<0.001],with statistical significance. CONCLUSIONS:Intrathecal injection of van-comycin combined with dexamethasone shows good clinical efficacy for intracranial infection,improves bacterial clearance rate, shortens treatment duration,significantly lowers intracranial pressure and protein quantitation,improves glucose quantitation of cere-brospinal fluid,with good safety.