Objective To observe the clinical effect of bisoprolol combined with simvastatin in the treatment of elderly patients with unstable angina pectoris.Methods 60 elderly patients with unstable angina pectoris were randomly divided into control group and study group according to the digital table method.The patients in the control group were treated with simvastatin,and the patients in the study group were treated with bisoprolol and simvastatin.The clinical therapeutic effect and adverse reactions of the two groups were compared.Results The total effective rate and the rate of ECG (86.67% and 80%)in the study group were significantly higher than those of the control group (76.67% and 46.67%)(χ2 =4.02,7.1 8,all P <0.05 ).The total incidence rate of adverse reactions (26.67%)in the study group had no significant difference compared with the control group (χ2 =0.08,P >0.05). Conclusion Bisoprolol combined with simvastatin had better clinical effect and small adverse reactions in the treat-ment of elderly patients with unstable angina.It was worthy of clinical use.

Objective Comparing the enhancement of contrast-enhanced ultrasound(CEUS) with the intensity of the blood signals of breast masses, and producing the parameter of peak intensity (PI), to determine whether they can reflect the differentiation of the benign breast masses from the malignant ones.Methods Fifty patients with the breast masses (25 benign,25 malignant) were implemented the contrastenhanced ultrasound inspection.The blood signals of the masses could be got before performing the CEUS,then the CEUS was performed.The enhancement of the masses was divided into 4 grades according to the enhancement of breast which was around the mass (no enhancement, low enhancement, equal enhancement,and high enhancement as well).The PIs of all masses and high enhanced massed were calculated by software in machine,then them were compared according to "the groups which had been classified by their maximal diameters.Results Forty-one of 50 cases showed an obvious enhancement using CEUS compared with the routine CDFI.Malignant masses were more obviously than that of benign ones ( P＜0.05).In the 50 cases,the no enhanceed ones( n = 2) and equal enhanced ones( n = 5) were benign,and 1 case of the low enhanced masses( n = 9) was malignant.The high enhanced masses ( n = 34) were malignant or benigh.About the high enhanced masses, there were statistics meanings using the parameter of PI for the masses whose maximal diameters＜2 cm( P＜0.05),and no statistics meanings when their maximal diameters≥2 cm(P＞0.05).Conclusions The CEUS of breast can improve the appreance of the tumor' s blood vessel obviously, especially for malignant masses.The PI of the breast benign masses are different from the malignant ones.Combination of them can help to discriminate benign masses from malignant ones.The parameter of PI is useless for differentially diagnosing the breast masses if their maximal diameters≥2 cm and the blood flow grade Ⅲ before CEUS.

BACKGROUND:Transverse acetabular fracture often involves the damage of anterior and posterior columns of acetabulum. The most popular fixation of the anterior and posterior columns needs the combined anterior and posterior approach. Big trauma is not conducive to patient’s recovery after surgery. Limited incision or percutaneous minimaly invasive lag screw placement can reduce soft tissue injuries, but the strength of the fixation lacks of biomechanical verification. OBJECTIVE: To compare different types of fixations for transverse acetabular fracture, explore the appropriate fixation options that can achieve effective fixation and reduce tissue injury by combing with repair approach and the condition of soft tissue. METHODS: The fourth generation of synthetic semi-pelvic sawbones was set as a template to establish a model of acetabular transverse fracture using finite element analysis. Five different fixation options were used to fix the transverse acetabular fracture. The magnitudes of anterior and posterior displacement of transverse fracture were compared to assess the stability of different options under a simulated condition of incomplete weight bearing stand. RESULTS AND CONCLUSION:The motion at anterior column was minimal when fixed by anterior column locking plate + posterior column screw and the minimum displacement at posterior column was the fixation of anterior column screw + posterior column locking plate. Both of the motions of these two fixations were less than the reconstruction plate fixation respectively. The worst fixation was the anterior column and posterior column lag screw fixation with the largest displacement. The anterior column locking plate + posterior column screw, accomplished by single approach, could not only reduce surgical trauma, but also has a stronger stability. Moreover, this fixation option is effective method to place posterior column lag screw under direct vision and reduce the difficulty of screw implantation.

Objective To discuss the causes of failure of transpedicular screw fixation in treatment of thoracolumbar fractures. Methods A retrospective analysis was done to analyze the failure causes of 24 patients (15 males and 9 females) who received pedicle screw fixation for their thoracolumbar fractures from June 2002 to June 2008 in our department. There were two patients with delayed infection, eight with pedicle screw breakage, one with connecting rod breakage, 10 with internal fixation loosening (including nut loosening) and three with poor screw position. Results All patients received reo-perations including removal of internal fixation plus debridement and lavage in two patients, simple removal of internal fixation in nine patients, removal of inter fixation and posterior fusion in two, replacement of the lengthened fixation plus posterior fusion in nine, and adjustment of the position and orientation of screw in two. All patients were followed up for 6-18 months (average 11 months) , which showed no any complications. Conclusion Improper surgical indication or approach, ineffective fusion, incorrect postoperative rehabilitation exercise, too late removal of the screws and improper surgical operation are main causes for failure of internal fixation.

ObjectiveTo discuss the clinical application of the temporary balloon occlusion of the common iliac artery in the control of hemorrhage in the operations of the old pelvic fractures.Methods From January 2006 to June 2009,twelve patients (10 males,2 females; mean age 33.9 years) with old pelvic fractures of Tile C type were treated operatively.Three cases were treated with external fixator.Operative treatments were delayed for the treatment of the life-threatening visceral injuries in six nonunions and three malunions.A balloon catheter was placed through intravascular intervention in the common iliac artery of the affected side.The balloon catheter was infolded when the osteotomy was performed and the operations were undertaken under temporary and total occlusion of the common iliac artery.Osteotomies and internal fixations were performed in 12 cases.Decompressions of lumbosacral trunk were undertaken in 4 cases complicated with injuries of sciatic nerve.ResultsThe mean time of operations was 290 min(range,210-367min).The mean time of occlusions was 65 min (range,45-90 min).The loss of blood ranged from 700 ml to 2800 ml,with an average of 1833 ml.All cases were followed up for 12-48 months,with an average of 35 months.The mean time of bone healing was 20.6 weeks (range,16-24 weeks).No thrombosis of the common iliac artery and deep venous thrombosis of the lower extremity or ischemic necrosis happened.In the four cases complicated with injuries of sciatic nerve,three recovered partly and could walk with a crutch and one recovered completely and could walk normally.Two cases limped and other six cases could walk normally.ConclusionThe effect of temporary balloon catheter occlusion of common iliac artery is reliable.It drastically reduces hemorrhage during the operation and avoid the complications of selective arterial embolism and ligation and makes the operations of the old pelvic fractures more safer.

Objective To investigate the analgesia effects of ultrasound-guided suprascapular nerve blocks for shoulder arthroscopy without impacting respiratory function.Methods Forty seven patients scheduled for shoulder arthroscopy,17 males and 30 females,aged 26-78 years,weighing 50-75 kg,ASA physical status Ⅰ or Ⅱ,were randomized into suprascapular nerve blocks group (group S,n=24) and interscalene plexus blocks group (group Ⅰ,n =23).0.375％ ropivacaine 20 ml and 1 ％ lidocaine plus 1 ml of dexamethasone 5 mg.The vital capacity before and 6 h after surgery,extubation time,total PACU duration,VAS scores at awake time and 6 h,12 h,24 h after surgery,total opiods consumption,and other complications were recorded.Results The patients in group S exbuted significantly earlier than in group Ⅰ [(13.0±3.9) min vs (21.2±4.0) min,P＜0.05].The mean vital capacity 6 h after surgery significantly decreased in group Ⅰ [(2 909±502) ml vs (3 533±726) ml,P＜0.05].There were no significant differences of VAS scores or opiods consumption between the two groups.Conclusion Selective suprascapular nerve blocks can provide effective analgesia for shoulder arthroscopy without impacting the vital capacity.

Objective To investigate the feasibility and clinical effect of percutaneous pedicle screw fixation in the treatment of ankylosing spondylitis (AS) with thoracolumbar fractures.Methods A retrospective case-series study was performed on 12 AS patients with thoracolumbar fractures admitted from January 2013 to January 2016.There were 9 males and 3 females,aged (42.7 ± 13.0) years (range,24-63 years).All patients received percutaneous minimally invasive pedicle screw fixation.The operation duration,intraoperative blood loss,length of incision,ambulation time,and time to basic life were recorded.Visual analogue scale (VAS) and Oswestry disability index (ODI) were evaluated before and after operation.Postoperative complications and bone fracture union were observed during the followup period.Results All patients were followed up for average 22 months (range,14-36 months).All patients underwent successful surgery,with operation duration and intraoperative blood loss of (178.0 ± 60.2) min and (116.7 ± 44.2) ml respectively.No serious complications such as blood vessel or nerve injury occurred during the operation.The incision length was 1.2-1.5 cm.All the patients were able to do exercise with the help of brace 2-3 days after the operation and returned to basic life after (23.4 ± 7.3)days postoperatively.At 1,3,6 and 12 months after operation,VAS and ODI differed significantly from the preoperative detections (P ＜ 0.05).During the follow-up,bone fracture union was observed in all patients,with no nail breakage or nail loosening occurred after operation.Conclusion For AS combined with thoracolumbar fractures,minimally invasive fixation can attain satisfactory curative effect,with advantages of minor lesion,little bleeding,fast recovery and sound bone union.

Objective:To investigate the effect of individualized positive end-expiratory pressure (PEEP) on postoperative lung complications in patients undergoing cardiac valve replacement.Methods:Sixty-four patients of both sexes, aged 40-70 yr, with body mass index of 18-26 kg/m 2, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, with New York Heart Association class Ⅱ or Ⅲ, undergoing elective cardiac valve replacement (single or double) from July to October 2020, were enrolled in this study.The patients were divided into 2 groups ( n=32 each) using a random number table method: control group (group C) and individualized PEEP group (group P). After recruitment maneuver, group C was set with a fixed PEEP of 4 cmH 2O, group P was titrated using a PEEP-step method, and PEEP was set at 4 cmH 2O after admission to intensive care unit (ICU). Before induction of anesthesia (T 0), before recruitment maneuver (T 1), at 20 min after PEEP ventilation (T 2), at 2 h after surgery (T 3), and at 24 h after surgery (T 4), arterial blood samples were taken for determination of serum interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) concentrations.The hemodynamic indicators (heart rate, mean arterial pressure and central venous pressure) at T 1-T 4 were recorded.Pulmonary complications were diagnosed according to clinical manifestations, imaging and blood gas analysis during the postoperative hospitalization.The postoperative length of hospital stay, extubation time and duration of ICU stay were recorded. Results:PEEP in group P [(6.1±1.4)cmH 2O] was significantly higher than that in group C ( P<0.05). Compared with group C, the concentrations of serum IL-6 and TNF-α at T 3 were significantly decreased, central venous pressure at T 2 was increased, and the incidence of postoperative pulmonary complications was decreased ( P<0.05), and no significant change was found in the length of hospital stay, extubation time and duration of ICU stay in group P ( P>0.05). Conclusion:Early application of individualized PEEP after termination of cardiopulmonary bypass can decrease the risk of postoperative pulmonary complications in patients undergoing cardiac valve replacement.

Objective To explore the influence of dexmedetomidine for nasal administration by three different concentrations on the stress response in patients with general anaesthesia during the peri-extubation period of gynecological surgery and to explore the optimized dosage.Methods Eighty patients undergoing general anaesthesia were randomly divided into four groups:control group (group C),and three different doses of intranasal dexmedetomidine,groups D1,D2,D3 receiving intranasal dexmedetomidine 0.6,1.2 and 1.8 μg/kg 30 min before the end of the operation,respectively.Group C was given the same volume of saline.Heart rate (HR),mean arterial pressure (MAP) and ratepressure-product (RPP) were recorded immediately after intranasal administration (T1),the end of the surgery (T2),recovery time (T3),extubation time (T4),1 min after extubation (T5),5 min after extubation (T6) and 10 min after extubation (T7).Blood samples were taken at T1,T2,T4 and T6 to detect the serum concentrations of norepinephrine (NE) and cortisol (Cor).Postoperative recovery outcomes were recorded.Results Compared with group C,MAP,HR and RPP at T3-T5 in group D1 were reduced significantly (P＜0.05).In addition,those were all decreased in groups D2 and D3 at T2-T7 (P＜0.05).Compared with group C,the serum concentrations of NE and Cor at T4 and T6 in group D1,at T2,T4 and T6 in groups D2,D3 were decreased obviously (P＜0.05).Awaken time,extubation time and PACU stay time were shortened significantly in groups C,D1 and D2 compared with group D3 (P＜0.05).Conclusion Intranasal administration of dexmedetomidine 30 min before the end of the operation could attenuate the extubation reaction and the adverse reaction of cardiovascular system during the peri-extubation period.

BACKGROUND:Talus cartilage injury is a common motor system disease.This type of injury will affect the patient's daily life and work ability,and may worsen the condition if left untreated.Surgical treatment is commonly used,but the selection of surgical methods and the evaluation of medium-and long-term follow-up results have always been difficult clinical problems. OBJECTIVE:To explore the influence of T1ρ technique on the range of quantitative evaluation of talus osteochondral injury on the choice of surgical method and the results of medium-and long-term follow-up. METHODS:A total of 154 patients with osteochondral injury of talus admitted to The Second Hospital of Tangshan from January 2019 to August 2022 were retrospectively selected as the study subjects.The lesion site of talus was examined by MRI before operation,and the T1ρ and T2 values of different types were compared.Different surgical methods were selected according to the different T1ρ values.Group A(n=73)was treated with microfracture surgery with T1ρ<45 ms;group B(n=81)was treated with autogenous bone and cartilage transplantation with T1ρ≥45 ms.The general clinical characteristics and curative effects of patients under different surgical methods were compared;the important factors of postoperative recurrence were analyzed by multivariate Logistic regression,and the relationship between T1ρ value and postoperative recurrence was analyzed by restricted cubic spline graph,y=1-1/(1+e-z)regression equation to build a prediction model.The stability of the model was verified by cross-checking method. RESULTS AND CONCLUSION:(1)Classification of talus osteochondral injury in 154 patients(type Ⅰ:36 cases;type Ⅱ:37 cases;type Ⅲ:40 cases;type Ⅳ:41 cases),T1ρ and T2 values of the four groups were statistically significant(P<0.05);pairwise comparison was also statistically significant(all P<0.05).(2)After treatment of 154 patients,7 cases(4.6％)had local swelling,3 cases(2.0％)had pain aggravation,and 5 cases(3.3％)had wound infection.There were 2 cases(1.3％)with poor cartilage healing.(3)After treatment,there were statistically significant differences between groups A and B in terms of American Orthopaedic Foot&Ankle Society score,visual analog scale score,plantar flexor motion range,dorsoextension motion range,subchondral bone marrow edema volume,interleukin-6,interleukin-8,C-reactive protein,procalcitonin,platelet-derived growth factor,transforming growth factor-β1,and efficacy(P<0.05).The total effective rate of group B(90％)was higher than that of group A(85％)(P<0.05).(4)Age(OR=1.589,95％CI:0.305-1.252,P=0.036),interleukin-6(OR=1.737,95％CI:0.974-5.254,P=0.049),interleukin-8(OR=1.385,95％CI:1.066-4.355,P=0.034),C-reactive protein(OR=1.957,95％CI:1.323-2.178,P=0.035),transforming growth factor-β1(OR=1.459,95％CI:0.897-2.455,P=0.038),T1-ρ(OR=1.687,95％CI:0.854-3.321,P=0.026),T2(OR=1.843,95％CI:0.657-2.454,P=0.036),complications(OR=1.719,95％CI:0.654-3.464,P=0.019),and classification of osteochondral injury of talus(OR=3.789,95％CI:1.023-5.897,P=0.028)were independent risk factors for postoperative recurrence.Microfracture surgery(OR=0.751,95％CI:0.321-1.264,P=0.012)and autogenous bone and cartilage grafting(OR=0.649,95％CI:0.246-1.356,P=0.023)were independent protective factors for recurrence after medium-and long-term follow-up.(5)When T1ρ value≤35 ms,the risk of postoperative recurrence decreased rapidly,and when T1ρ value>35 ms,the risk of postoperative recurrence increased rapidly.(6)Further stepwise regression analysis showed that these nine risk factors were most closely associated with postoperative recurrence,and the formula for postoperative recurrence was obtained.The probability of postoperative recurrence was calculated using the regression equation.When P=0.75,the maximum value of Jorden index was 77.728,indicating that the model has a better prediction effect.(7)It is indicated that the quantitative evaluation of T1ρ before operation can effectively guide the selection of surgical methods,improve the success rate of surgery and the quality of life of patients.