Objective To compare the clinical efficacies of polypropylene-polyglactic composite mesh, polyester mesh, polypropylene mesh in Lichtenstein repair for inguinal hernia.Methods The clinical data of 1 080 patients with primary unilateral inguinal hernia who were admitted to the Tianjin People's Hospital from February 2012 to May 2013 were prospectively analyzed.A randomized controlled study was performed based on a random numble table.All the patients were allocated into the ProGrip group (Parietex ProGripTM Self-Fixating Mesh), PET group (ParietexTM Lightweight Monofilament Polyester Mesh) and PP group (BardTM Soft Mesh).Patients received standard Lichtenstein tension-free repair under local anesthesia and were followed up by outpatient examination and telephone interview till May 2014.The indexs observed during the follow-up included occurrence of complications, post-operative pain and postoperative health-related quality of life.The following indexes were recorded : time of mesh fixation, operation time, hernia recurrence, pain degree at postoperative week 1 and month 1, 6, 12 by numerical rating scale (NRS), quality of life at postoperative month 1 by SF-36 questionnaire survey including physical function, role physical, body pain, general health, vitality, social function, role emotional,mental health.Measurement data with normal distribution were presented as x ± s.Comparisons among groups were analyzed by ANOVA and pairwise comparison by t test.Measurement data with skewed distribution were presented as M (range) and repeated measurement data were analyzed using the repeated measures ANOVA.Count data were evaluated by the chi-square test and Fisher exact probability.Postoperative moderate and severe pain rates were evaluated by the Kaplan-Meier method and analyzed by the Log-rank test.Results There were 1 022 patients screened for eligibility including 367 patients in the ProGrip group, 346 patients in the PET group and 309 patients in the PP group.The time of mesh fixation and operation time were (1.3 ± 0.5) minutes and (30 ± 5) minutes in the ProGrip group, (4.9 ± 0.9) minutes and (45 ± 7) minutes in the PET group, (5.0 ± 0.9) minutes and (44 ± 7)minutes in the PP group, respectively, showing significant differences among the 3 groups (F =6.21, 4.33,P ＜ 0.05).There were significant differences in the time of mesh fixation and operation time between the ProGrip group and the PET group (t =1.36, 4.39, P ＜ 0.05), and also between the ProGrip group and the PP group (t =2.67, 2.99, P ＜ 0.05).There was no significant difference in the time of mesh fixation and operation time between the PET group and the PP group (t =0.98, 0.63, P ＞ 0.05).Nine hundred and nine patients were followed up for a median time of 13 months (range, 12-26 months) , with a follow-up rate of 88.943％ (909/1 022).The number of recurred hernia in the ProGrip group, the PET group and the PP group was 1, 0, 0,showing no significant difference (P ＞ 0.05).The NRS scores of pain from postoperative week 1 to postoperative month 12 were ranged from 0 (0-2) to 0 (0-0) in the ProGrip group, from 2(0-5) to 0(0-0) in the PET group and from 1 (0-4) to 0 (0-0) in the PP group.The number of patients with moderate and severe pain was ranged from 52(14.17％) to 0(0) in the ProGrip group, from 87 (25.14％) to 0 (0) in the PET group and from 89 (28.80％) to 0(0) in the PP group.There were no significant differences in the changing trends of NRS scores of pain and number of patients with moderate and severe pain among the 3 groups (F =1.66, x2=1.52, P ＞ 0.05).The scores of physical function in the ProGrip group, PET group, PP group at postoperative month 1 were 52 ± 4,50 ± 6, 50 ± 6, the scores of role physical were 50 ± 6, 50 ± 6, 50 ± 5, the scores of body pain were 52 ± 7, 52 ± 7, 52 ± 7, the scores of general health were 63 ± 4, 57 ± 9, 58 ± 8, the scores of vitality were 63 ± 5, 62 ± 6,63 ± 6, the scores of social function were 58 ± 4, 58 ± 8, 57 ± 8, the scores of role emotional were 59 ± 4, 57 ± 8,58 ± 8, and the scores of mental health were 65 ± 4, 63 ± 5, 63 ± 6, respectively, showing no significant differences in above indexes among the 3 groups (F =2.36,3.65,1.98,2.41, 6.32, 2.33, 4.21, 3.52, P ＞ 0.05).Conclusion Patients undergoing Lichtenstein repair for inguinal hernia with polypropylene-polyglactic composite mesh, polyester mesh and polypropylene mesh have comparative of incidence of postoperative complications, postoperative pain, quality of life, and present postoperative long-term low recurrence, low incidence of pain and relatively high quality of life.

Arthroplasty, Replacement ; Elbow Joint ; injuries ; surgery ; Humans ; Joint Instability ; therapy ; Tennis Elbow ; therapy

OBJECTIVETo explore clinical effects of three nonparallel screws in treating femoral neck fractures.

METHODSFrom September 2008 and May 2009, 29 patients were treated, including 12 males and 17 females with an average age of 52 years (ranged from 27 to 62 years). Before operation, according to Garden classification system, 2 cases were Garden type II (undisplaced fracture), 18 cases were Garden type III (partial displaced fracture) and 9 cases were Garden type IV (complete displaced fracture). After fracture reduction in operation, Pauwels classification system was used to classify the type, and 12 cases were type II, 17 cases were type III Closed reduction and internal fixation with three non-parallel screws were used to treat. The surgery X-ray and follow-up X-ray were compared to observe whether femoral neck abbreviate and screw exit appeare. Harris scoring was used to evaluate function.

RESULTSAll patients were followed-up from 34 to 44 months with an average of 38 months. The mean time of bone union was 7 (ranged, 3 to 12) months. Nonunion occured in 4 cases with Garden IV, and femoral head necrosis occurred in 2 cases. For Harris scoring, two cases with nondisplaced fracture were 100. Among 27 cases with displaced fractures, 23 cases achieved bone union without femoral head necrosis, average Harris scale was 91.35 +/- 8.00, and the average Harris scale of 4 cases with bone nonunion was 61.23 +/- 5.12. For all but one, there was no femoral neck crispation after bone union.

CONCLUSIONNonparallel screws for femoral neck fractures can effectively control abbreviation and screw tail exit after fracture healing.

Adult ; Bone Screws ; Female ; Femoral Neck Fractures ; diagnostic imaging ; surgery ; Follow-Up Studies ; Fracture Fixation, Internal ; instrumentation ; Humans ; Male ; Middle Aged ; Tomography, X-Ray Computed

OBJECTIVETo evaluate the effect and complication of surgical treatment for Pilon fracture using the posterolateral approach.

METHODSFrom August 2009 to March 2011, 15 patients with Pilon fractures (2 in B3,13 in C) and with a separate displaced posterior malleolar fragment was treated in two-stage: the first stage management was on stabiliztion of the soft tissue envelope with temporary external fixator of spanning arthritis, and the second stage management was open reduction and internal fixation with posterolateral approach and anteromedial or anteralateral approach.

RESULTSAll patients were followed-up for 12 to 17 months (14.2 months in average). Thirteen of the 15 fractures healed, but 2 fractures needed autologous bone graft procedure duo to nonuion. There was no wound complication related to poterolateral incion. Fourteen fractures had less than 2 mm of incongruity of distal tibia joint. According to Baired-Jackson criteria, the results were excellent in 2 cases, good in 7, fair in 4, and poor in 2.

CONCLUSIONThe posterolateral approach offers direct visualization for the reduction and fixation of the fibula and posterior distal fragment of the tibia Pilon fractures, faciliate the management of this difficult fracture pattern.

Adult ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Tibial Fractures ; surgery

OBJECTIVETo report the method and result of open arthrolysis of patients who suffered from severe post-traumatic elbow stiffness.

METHODSOf the 12 patients, there were 9 male and 3 female, average age of 32 years old (16 - 47 years). Primary injury included 7 simple fractures, 1 simple dislocation, 2 fracture dislocations and 2 soft tissue injury. The averaged time of immobilization after injury was 3.3 weeks (0 - 8 weeks). The averaged time between injury and open arthrolysis was 6.4 months (1 - 14 months). Before open arthrolysis, the mean arc of total motion was 33.8 degrees (0 degrees - 80 degrees ). Three patients suffered from forearm rotation deficiency. Posterior approach was used for 4 patients, medial approach for 2 patients and both medial and lateral approach for 6 patients. tissues were resected, which hindered the motion of the elbow and perform proximal radioulnar joint arthrolysis for some patients. After arthrolysis, the arc of elbow motion could reach 0 degrees - 140 degrees , and for the patients who suffered from forearm rotation deficiency, pronation 80 degrees and supination 90 degrees were gotten. Ulnar nerve transposition was not a routine. The patients began active and active-assisted elbow and forearm movement the first day after operation. Indomethacin was taken the first day after open arthrolysis routinely.

RESULTSTwelve patients were followed up for 14 - 18 months (averaged 15.8 months). At the latest follow-up, the mean arc of total motion was 120.8 degrees (100 degrees - 140 degrees ). Nine patients recovered the functional arc of 30 degrees - 130 degrees , and 10 patients extended to less than 10 degrees , and 4 patients could extend to 0 degrees . As for the 3 patients who suffered forearm rotation deficiency, the forearm rotation improved. The mean Mayo elbow performance score was 70.4 (50 - 90) before open arthrolysis, and 98.8 (85 - 100) after open arthrolysis. No patient was found to have signs of heterotopic ossification.

CONCLUSIONSFor the treatment of post-traumatic stiff elbow, with careful open arthrolysis and early active and active-assisted exercise we can get good results.

Adolescent ; Adult ; Elbow Joint ; injuries ; surgery ; Female ; Follow-Up Studies ; Humans ; Joint Diseases ; etiology ; surgery ; Male ; Middle Aged ; Motion Therapy, Continuous Passive ; Range of Motion, Articular ; Treatment Outcome

OBJECTIVEIntravenous anesthetics, such as propofol, are widely used in general anesthesia. Neurodegeneration and neurocognitive impairment after exposure to propofol in neonatal rats have raised concerns regarding the safety of pediatric anesthesia. We examined the effects of neonatal propofol exposure on brain cell viability, as well as expression of hippocampal survivin and Caspase-3 mRNA and protein.

METHODSOne hundred male Sprague-Dawley rats aged 7 d that were weighed 10-15 g were randomly divided into 4 groups (n = 25 each group). Group A: the rats were injected with no drugs. Group B: the rats were intraperitoneally injected with 50 mg/kg propofol. Group C: the rats were first intraperitoneally injected with 50 mg/kg propofol and another 50 mg/kg propofol was used when the dynamic response of rats appeared again. Group D: the rats were first intraperitoneally injected with 50 mg/kg propofol and another 50 mg/kg propofol was used three times once the dynamic response of rats appeared. To study the effects of propofol exposure on respiratory and metabolic function, arterial blood was aspirated from the left ventricle of neonatal rats 2 h after discontinuation of propofol. pH, PaO(2), PaCO(2), HCO(3)(-), BE and SaO(2) were detected by blood gas analyzer. Moreover, to examine the effects of propofol exposure on short-term cellular viability, the ultrastructure of neurons was observed by transmission electron microscope and Fluoro-Jade B (FJB) staining was performed to examine neuronal degeneration in hippocampal CA1 region of neonatal rats. Survivin and Caspase-3 mRNA and protein expression in hippocampus were detected by semi-quantitative reverse transcription polymerase chain reaction (RT-PCR) and Western blotting 2 h after discontinuation of propofol.

RESULTSThe time of anesthesia maintaince in newborn rats was the longest in Group D and the time of anesthesia maintaince in Group C was longer than that in Group B. Two hours after discontinuation of propofol, pH, PaO(2), PaCO(2), HCO(3)(-), BE and SaO(2) of arterial blood in rats were not significantly different among groups A, B, C and D (P > 0.05). The structure of hippocampal neurons was normal in Group A and Group B while 100 mg/kg propofol resulted in nuclear blebbing and 200 mg/kg propofol led to nuclear fragmentation, chromatin condensation and apoptotic bodies. Cellular degeneration, as measured by Fluoro-Jade B staining, significantly increased in hippocampal CA1 region in the anesthesia groups compared with littermates in the no anesthesia group. FJB-positive stained degenerative neurons in groups B, C and D were (2.5 ± 1.3), (7.1 ± 2.3) and (9.4 ± 2.6), which were different from that in Group A (0.6 ± 0.3) (P < 0.05). Moreover, the number of FJB-positive neurons was the highest in Group D, that in Group C was more than that in Group B. At the same time point, apoptosis was measured by expression of Caspase-3 and Survivin mRNA and protein in hippocampus of rats. Caspase-3 mRNA in groups A, B and C was (0.78 ± 0.12), (0.84 ± 0.17) and (0.89 ± 0.19), while Caspase-3 protein in groups A, B and C was (0.22 ± 0.05), (0.26 ± 0.07) and (0.21 ± 0.06). Survivin mRNA in groups A, B and C was (0.56 ± 0.12), (0.58 ± 0.15) and (0.53 ± 0.16), while Survivin protein in these 3 groups was (0.24 ± 0.07), (0.21 ± 0.05) and (0.23 ± 0.06). Compared with that in Group A, Caspase-3 and Survivin mRNA and protein were not significantly different among Group B and Group C (P > 0.05). However, Caspase-3 mRNA and protein in Group D were (1.21 ± 0.14) and (0.42 ± 0.12), which were higher than that in the other 3 groups (P < 0.05). Survivin mRNA and protein in Group D were lower than that in the other 3 groups (P < 0.05).

CONCLUSIONSA high dose of propofol exposure may destroy the structure of neurons, induce neurodegeneration, increase Caspase-3 activity and inhibit survivin expression in hippocampus of newborn rats in vivo.

Anesthetics, Intravenous ; administration & dosage ; pharmacology ; Animals ; Animals, Newborn ; Blood Gas Analysis ; Caspase 3 ; genetics ; metabolism ; Dose-Response Relationship, Drug ; Gene Expression Regulation ; drug effects ; Hippocampus ; drug effects ; metabolism ; Injections, Intraperitoneal ; Male ; Microtubule-Associated Proteins ; genetics ; metabolism ; Neurons ; metabolism ; pathology ; Propofol ; administration & dosage ; pharmacology ; RNA, Messenger ; genetics ; metabolism ; Random Allocation ; Rats ; Rats, Sprague-Dawley

To determine the optimal condition of pollen germination. The pollen of Prunella vulgaris was cultured in vitro. Pollen germination rates were recorded using 10% H3BO4, 30% Ca(NO3)2, 20% MgSO4 and 10% KNO3 as the basic mineral medium with PEG of different molecular weight, sucrose of various density and multiple pH value. The rates were also measured under different cultivation temperature and pollen acquisition time. The optimal condition of pollen germination is 10% H3 BO4, 30% Ca(NO3)2, 20% MgSO4, 10% KNO3, and 25% PEG-4000 as the medium, with pH about 6. 5 and pollen acquired at the beginning of blossom.
Flowers ; physiology ; Pollen ; physiology ; Prunella ; physiology

OBJECTIVETo improve the ability of recognizing, diagnosing and treatment for the femoral shaft fractures combined with ipsilateral occult femoral neck fractures, and reduce the rate of loss-diagnosis.

METHODSBy retrospective study of 50 patients who sustained ipsilateral femoral shaft and neck fractures from March 1998 to October 2003, 9 cases were femoral shaft fractures combined ipsilateral femoral neck fractures. The neck fractures were diagnosed separately before, during and after operation. Among the 9 cases, 5 cases treated with reconstructive intramedullary nail to fix both shaft and neck fractures; 3 cases were treated with retrograted intramedullary nail to fix shaft fractures and with canulated screws to fix neck fractures; another one was sustained two operations, after the fixation of shaft by intramedullary nail, the neck fracture was found, the neck fracture was fixed with canulated screws anterior and posterior of the nail.

RESULTSNine cases were followed up for average 20 months. All femoral shaft fractures were united during 6 months; and all neck fractures were united during 3 months.

CONCLUSIONSFemoral shaft fractures combined with ipsilateral occult femoral neck fractures have a high rate of loss-diagnosis during the early stage after injure, the orthopaedic surgeons should consider the femoral neck fracture by analyzing the mechanism of high energy injury patient with femoral shaft fracture. The occult femoral neck fractures can be diagnosed by CT scan before operation. During and after the operation of fixing the femoral shaft fractures, the femoral neck should be observed intensively to identify the exist of fractures.

Adult ; Femoral Fractures ; complications ; diagnostic imaging ; surgery ; Femoral Neck Fractures ; complications ; diagnostic imaging ; surgery ; Follow-Up Studies ; Fracture Fixation, Intramedullary ; methods ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Tomography, X-Ray Computed

OBJECTIVETo introduce a new way of treatment for elbow stiffness and instability.

METHODS30 cases of elbow trauma were treated with mobile hinged Orthofix elbow fixator, 26 of them were followed up. There are 15 male patients and 11 female patients. The average age is 32.6 years old. The 26 injured elbows involved 12 cases on left side and 14 cases on right side; Sixteen cases on the dominant side and 10 cases on the non-dominant side. Sixteen cases had elbow stiffness, 5 cases had acute radial head fracture and posterior dislocation of the elbow, 3 of cases had Monteggia's fracture dislocation, and 2 cases had neglected posterior dislocation of the elbow.

RESULTSThe average follow up time was 6 months (3 - 12 month). The mean time of fixation with fixator was 8.5 weeks (6 - 11 weeks). The mean ROM of the 16 cases of elbow stiffness was (37.5 +/- 0.8) degrees before operation, and (96.5 +/- 0.6) degrees operation, with a significant difference (P < 0.05). The mean Mayo elbow score was (69.5 +/- 1.7) before operation, compared with (82.8 +/- 1.6) after operation, with a significant difference (< 0.05). For the other 10 cases (5 cases with acute radial head fracture and posterior dislocation of the elbow, 3 cases with Monteggia's fracture dislocation, 2 cases with neglected posterior dislocation of the elbow), the average ROM of the elbow flexion-extension was 95 degrees (65 degrees - 150 degrees ); The average range of flexion was 117 degrees; the average loss of extension was 22 degrees; the average pronation was 76 degrees (20 degrees - 90 degrees ), the average supination was 75 degrees (15 degrees - 90 degrees ). Nine of the cases achieved anatomic reduction and proved by X-ray. The mean Mayo elbow score was 84 (49 - 96). Three cases were rated excellent, 4 good, 2 fair and 1 poor. The rate of excellent and good was 70% (7/10). Nine cases had no pain or mild pain, and did not need analgesic. Eight cases returned to their former work, 5 of the cases had complications.

CONCLUSIONSThe mobile hinged elbow external fixator have following advantages: (1) distraction of the articular space and enhance fracture healing; (2) allow early movement of the elbow during healing; (3) provide stable environment for the healing after arthrolysis and reconstruction. Mobile hinged elbow external fixator can achieve successful result in the treatment of elbow stiffness or unstable fracture dislocation of elbow.

Adolescent ; Adult ; Aged ; Elbow Joint ; injuries ; surgery ; External Fixators ; Female ; Follow-Up Studies ; Fracture Fixation ; methods ; Humans ; Joint Dislocations ; complications ; surgery ; Joint Instability ; surgery ; Male ; Middle Aged ; Monteggia's Fracture ; complications ; surgery ; Radius Fractures ; complications ; surgery ; Treatment Outcome

Objective To study the efficacy and safety of carotid endarterectomy ( CEA) in the treatment of carotid artery stenosis with different neurological deficits .Methods The clinical data of 59 patients with carotid stenosis treated by carotid endarterectomy in the department of neurosurgery of affiliated hospital of Xuzhou medical university from September 2015 to February 2017 were analyzed retrospectively ,a total of 62 operations were performed in these patients ( including 3 patients accepted bilateral operation ) .According to the preoperative 1 day nerve function which evaluated by the modified Rankin scale (mRS)score,they were divided into mRS <3 group(n=47),mRS≥3 group (n=15).They were followed up for 6 to 24 months,the neurological function of 62 patients was scored again by mRS at 6 months after sur-gery.The clinical data and the difference of surgical efficacy and safety of perioperative period between the 2 groups were analyzed and com-pared.Results The 62 times of operations were successful in patients .The neurological function of the 2 groups were significantly improved compared with the preoperative,the difference was statistically significant(P<0.05).In the mRS≥3 group,there were 1 patients with perio-perative cerebral infarction died of cerebral hernia ,1 case of consciousness disorder caused by high perfusion and 1 cases of postoperative in-tracranial hemorrhage caused by high perfusion .In the mRS<3 group,there was 1 case left contralateral hemiplegia caused by a large area of cerebral infarction .The incidence of cerebral apoplexy within 30 days after procedure in the mRS≥3 group was significantly higher than that in the mRS<3 group.There was no new stroke in 61 patients during the long-term follow-up.Conclusion Mild(mRS<3) and severe(mRS≥3) of patients has improved nervous function from CEA;perioperative risk of patients with severe neurological deficits is relatively higher , but the preventive effect for the prevention of ischemic stroke recurrence is worthwhile .