Objective To compare the efficacy of different analgesia regimens in elderly patients with femoral neck fracture undergoing posture changing during epidural anesthesia. Methods Ninety patients (35 males,55 females,aged 65-90 years,48-78 kg)with femoral neck fracture who would be treated with artificial femoral head replacement were randomly divided into 3 groups (n = 30 each):femoral nerve block group (group FNB),fascia iliaca compartment block group (group FIC)and intravenous group (group IV).Femoral nerve block or fascia iliaca compart-ment block was performed 30 min before epidural anesthesia (EA)in FNB group or FIC group re-spectively.Fentanyl 0.5 μg/kg was injected intravenously 3 min before EA.In the three groups,addi-tional 0.25 μg/kg fentanyl was administrated intravenously to keep the VAS scores <4 before posi-tioning.EA was performed between L1-2 in a position of troubled leg upper,and patients returned to supine position after epidural catheterization.The VAS scores at T0 (after entering the operation room),T1 (in supine posture before EA),T2 (before posture changing),T3 (while supine from lateral posture after EA),T4 (3 min after T3 ),the time for achieving EA,the fentanyl consumption, the cases of cardiovascular events and hypoxemia was recorded.Results Compared with group IV, VAS scores at T1 ,T2 ,the fentanyl consumption,time for achieving EA,and incidence of cardiovas-cular events and hypoxemia in group FNB and group FIC decreased significantly (P <0.05 or 0.01). There was no significant difference between group FNB and group FIC.Conclusion Preemptive anal-gesia regimens through both femoral nerve block and fascia iliaca compartment block during epidural anesthesia can reduce the fentanyl consumption,as well as decrease the incidence of cardiovascular e-vents and hypoxemia.

Objective To explore the anatomical morphology of femoral trochlear groove and the difference between normal males and females.Methods Eighty healthy volunteers were recruited,including 42 males and 38 females with an average age of 36.2 years (range,21-55 years).All the volunteers without knee unstabilization,pain and wound.CT scan of right femurs were performed and 3-D model were reconstructed.The anatomical parameters of right femoral trochlear groove were measured,which included transepicondylar axis,medial and lateral length of trochlear groove,medial and lateral condylar height,sulcus angle,depth of trochlear groove,transcondylar axis,anterior femoral condylar angle,trochlear groove position,and then compared the morphologic difference of trochlear groove between males and females.Results The average width of transepicondylar axis was 79.21±3.80 mm for males and 70.73±2.91 mm for females (t=-53.40,P=0.00).The minimum sulcus angle was acquired at 45° flexion for males and 42° flexion for females.It was 133.92°±4.76° for males and 132.71°±4.36° for females.The maximum length of transepicondylar axis was acquired at 87° flexion for males and 90° flexion for females.It was 42.36±3.48 mm for males and 39.03 ±3.36 mm for females.The anterior femoral condylar angle decreased with the increasing flexion angle of knee (P＞0.05).The position of the trochlear groove moved laterally with the increasing flexion angle of knee (P＞0.05).Conclusion There is no significant difference between male and female in the geometry of femoral trochlear groove,however there is a significant difference in sizes.Therefore,during design the knee prosthesis,close approximation of size is essential,while gender differences in morphology need not be considered a factor.

Objective To evaluate the efficacy and safety of local infiltration analgesia in the multimodal analgesia protocol.Methods Sixty patients who were scheduled to undergo TKA were randomly divided two groups:local infiltration analgesia (LIA) group (n=30) or the non-local infiltration analgesia (N-LIA) group (n=30).All patients were given Celecoxib 200 mg bid,3 days preoperative,and a single-injection femoral nerve block (SFNB) half an hour before the surgery (ropivacaine 3.3 g/L,30 ml).The LIA group was given local infiltration analgesia with ropivacaine (2.5 g/L,60 ml) and 0.1 mg epinephrine before suture the operative incision.The N-LIA group didn't do the LIA.Both of the two groups didn't use the patient controlled analgesia.The VAS scores,the knee joint range of motion,the muscle strength of quadriceps femoris and the side effects and complications were recorded.Results The VAS scores were lower in LIA group than in the N-LIA group,these scores at 2 h to 48 h after surgery at rest and after 24 h at motion had statistical significance.The range of motion and the muscular strength of quadriceps femoris in the LIA group were better than in the N-LIA group.In the LIA group the use of opioids was less and the side effects were lower.The average length of hospital stay after the operation was shorter in the LIA group than the N-LIA group.Conclusion This multimodal perioperative analgesia protocol that include SFNB and LIA offered improved pain control and minimal side effects to patients undergoing TKA.

Objective To explore the perioperative efficiency and safety of different regimen of tranexamic acid (TXA) in total knee arthroplasty (TKA).Methods From February 2013 to May 2013,150 female patients with knee osteoarthritis underwent unilateral TKA were randomly divided into three groups,50 cases in each group.Patients received 10 mg/kg TXA by fast intravenous infusion before closing the wound in first group (single dose group),patients in second group received two doses of 10 mg/kg TXA before closing the wound and 3 hours postoperation (repeated dose group),patients in the third group didn't receive TXA (control group).The postoperative blood loss via drainage,the total blood loss,the hidden blood loss,the postoperative hemoglobin concentration at different times and the numher of patients need blood transfusion were recorded.All patients were observed for detecting deep vein thrombosis (DVT) by the color doppler ultrasonography within 5 days postoperation,and the symptomatic DVT and pulmonary embolism (PE) were observed within 90 days postoperation.Results The blood loss via drainage was significantly less in the single dose group (273.6±99.6 ml) and repeated dose group (168.5±80.8 ml) compared with the control group (447.2±101.9 ml),and it was significantly less in the repeated dose group than the single dose group; the total blood loss was significantly less in the single dose group (959.1±291.7 ml) and repeated dose group (818.7±206.9 ml) compared with the control group (1 100.8±288.3 ml),and it was significantly less in the repeated dose group than in the single dose group; there was no differ ences about the hidden blood loss among the three groups.The hemoglobin concentration was significantly higher in the single dose group and repeated dose group than in the control group in day 1,3 and 5 postoperation; and it was significantly higher in the repeated dose group compared with the single dose group.The ratio of transfusion was significantly less in the single and repeated dose groups than in the control group,but no differences exists between the single dose group and repeated dose group.There was no DVT in all of the three groups within 5 days postoperation,and there was no symptomatic DVT and PE in all of the three groups within 90 days.Conclusion 10 mg/kg of TXA infused intravenous before closing the wound is effective and safe in TKA,another dose 3 hours postoperation is much more effective and will not increase the danger of DVT and PE.

OBJECTIVETo investigate the clinical results of modified Sutherland pelvic osteotomy for developmental dysplasia of hip (DDH).

METHODSSutherland pelvic osteotomy were performed in 10 patients (11 hips) with DDH. Among them, there were 3 male (3 hips) and 7 female (8 hips) patients, aged (32 ± 8) years. During operation, arthroscopes were performed additionally to remove the existing hyperplasia tissue in the fossae ovalis and trimming acetabulum and glenoid labrum, thus to insure the better match between the femoral head and the realigned acetabulum. The change of imaging indexes were acquired by comparing the preoperative X-ray with the postoperative X-ray. The change of hip function and life quality were acknowledged according to contrast and analysis Harris hip score and Short Form 12-items Health Survey (SF-12) before and after osteotomy.

RESULTSAll patients were followed up for a mean of (5.2 ± 2.3) years, the osteotomy were all union in 3 months. The acetabular head index was 71 ± 8 before operation, and 86 ± 4 after operation. The pre- and post-operative centre edge angle were (7 ± 9)° and (33 ± 9)°, sharp angle were (48 ± 4)° and (37 ± 5)°, acetabular index angle were (24 ± 8)° and (11 ± 5)° respectively. The average Harris score improved from 42 ± 13 preoperatively to 90 ± 5 postoperatively, with 100% excellent and good results. Every domains of SF-12 was improved in the different extents postoperatively, the improvement of physical component summary was more conspicuous than mental component summary. The imaging indexes, Harris and SF-12 were all improved with significant difference (all P < 0.05).

CONCLUSIONSThe modified Sutherland pelvic osteotomy is effective. It could increase the load bearing capacity of hip, and improve the quality of life.

Adult ; Arthroscopy ; Female ; Hip Dislocation, Congenital ; surgery ; Humans ; Male ; Osteotomy ; methods ; Pelvic Bones ; surgery ; Treatment Outcome

OBJECTIVETo explore the associations between behavioral risk factors and overweight and obesity among Chinese primary and middle school students in 2010.

METHODSA total of 149 912 primary and middle school students aged 9 - 18 were selected from "2010 National Physical Fitness and Health Surveillance" while underweight students excluded. Questionnaires and height, weight and other physical index were performed. Logistic regression was used to analyze the association between overweight, obesity and sleep time, diet, physical exercise intention and behavior as well as sedentary behavior.

RESULTSOf students surveyed, the proportion of short sleep time was higher in obese students than in normal weight students, the prevalence of short sleep time was 93.60% (118 394/126 491), 94.39% (15 053/15 947) and 95.09% (6782/7132) in normal weight, overweight and obese students, respectively (P < 0.05); the proportion of egg intake with no more than 3 times per week was lower in obese students than in normal weight students (56.49% (4025/7125) vs 65.25% (82 518/126 464)) (P < 0.05); the proportion of never drinking milk was lower in obese students than in normal weight students (7.08% (505/7134) vs 7.55% (9 545/126 503)) (P < 0.05); and when compared with those of normal (29.53%, 37 354/126 482), more overweight students reported that they had spent 2 or more hours on homework (30.17%, 4 809/15 941) (P < 0.05). The proportions of physical activity intentions were significantly lower in obesity group of male students than those of normal male group, and the proportion of liking physical education, being willing to participate in the extracurricular sports activities, and being willing to participate long running exercise was 67.7% (4828/7134), 71.2% (5083/7135) and 35.9% (2560/7135) in obese students compared with 68.6% (86 776/126 511), 72.6% (91 814/126 509) and 47.4% (59 914/126 512) in normal weigh students, respectively. In the 13 - 15 age group, the proportion of having been physically active for a total of at least 60 minutes per day was lower in obese group (19.87%, 376/1893) than in normal group (20.66%, 8 253/39 941) (P < 0.01). Logistic regression analysis showed that the students with short sleep time were more likely to get obesity than those without short sleep time (adjusted odds ratio (AOR): 1.11, 95%CI: 1.00 - 1.25). Egg intake with no more than 3 times per week was negatively associated with the probabilities of being at risk for obesity (AOR: 0.88, 95%CI: 0.83 - 0.92), while, never drinking milk was independently related to obesity (AOR: 1.14, 95%CI: 1.03 - 1.25). Disliking physical education (AOR: 1.23, 95%CI: 1.16 - 1.30), unwilling to participate long running exercise (AOR: 2.16, 95%CI: 2.05 - 2.28) and spending 2 or more hours on homework (AOR: 1.09, 95%CI: 1.02 - 1.15) were independently related to obesity. The patterns of influence factors in different groups were not alike.

CONCLUSIONOverweight and obesity prevalence was higher in China's primary and middle school students in 2010, and the bad dietary behavior, static life style were highly interconnected.

Adolescent ; Child ; China ; epidemiology ; Exercise ; Female ; Health Behavior ; Health Surveys ; Humans ; Life Style ; Logistic Models ; Male ; Obesity ; epidemiology ; Overweight ; epidemiology ; Risk Factors ; Students ; Surveys and Questionnaires

OBJECTIVETo analyze the level of mortality of brain tumor and its changes at different periods in China.

METHODSDeath records for tumor of brain and central nervous system, which the code of international classification of diseases-10 (ICD-10) were C70-C72, were extracted from the database of the Third National Retrospective Sampling Survey of Death Causes in China during 2004 to 2005. The corresponding population data was linked to the data of death records, that the total population was 142 660 482 person years (72 970 241 person years in male, 69 690 241 person years in female). Then crude death rate, age-specific death rate, the constitute proportion to all death caused by tumor and the age-standardized death rate were calculated by taking reference of Chinese standard population or the world standard population. The indexes of mortality were compared with that of previous retrospective surveys of death causes at 1973 - 1975 and 1990 - 1992.

RESULTSThe result showed that during 2004 to 2005, the number died from brain tumor was 4463 and the crude death rate in China was 3.13/100 000, which accounted for 2.30% of the all number died from tumor (193 841 cases). The age-standardized death rate by Chinese standard population was 2.37/100 000 and the age-standardized death rate by the world standard population was 2.90/100 000. Of which, there were 2556 death cases for males with crude death rate of 3.50/100 000. While for females, the crude death rate was 2.74/100 000 (1907 death cases). Age-standardized death rates by Chinese standard population in male and female were 2.71/100 000 and 2.03/100 000 respectively. The age-standardized death rate by world standard population was 3.31/100 000 for male and for female that was 2.48/100 000. The age-specific death rate of brain tumor in China was increasing as age growing. The crude death rates were 3.78/100 000 (1809/47 899 806), 2.80/100 000 (2654/94 760 676), and the age-standardized death rates by Chinese standard population were 2.71/100 000 and 2.20/100 000 for urban and rural area respectively, and the crude death rates of brain tumor in east, middle and west region were 3.60/100 000 (1894/52 556 694), 3.14/100 000 (1565/49 781 225), 2.49/100 000 (1004/40 322 563). The age-standardized death rates by Chinese population were 2.57/100 000, 2.43/100 000 and 2.02/100 000. Compared to the data in the first survey during 1973 to 1975, in which the crude death rate was 1.13/100 000 and age-standardized death rate by Chinese standard population was 1.10/100 000, the crude death rate and age-standardized death rate by Chinese standard population were increased by 176.99% and 115.45% respectively. While compared with the second survey during 1990 to 1992, that crude death rate was 1.89/100 000 and age-standardized death rate by Chinese standard population was 1.74/100 000, the rising percent of the rates were 65.61% and 36.21% respectively.

CONCLUSIONThe level of mortality of brain tumor has been changing with an increasing trend from the period of 1973 - 1975 to the period of 2004 - 2005. The rate in male was higher than that of female with great diversity in different areas in China.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Brain Neoplasms ; epidemiology ; mortality ; Cause of Death ; Child ; Child, Preschool ; China ; epidemiology ; Death Certificates ; Female ; Health Surveys ; Humans ; Infant ; Infant, Newborn ; Male ; Middle Aged ; Young Adult

Objective To investigate the effect of electroacupuncture on the expressions of endoplasmic reticulum stress-related proteins in the substantia nigra in a rat model of rotenone-induced Parkinson disease.Methods One hundred and twenty healthy male SD rats were randomized to normal, sham operation, model, electroacupuncture pretreatment, and 7-day, 14-day, 21-day and 28-day electroacupuncture treatment groups, 15 rats each. A model of Parkinson disease was made by subcutaneous injection of rotenone in the nape. The sham operation group received an injection of equal volume of sunflower oil emulsion. The normal, sham operation and model groups were not treated. The electroacupuncture treatment group received electroacupuncture at points Fengfu (GV 16)and Taichong (LR 3) after model making. The electroacupuncture pretreatment group received model making after 7 days of electroacupuncture treatment. TH and α-syn positive cells expressions in rat substantia nigra were determined by immunohistochemical method. BiP and CHOP expressions in rat substantia nigra were examined by Western blotting. Results The model group rats had obvious syndrome characteristic of PD and rat behavior score decreased significantly after electroacupuncture intervention (P<0.01).α-syn positive cells expression and BiP and CHOP expressions in rat substantia nigra increased significantly and TH positive cells expression in rat substantia nigra decreased significantly in the model group compare with the normal and sham operation groups (P<0.01).α-syn positive cells expression and BiP and CHOP expressions in rat substantia nigra decreased significantly and TH positive cells expression in rat substantia nigra increased significantly in every electroacupuncture treatment group compare with the model group (P<0.01).Conclusions The mechanism of electroacupuncture prevention and treatment of Parkinson disease may be related to its significant inhibition of the expressions of endoplasmic reticulum stress-related proteins and protection of dopaminergic neurons.

BACKGROUNDWall shear stress is an important factor in the destabilization of atherosclerotic plaques. The purpose of this study was to assess the distribution of wall shear stress in advanced carotid plaques using high resolution magnetic resonance imaging and computational fluid dynamics.

METHODSEight diseased internal carotid arteries in seven patients were evaluated. High resolution magnetic resonance imaging was used to visualize the plaque structures, and the mechanic stress in the plaque was obtained by combining vascular imaging post-processing with computational fluid dynamics.

RESULTSWall shear stresses in the plaques in all cases were higher than those in control group. Maximal shear stresses in the plaques were observed at the top of plaque hills, as well as the shoulders of the plaques. Among them, the maximal shear stress in the ruptured plaque was observed in the rupture location in three cases and at the shoulder of fibrous cap in two cases. The maximal shear stress was also seen at the region of calcification, in thrombus region and in the thickest region of plaque in the other three cases, respectively.

CONCLUSIONDetermination of maximal shear stress at the plaque may be useful for predicting the rupture location of the plaque and may play an important role in assessing plaque vulnerability.

Aged ; Carotid Arteries ; pathology ; physiopathology ; Carotid Artery Diseases ; pathology ; physiopathology ; Computer Simulation ; Female ; Humans ; Magnetic Resonance Imaging ; methods ; Male ; Middle Aged ; Stress, Mechanical

OBJECTIVETo study the pathological changes of the liver tissues of patients with HIV infection.

METHODS14 biopsy and 12 autopsy liver tissues were examined histologically. HIV-1 related antigen of outer membrane protein gp120 and capsid protein p24 were examined with their corresponding monoclonal antibodies by immunohistochemistry.

RESULTSIn the biopsy group, cytomegalic virus (CMV) infection was found in one (1/14) case, outer membrane protein gp120 and/or capsid protein p24 antigen were detected in Kupffer cells and in some of the lymphocytes in 11 cases. All the hepatocytes were negative for outer membrane protein gp120 and capsid protein p24 antigens. In the autopsy group, there were 5 (5/12) cases of liver tissues with CMV infection and 5 cases each with mycobacterium and Toxoplasma gondii infection. Capsid protein p24 was detected in liver tissues in 3 cases.

CONCLUSIONThere is HIV infection in liver tissue of patients with HIV. The rate of opportunistic infections in liver biopsy samples was lower than that in the autopsy liver tissues of patients with HIV.

Adult ; Female ; HIV Core Protein p24 ; biosynthesis ; genetics ; HIV Envelope Protein gp120 ; biosynthesis ; genetics ; HIV Infections ; pathology ; Humans ; Liver ; pathology ; Male ; Middle Aged