Objective To report the clinical results of minimally invasive percutaneous plate osteosynthesis (MIPPO) in treatment of type C fractures of distal femur.Methods A retrospective study was conducted to an- alyze 14 consecutive cases of distal femoral fractures who had been treated with MIPPO in our department from April 2002 to February 2005.According to AO/ASIF classification,there were three cases of type C1,six cases of type C2,and five cases of type C3.At first,the fractures of articular surface were directly reduced and fixed with spongy screws.Next,the condylar fractures were indirectly reduced and fixed with buttress or LISS (less invasive stabi- lization system) plates through transarticular approach.Results Follow-ups,ranging from 10 to 32 months for 12 cases,revealed that they all reached union.The time for their bony union was 10 weeks to 12 months (mean,4.6 months).Their functional recovery was evaluated according to criteria by Kolmert and Wulff.Four cases were rated as excellent,five as good,two as fair and one as poor.The total satisfactory rate was 75%.Conclusion MIPPO is a safe and effective procedure for the type C fractures of the distal femur with the benefits of limited invasion to soft tissues and a high rate of bone union.

OBJECTIVETo investigate the early clinical efficacy of induced membrane technique for reconstruction of large bone defects after debridement in adults with chronic osteomyelitis of limbs.

METHODSFrom March 2010 to March 2012,a total of 23 adult patients with chronic osteomyelitis of limbs were treated in our department. There were 15 males and 8 females, with a mean age 35.2 years old (ranged from 26 to 49 years old). Sixteen patients had open fracture history. According to the lesion site, there were 12 cases of tibia, 7 cases of femur, 3 cases of humerus, and 1 case of both radius and ulna. Among them, 19 patients had diseases in diaphysis and 4 patients in the metaphysis. The mean interval from infection to operation was 6.9 months (ranged from 4 to 13 months). All the patients were treated by using induced membrane technique. The follow-up evaluation included clinical complications, time of bone healing and limbs function. The Chinese version of SF-36 scores was used in the assessment of quality of life pre- and post-operation.

RESULTSThe average duration of follow-up was (27.6 ± 5.3) months (ranged from 18 to 43 months). Two patients had postoperative flap edge necrosis, 1 patient had superficial iliac incision infection, no obvious complications were recorded. Twenty patients obtained radiological union at a mean time of 4.6 months (ranged from 3 to 7 months). Among them, 16 patients treated with lower limbs surgery achieved full weight-bearing at about 5.2 months (ranged from 4 to 8 months) postoperatively. Four patients suffered from reinfection during follow-up, but 3 of them achieved complete bone healing after the second surgeries with induced membrane technique. At the final follow-up, there was a substantial improvement in each dimension scores and total scores of SF-36 as compared with those before surgery.

CONCLUSIONWhen treating with adult chronic osteomyelitis of limbs, the induced membrane technique can effectively reconstruct large bone defects after debridement, significantly shorten treatment cycle, provide satisfactory results with minimal complications, promote good recovery of limbs function and require relatively simple operation technique.

Adult ; Chronic Disease ; Extremities ; surgery ; Female ; Humans ; Male ; Middle Aged ; Osteomyelitis ; surgery ; Reconstructive Surgical Procedures ; methods

OBJECTIVETo evaluate the clinical outcome of accessory navicular fusion for treatment of the painful accessory navicular bone of type II in adults.

METHODSFrom June 2006 to June 2012, a total of 38 feet (in 35 adult patients) with painful accessory navicular with type I underwent an fusion operation of the primary and accessory navicular bones,including 26 males and 9 females with a mean age of (32.4±7.3) years old ranging from 18 to 44 years old. The course of disease ranged from 3 to 10 months. The perioperative complications and radiological outcomes were observed and recorded. The foot function before and after operation were assessed by the American Orthopedic Foot and Ankle Society (AOFAS) midfoot score, and the easement of the pain was evaluated by visual analog score (VAS).

RESULTSTwo patients had transient superficial inflammation of the incision, no obvious perioperative complications occurred. All patients were follow-up for (53.5±14.7) months (12 to 84 months). Bone union was confirmed on plain radiography in 32 cases (35 feet). The mean time from the operation to union was (13.7±2.3) weeks (9 to 18 weeks). Postoperative pain VAS score was improved obviosly than preoperative (V=12.14,P< 0.01). The talar-to-first metatarsal angle [(9.4±3.5)° vs (8.3±2.7)°, t=0.736, P>0.05)], calcaneal tilt angle [(17.7±2.2)° vs (18.9±3.4)°, t=0.794, P>0.05],talonavicular uncoverage angle [(14.3±3.4)° vs(12.5?4.6)°,t=0.947, P>0.05) ],and height of the first tarsometatarsal joint [(14.8±3.1) mm vs (15.9±2.8) mm,t=0.814,P>0.05)] before and after operations had no statistic difference. The AOFAS midfoot score was improced from preoperative 45.6±5.3 to postoperative 82.5±7.4 (t=3.214,P< 0.01).

CONCLUSIONFor the painful accessory navicular bone of type II in adults, if the patient has a large navicular bone and not complicated with rigid flatfoot, once the conservative treatment fails, fusion of the primary and accessory naviculars may be a successful intervention. Overall, the procedure provides reliable pain relief, definite foot function improvement, and good patient satisfaction.

Adolescent ; Adult ; Female ; Follow-Up Studies ; Foot Diseases ; physiopathology ; surgery ; Humans ; Male ; Tarsal Bones ; abnormalities ; physiopathology ; surgery ; Treatment Outcome ; Young Adult

OBJECTIVETo evaluate preoperative application of recombinant human erythropoietin (rHuEPO) in reducing transfusion requirements in elderly patients undergoing elective surgery for femoral intertrochanteric fractures.

METHODSFrom January 2011 to December 2013,442 cases of elderly patients with femoral intertrochanteric fracture were retrospectively reviewed. According to inclusion and exclusion criteria, 119 cases were eventually included and divided into the treatment group and the control group. There were 12 males and 40 females, with a mean age (71.4 ± 12.8) years old, and the patients received preoperative administration of rHuEPO 10,000 U qod combined with iron dextran 200 mg (3 times each day). While 16 males and 51 females in control group, with a mean age (70.9 ± 16.2) years old, and the patients only received preoperative administration of iron dextran 200 mg (3 times each day). All the patients received closed reduction and PFNA-II or Internal fixation surgeries. The perioperative blood transfusion rate, average amount of blood transfusion, postoperative complications, the length of hospital stay and mortality within 30 days were compared between the two groups.

RESULTSThere were no statistical differences between two groups in the baseline indexes (P > 0.05). Overall,71 of 119 patients (59.7%) received at least one unit allogeneic blood transfusion (ABT). However,there were significant differences in perioperative ABT rates (48.1% vs 68.7%, χ2 = 4.77, P < 0.05) and the average amount of blood transfusion between treatment group and control group, which were (1.8 ± 0.4) U/pte vs (3.6 ± 1.1) U/pte (t = 2.244, P < 0.05). Postoperative hemoglobin (Hb) on postoperative days 7 and 30 was higher in treatment group than that in control group. In addition, in treatment group, Hb levels were higher on postoperative day 30 than those on admission, which were (128.2 ± 20.6) g/L vs (118.2 ± 18.9) g/L (t = 2.133, P < 0.05). There were no statistical differences in postoperative complications, the length of hospital stay and mortality within 30 days.

CONCLUSIONFor elderly patients with femoral intertrochanteric fractures undergoing elective surgery, preoperative application of rHuEPO can significantly reduce perioperative transfusion requirements, and is likely to reduce ABT-related infection, but its long-term safety remains to be evaluated.

Aged ; Aged, 80 and over ; Blood Transfusion ; Case-Control Studies ; Erythropoietin ; administration & dosage ; Female ; Femoral Fractures ; blood ; surgery ; therapy ; Fracture Fixation, Internal ; Hemoglobins ; analysis ; Hip Fractures ; blood ; surgery ; therapy ; Humans ; Male ; Preoperative Care ; Retrospective Studies

OBJECTIVETo evaluate the early clinical and radiographic outcome of scaphoid non-unions treated with Acutrak headless compression screw.

METHODSFrom January 2008 to July 2011,21 patients with scaphoid non-union were treated in our department. There were 18 males and 3 females with a mean age of (23.6 +/- 4.6) years; 12 cases were on right hand and 9 were on left. According to Herbert-Fisher classification, there were 10 cases with type D1, 7 cases with type D2, 3 cases with type D3, and 1 case with type D4. The mean time from injury to operation was (12.4 +/- 2.7) months. All patients were treated with Acutrak headless compression screw fixation (6 cases received 2 screws fixation, 15 cases received 1 screw fixation, and Matti-Russe bone grafting was applied in 7 cases). The carpal height, the scaphoid index and changes of the scapholunate angle were assessed before and after the operation. Range of motion and grip strength were recorded and the wrist function was assessed according to the Patient-Rated Wrist Evaluation (PRWE).

RESULTSAverage duration of follow-up was (21.3 +/- 3.6) months. All the patients attained radiological union in a mean time of (13.3 +/- 2.4) weeks following the operation. No obvious complications were recorded. The surgical treatment allowed the preoperative mean scaphoid index of 0.61 +/- 0.13 and the preoperative mean scapholunate angle of (59.4 +/- 6.8) degree to be improved to 0.69 +/- 0.10 and (44.3 +/- 8.2)degree postoperatively, respectively. There was a substantial improvement in grip strength and pain amelioration after surgery. The preoperative mean PRWE score of 45.2 +/- 4.7 was improved to 76.1 +/- 5.2 postoperatively. All patients returned back to the original work,the average time from surgery to work was (6.0 +/- 1.1) months.

CONCLUSIONFor scaphoid non-unions, Acutrak headless compression screw fixation can provide anatomical reduction, provide satisfactory results with a high union rate, well return of function and minimal complications in the early stage.

Adolescent ; Adult ; Bone Screws ; Female ; Fracture Fixation, Internal ; Fractures, Ununited ; surgery ; Humans ; Male ; Range of Motion, Articular ; Scaphoid Bone ; injuries ; physiopathology ; surgery ; Treatment Outcome ; Wrist Injuries ; physiopathology ; surgery ; Wrist Joint ; physiopathology ; surgery ; Young Adult

Objective: To observe the effects of electroacupuncture (EA) on the protein and gene expressions of Bax, Caspase-3 and Bcl-2 in cerebral cortex of type 2 diabetic rats with cognitive impairment (CI), and to explore the mechanism of EA in improving the learning and memory abilities. Methods: A total of 100 Sprague-Dawley (SD) rats were divided into a normal group (n=10) and a model group (n=90) by random number table method. Rats in the model group were intraperitoneally injected with a small dose of streptozotocin (STZ) to establish the type 2 diabetic models, after being fed with high-fat and high-sugar diet for 1 month. Twenty CI rats were selected from the 50 successful model rats by the Morris water maze (MWM) test and randomly divided into a model group and an EA group according to the blood glucose level and MWM data (n=10). Rats in the EA group received acupuncture at Zusanli (ST 36), Neiting (ST 44) and Yishu (Extra), of which Zusanli (ST 36) and Neiting (ST 44) were stimulated by EA apparatus, 20 min/time, once a day for 6 d a week and 4 consecutive weeks. The rats in the model and the normal groups were fixed without treatment. After 4-week treatment, the random blood glucose level of the rats was measured; the learning and memory abilities of rats were measured by MWM; terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) assay was used to detect apoptotic cells; Western blot (WB) and real-time quantitative polymerase chain reaction (RT-qPCR) were used to detect the protein and gene expressions of Bax, Caspase-3 and Bcl-2 in cerebral cortex. Results: After modeling, the random blood glucose level and the escape latency tested by MWM were significantly increased, and the number of crossing the platform tested by the MWM was decreased in the EA and model groups, and were significantly different from those in the normal group (P<0.05 or P<0.01), while the differences between the model group and the EA group were not statistically significant (all P>0.05). After 4-week treatment, the random glucose level and the escape latency tested by MWM were significantly increased (both P<0.05), and the number of crossing the original platform tested by the MWM was significantly reduced (P<0.01), the protein and gene expressions of Bax and Caspase-3 were significantly increased (all P<0.001), the protein and gene expressions of Bcl-2 were significantly reduced (both P<0.001), and the number of neuron apoptosis was significantly increased (P<0.001) in the model group than in the normal group; the random blood glucose level was significantly reduced (P<0.05), the escape latency tested by MWM was significantly shortened (P<0.05), and the number of crossing the original platform tested by MWM was significantly increased (P<0.05), the protein and gene expressions of Bax and Caspase-3 were significantly reduced (all P<0.001), the protein and gene expressions of Bcl-2 were significantly increased (both P<0.001), and the number of neuron apoptosis was significantly reduced (P<0.001) in the EA group than in the model group. Conclusion: EA can improve the learning and memory damages induced by type 2 diabetic model rats with CI; the action mechanism may be achieved via anti-apoptosis.

OBJECTIVE: To study the expression levels of glial cell line-derived neurotrophic factor family receptor α-1 (GFRα1) and enhancer of zeste homolog 2 (EZH2) in the intestinal tissue of children with Hirschsprung's disease (HSCR), as well as the role of EZH2 in the regulation of GFRα1 gene expression and the pathogenesis of HSCR. METHODS: The samples of colon tissue with spasm from 24 children with HSCR after radical treatment of HSCR were selected as the experimental group, and the samples of necrotized colon tissue from 18 children with neonatal necrotizing enterocolitis after surgical resection were selected as the control group. Real-time PCR and Western blot were used to measure the expression levels of GFRα1 and EZH2 in colon tissue in both groups. Human neuroblastoma SH-SY5Y cells were divided into an EZH2 over-expression group and a negative control group. The cells in the EZH2 over-expression group were transfected with pCMV6-EZH2 plasmid, and those in the negative control group were transfected with pCMV6 plasmid. The expression levels of EZH2 and GFRα1 were measured after transfection. RESULTS: Compared with the control group, the experimental group had significant reductions in the mRNA and protein expression levels of GFRα1 and EZH2 in colon tissue (P<0.05), and the protein expression of EZH2 was positively correlated with that of GFRα1 (r=0.606, P=0.002). Compared with the negative control group, the EZH2 over-expression group had significant increases in the expression levels of EZH2 and GFRα1 after SH-SY5Y cells were transfected with EZH2 over-expression plasmid (P<0.05). CONCLUSIONS Low expression of EZH2 in the colon tissue of children with HSCR may be one of the causes of inadequate expression of GFRα1 and onset of HSCR.
Child ; Colon ; Enhancer of Zeste Homolog 2 Protein ; genetics ; Glial Cell Line-Derived Neurotrophic Factor Receptors ; genetics ; Hirschsprung Disease ; genetics ; Humans ; Infant, Newborn ; RNA, Messenger

OBJECTIVE: To evaluate the clinical therapeutic effect and security of lymphoplasmapheresis (LPE) for Guillain-Barre syndrome (GBS). METHODS: Sixty-six GBS patients were randomly divided into 2 groups: the therapy group (33 patients) were treated with LPE in addition to the medical treatment; the control group (33 patients) only accepted the medical treatment. The therapeutic effect was evaluated with the initial recovery time of myodynamia and the myodynamia score difference, and the side effect of the therapy group was observed. RESULTS: The therapy group were treated with LPE for 48 times,1.5 times per person. The average initial recovery time was quicker in the therapy group compared with that in the control group [(6.45+/-3.01) vs (8.36+/-3.83) days]. The difference of limb myodynamia score between pre-treatment and post-treatment in the therapy group was more than that in the control group. The improved number in the therapy group was more than that in the control group, but the ineffective number in the therapy group was not as many as that in the control group. The total effective rate in the therapy group was higher than that in the control group (51.5% vs 27.7%); the average hospital day in the therapy group was shorter than that in the control group [(19.42+/-7.25) vs (24.00+/-8.64) days]; and the difference had statistical significance(P<0.05). The average myodynamia score after the first LPE increased, but the difference had no statistical significance (P>0.05). After the second and the third LPE, the average myodynamia score continued to rise, and the difference had statistical significance (P<0.05). The incidence rate of side effects in the therapy group was 12.5%. Urticaria and hypotension were the major side effects, but they were light and could be relieved by symptomatic treatment. CONCLUSION The therapeutic effect of LPE is definite, and the side effect is scarce. LPE is safe and effective, and it is worth of generalization and applying in clinical practice.
Adolescent ; Adult ; Female ; Guillain-Barre Syndrome ; therapy ; Humans ; Leukapheresis ; Male ; Plasmapheresis ; Treatment Outcome ; Young Adult

Objective: To evaluate the associative role of depression and apolipoprotein E epsilon 4 allele (APOEε4) in subjective cognitive decline (SCD) and its progression to objective cognitive decline. Methods: After literature search in electronic databases, studies were selected by following precise eligibility criteria. Meta-analyses were performed to examine the role of APOEε4 and depression in SCD or its progression to mild cognitive impairment (MCI) or dementia. Results: APOEε4 positivity was not different between SCD and normal individuals but was significantly higher in individuals with SCD plus than in normal individuals [odds ratio: 2.39 (95% CI: 1.87, 3.05); p<0.00001] and in SCD converters than in non-converters [odds ratio: 5.19 (95% CI: 2.36, 11.42); p<0.00001]. Depression was significantly higher in individuals with SCD [standardized mean difference: 0.63 (0.45, 0.82); p<0.00001] and SCD plus [standardized mean difference: 0.83 (0.43, 1.22); p<0.0001] than in normal individuals. However, depression was not different between SCD and MCI or between SCD converters and non-converters. Age of SCD converters was higher than non-converters [mean difference: 2.95 years (0.58, 5.31)]. Conclusion Whereas APOEε4 positivity was higher in SCD plus and SCD converters, depression was higher in SCD and SCD plus but was not different between SCD and MCI.

Objective - To investigate the effect of lung flora dysbiosis on the process of pulmonary fibrosis and lung epithelial （ ） Methods - mesenchymal transition EMT in mice with silicosis. Male C57BL/6 mice of specific pathogen free grade were ， ， ， （ ） randomly divided into the blank control group silicosis model group solvent control group vancomycin VM + ampicillin （ ） ， （ ） （ ） ， AMP group metronidazole MNZ + neomycin NEO group and mixed treatment group 12 mice in each group. Except for ， ， the blank control group which was given 20.0 µL of 0.9% NaCl solution the other five groups of mice were dosed with 20.0 µL of silica dust suspension at a mass concentration of 250.0 g/L using a single tracheal drip to establish the silicosis mouse model. ： The intranasal drip method was used to treat silicosis mice in each group as following mice in the solvent control group were - ； ； given double distilled water mice in the VM+AMP group were given VM at a mass concentration of 0.5 g/L and AMP at 1.0 g/L ； mice in the MNZ+NEO group were given MNZ at a mass concentration of 1.0 g/L and NEO at 1.0 g/L mice in the mixed ， treatment group were given the same doses of the four antibiotics mentioned above all in a drip volume of 50.0 µL. Silicosis ， ， mice were treated seven days and half an hour before silica dusting and 7 14 and 21 days after silica dusting. Mouse lungtissue was collected aseptically 28 days after silica dusting. Hematoxylin eosin and Masson trichrome staining methods were - used to observe the pathological changes. Western blotting was used to detect the relative protein expression of α smooth muscle （ - ）， - （ - ） （ ） actin α SMA E cadherin E CAD and vimentin VIM . Immunohistochemistry was used to detect the relative expression of - - E CAD and VIM. Real time fluorescence quantitative polymerase chain reaction was used to detect the expression levels of （Col1a2） Results collagen type Ⅰ alpha 2 mRNA in lung tissues. The histopathological results showed that the alveoli of the ， blank control group were thin and structurally intact with few surrounding infiltrating inflammatory cells and no abnormal ， distribution of collagen fibers. The alveoli of the silicosis model group were structurally disorganized with a large number of ， ， infiltrating inflammatory cells thickened alveolar walls and cellular fibrous nodules with abundant blue collagen deposit. In the ， ， VM+AMP group MNZ+NEO group and the mixed treatment group the inflammation and fibrosis were reduced with diferent degrees in the lung tissues compared to the silicosis model group and the solvent control group. The relative expression levels of - ， Col1a2 α SMA VIM protein and mRNA in lung tissues of mice in the silicosis model group were higher than those in the blank （ P ）， -CAD control group all <0.05 and the relative expression levels of E protein were lower than those in the blank control （P ） - ， Col1a2 group <0.05 . The relative expression levels of α SMA VIM protein and mRNA in lung tissues of mice in the MNZ+ （ P ）， -CAD NEO group and the mixed treatment group were lower all <0.05 and the relative expression levels of E protein were （P ）， Conclusion higher <0.05 when compared with the silicosis model group and the solvent control group. Pulmonary fibrosis ， - was reduced in silicosis mice with interventions in lung flora where anaerobic and gram negative bacteria affected pulmonary fibrosis and dysbiosis of the lung flora affected pulmonary EMT.