UNLABELLEDABSTRA CT OBJECTIVE To compare the complications and clinical outcome of titanium elastic nail (TEN) versus plate-screw fixation (PF) for the treatment of upper segment fractures of femoral shaft in children.

METHODSFrom May 2006 and August 2012,32 consecutive children with upper segment fractures of femoral shaft were studied prospectively. They were randomly divided into TEN group and PF group. Ninteen patients were treated with titanic elastic nail (TEN) fixation including 11 males and 8 females with an average age of (6.9?2.2) years old ranging from 3 to 11,11 cases of them were type A, 6 cases were type B,2 cases were type C according to AO classification. The other 13 patients were treated with plate-screw fixation (PF) including 9 males and 4 females with an average age of (7.5±2.1) years old ranging from 5 to 12 years, and 3 cases of them were type A,6 cases were type B,2 cases were type C. Operative time, blood loss,incision length,the time of hospitalization,fracture healing time, postoperative complications and function recovery between two groups were compared and evaluated.

RESULTSThe average follow-up period of the patients was 25.3 months (ranging from 15 to 48 months) in TEN group, and 36.2 months (ranging from 13 to 36 months) in the PF group. The operation time, time of hospitalization, the time of implants removed after the initial surgery, fracture healing time in TEN group were respectively (56.7±11.2) min, (6.6±3.9) d, (8.1±2.3) months, (12.6+3.8) weeks; and in PF group were respectively (51.5±8.3) min, (7.8±4.8) d, (7.8±1.6) months, (11.8±2.8) weeks, there was no significant difference between two groups (P>0.05). However, the length of incisions was (4.3±1.7) cm and the intraoperative blood loss was (12.7+3.2) ml in TEN group,which were significantly less than that in PF group respectively (89.2±21.1) ml and (11.6?2.3) cm (P<0.05). There was no statistically difference in postoperative in complication between two groups, but the patients in TEN group had a higher incidence of soft tissue irritation and misalignment. Outcome scores according to Sanders had no significant difference between two groups (P>0.05). In TEN group,the result was excellent in 13 cases, good in 3,fair in 2, and poor in 1, while in PF group excellent in 10, good in 2, fair in 1.

CONCLUSIONThere is no significant difference in therapeutic effects between TEN and PF for children with upper segment fractures of femoral shaft. The internal fixation should be selected according to the associated fracture type, weight, the expected value of the parents, scars, and so on.

Blood Loss, Surgical ; Bone Nails ; Bone Plates ; Bone Screws ; Child ; Child, Preschool ; Female ; Femoral Fractures ; complications ; physiopathology ; surgery ; Fracture Fixation, Intramedullary ; instrumentation ; Fracture Healing ; Hip ; physiopathology ; Humans ; Male ; Operative Time ; Postoperative Complications ; epidemiology ; Prospective Studies ; Treatment Outcome

To estimate the tolerance limit and the tolerance interval of disease incubation,under the theory that the observations(samples)were subject to Poisson distribution,the tolerance limits and tolerance interval of disease incubation were calculated based on beta-distribution with integer parameter.Expressions on the relation were obtained,including the statistics on tolerance limits of both minimum and maximum orders while the tolerance was the difference between minimum and maximum order statistics and the parameters of Poisson distribution on the sample size.Using the incomplete observations as an example,reasonable unit of sample size was considered and chosen.

Abstract: Objective To analyze the epidemiological characteristics of viral hepatitis E in Fujian Province from 2012-2021, and to provide scientific evidence for the prevention and control of hepatitis E in the future. Methods Descriptive epidemiological method was used to analyze hepatitis E cases in Fujian Province from 2012 to 2021. Results From 2012 to 2021, a total of 8 877 cases of hepatitis E were reported in Fujian Province from 2012-2021. The overall incidence rate showed a decreasing trend (χ2trend =458.14, P<0.001), with the lowest incidence rate of 1.32/100 000 in 2020 and an annual average incidence rate of 2.29/100 000 per year. The incidence was higher in winter and spring, with the months of March and April having the highest number of reported cases (2 146, 24.17%) and the fewest cases were reported in September (571, 6.43%). The difference in reported incidence rates between cities was statistically significant (χ2=1 877.75, P<0.01). The comprehensive experimental zone of Pingtan had the highest average reported incidence rate of 6.03/100 000, while Zhangzhou had the lowest at 0.94/100 000. The number of male cases was higher than the number of female cases, with a male to female ratio of 2.04∶1. The disease was most prevalent among middle-aged and elderly individuals, with the age group of 40-<65 years having the highest number of reported cases, accounting for 57.44% (5 099/8 877) of all cases. The age group of 50-<55 years had the highest reported incidence, with the number of reported cases increasing with age below 50 years, but decreasing with age over 50 years. As for occupational distribution, peasants had the highest proportion of the disease, accounting for 34.49% (3 062 cases) of the total cases. Conclusions The reported incidence rate of hepatitis E in Fujian showed a downward from 2012 to 2021. Due to the impact of COVID-19, incidence of the lowest was 2020, but it did not reflect the true situation of the disease, which may have affected trend of hepatitis E. In order to control and reduce the incidence of hepatitis E, efforts should be made to increase publicity and education on health knowledge and vaccination among key areas and populations, strengthen monitoring and diagnostic capability, and implement comprehensive prevention and control measures.

To investigate the utility of optomap panoramic 200Tx in screening fundus disease among the patients after cataract surgery.
●METHODS: From November 18 th to December 31st , 2013 all 146 post- cataract surgery patients were recruited. All non - mydriatic fundus images were taken with the optomap panoramic 200Tx and were diagnosed by one masked retinal specialist. Non - mydriatic direct ophthalmoscope exam and mydriatic slit-lamp lens exam were also done by other two masked specialists. Comparisons of the three methods were made.
●RESULTS: Among 146 patients ( 161 eyes), 40 eyes (24. 8%) of retinal lesions was detected by non-mydriatic direct ophthalmoscope exam, 59 ( 36. 7%) by non -mydriatic optomap 200Tx exam, and 61 (37. 9%) by slit-lamp lens exam. Nine eyes ( 5. 6%) needed medical intervention immediately. Results of optomap 200Tx exams and slit - lamp lens exams were similar without statistically significant difference ( P > 0. 05), better than direct ophthalmoscope exam ( P < 0. 05) with statistically significant difference.
● CONCLUSlON: Opacification of the refractive medium makes thorough fundus examination impossible. So post-operative fundus examination is highly necessary and should be a routine. Optomap panoramic 200Tx, which shows no statistically difference from mydriatc slit- lamp lens exam, is a convenient and feasible method in discovering fundus pathological changes.

Objective To stuay CT findings of adrenal gland trauma(AGT).Methods The CT images of adrenal gland trauma which were found in 1712 patients who had emergency abdominal CT examinations for assessment of blunt force trauma were analyzed restrospectively.Results Among 1712 cases.we identified 29 patients(1.7%)with adrenal gland traumatic lesions.A total of 32 lesions were found.Twenty-six lesions were unilateral(23 right-sided,3 left-sided),and 3 cases were bilateral(6 lesions).Main CT findings were as followed:(1)Adrenal hematomas appeared as discrete round or oval masses expanding the adrenal gland in 22 patients with 25 lesions.The lesions were hyperdense or of homogeneous density in plain scan and did not enhance in three-phase contrast-enhanced dynamic scan.The splayed adrenal limbs around hematoma were enhanced significantly as eurvilinear structures.(2)Mild to moderate uniform swelling of gland was shown in 4 cases.(3)Diffuse irregular hemorrhage obliterating the gland was shown in 3 cases.Contrast extravasation was shown in 1 case,which was active bleeding from the broken adrenal gland proven by operation.Associated CT findings included strand-like hemorrhage of the periadrenal fat and posterior pararenal hemorrhage mimicking thickened diaphragmatic crus.The concurrent injuries of ipsilateral thorax or/and abdomen were found in 25 patients.Conclusion The AGT has typical CT findings.Familiarity with characteristic CT findings of adrenal trauma is essential for the radiologist to avoid misdiagnosis.

OBJECTIVE:To study the time-effect and dose-effect of paeonol on the apoptosis of knee osteoarthritis(OA)artic-ular chondrocyte in rabbits and the mRNA expression of its related protein Bcl-2 and Bax. METHODS:60 big-ear rabbits were ran-domly divided into normal (normal saline) group,model (normal saline) group,paeonol high-dose,medium-dose and low-dose groups and triamcinolone acetonide(positive drug)group,with 10 rabbits in each group. Except for normal group,OA model was induced by right knee anterior cruciate ligament (ACLT) and the medial meniscus 1/3 resection in those groups. After modeling, different doses of paeonol(0.8,0.4,0.2 mg/kg),triamcinolone acetonide 0.2 mg/kg were injected into right articular cavity twice a week. 4 weeks and 8 weeks after administration,articular cartilage specimens were collected. Ultrapathological structure changes of articular chondrocytes were observed by electron microscope. Apoptosis of cartilage cell was observed by TUNEL and apoptotic index was calculated. mRNA expression of apoptosis related genes of Bcl-2 and Bax in articular cartilage tissue of rabbits were de-tected by in situ hybridization technique. RESULTS:Compared with normal group,articular chondrocyte of model group showed early and middle stage apoptosis morphology change after 4 and 8 weeks,and apoptosis index increased significantly and the mRNA expression of Bcl-2 and Bax was up-regulated (P<0.01);4 and 8 weeks later after administration,compared with model group,apoptosis index decreased and mRNA expression of Bax was down-regulated in paeonol groups,while mRNA expression of Bcl-2 was up-regulated(P<0.05 or P<0.01). Electron microscopy ultrastructural observation showed articular chondrocyte of pae-onol high-dose and middle-dose groups were in early stage of apoptosis.CONCLUSIONS:Paeonol can slow down articular chondro-cyte degeneration and destroy in OA model rabbits in time and dose dependently. Its mechanism may be associated with expression up-regulation of Bcl-2 and expression down-regulation of Bax.

There is a considerable increase in incidence of proximal humerus fractures.Locking plates are widely applied in the treatment of proximal humerus fractures due to their superior advantages.However,they may still lead to a high incidence of complications,especially in complex proximal humerus fractures.Reconstruction of medial support for a proximal humerus fracture can reduce complications effectively.At present,there is no consensus on the optimal method for medial support.The methods commonly used for medial support as an auxiliary fixation of proximal humerus fracture include screw support,bone transplantation,bone substitute and dual plates,all of which are discussed in this review.

Objective To investigate the effects of recombinant human osteoprotegerin(rhOPG) on RANKL ,OPG protein expression in alveolar bone tissue of rats with periodontitis to provide the experimental evidence for the application of rhOPG in pe‐riodontitis treatment .Methods Totally 22 Wistar rats were enrolled .The random number table was adopted to select two healthy rats as the healthy group .The rest 20 rats were selected as the experimental group for establishing the rat models of periodontitis , and then subdivided into the experimental control group (n=10) and rhOPG group (n=10) .Rats in the rhOPG group were locally injected by rhOPG 10 mg/kg at periodontal pocket gap of maxillary second molar ,while those in the experimental control group were injected by sterile water for injection at the same site and some volume .The streptavidin‐perosidase(SP) method was em‐ployed to detect the expression of RANKL ,OPG protein in alveolar bone tissue .Results Compared with the healthy group ,the ex‐pression levels of OPG in alveolar bone tissue of rats in the experimental group were lower with statistically significant difference (P<0 .05) ,while the difference of RANKL expression levels between the two groups showed no statistical significance(P>0 .05) . Compared with the experimental control group ,the expression level of OPG protein in alveolar bone tissue of rats in the rhOPG group was significantly up‐regulated ,while that of RANKL protein was significantly down‐regulated(P<0 .05) .The OPG expres‐sion level after treatment in the rhOPG group was markedly enhanced ,while the RANKL expression level was reduced compared with before treatment ,the difference was statistically significant (P<0 .05) .Conclusion rhOPG may regulates the expression of RANKL and OPG in alveolar bone tissue of rats with periodontitis .

Objective To investigate the correlation between serum total bile acid level and coronary atherosclerosis. Methods The clinical data of 1408 patients who had underwent coronary angiography were retrospectively analyzed. The patients were divided into coronary atherosclerosis group (stenosis ≥ 50%, 681 cases) and coronary normal group (stenosis < 50%, 727 cases) according to the results of coronary angiography. The general clinical data, serum total bile acid, serum creatinine, fasting plasma glucose, low-density lipoprotein cholesterol (LDL-C) and so on were compared between 2 groups, and the indexes analyzed by Spearman correlation analysis and multivariate Logistic regression analysis. Results There were no significant differences between 2 groups in the sex constitution, the family history of hyperlipidemia and the history of lipid-lowering therapy (P>0.05). The rate of smoking, rate of hypertension, rate of diabetes, age, body mass index (BMI), creatinine, fasting plasma glucose, total bile acid and low density lipoprotein cholesterol in coronary atherosclerosis group were significantly higher than those in coronary normal group:18.6%(127/681) vs. 14.2%(103/727), 64.6%(440/681) vs. 45.8%(333/727), 48.5%(330/681) vs. 22.7%(165/727), (58.9 ± 12.2) years vs. (56.7 ± 13.1) years, (25.6 ± 4.3) kg/m2 vs. (24.9 ± 4.5) kg/m2, (70.28 ± 15.94)μmol/L vs. (52.79 ± 12.75)μmol/L, (6.82 ± 2.73) mmol/L vs. (5.57 ± 2.35) mmol/L, (7.86 ± 4.38)μmol/L vs. (5.63 ± 3.71)μmol/L and (3.32 ± 0.69) mmol/L vs. (2.28 ± 0.57) mmol/L, and there were statistical differences (P<0.05 or <0.01). The Spearman correlation analysis result showed that coronary atherosclerosis was positively correlated with men, age, diabetes, hypertension, BMI, serum creatinine and total bile acid (r=0.084, 0.068, 0.322, 0.263, 0.073, 0.248 and 0.176; P < 0.05 or < 0.01). The multivariate Logistic regression analysis result showed that men, diabetes, hypertension, serum creatinine, BMI ( >24 kg/m2) and total bile acid levels were risk factors of coronary atherosclerosis (P<0.05 or<0.01). Conclusions The serum total bile acid level is positively correlated with the severity of coronary atherosclerosis, which may be one of the independent risk factors for coronary atherosclerosis.

] AIM: Lysophosphatidic acid (LPA) is a bioactive phospholipid known to have growth factor-like activity on fibroblasts, and is involved in cardiovascular diseases. Besides direct effects, usually, LPA can work together with other bioactive factors to regulate cardiovascular homeostasis by induction of their expression and production, or increase in their activity. Among variety of bioactive factors, adrenomedullin (ADM) is a multifunctional peptide with an important cytoprotective effect against cardiovascular damage, but the interaction between ADM and LPA on adventitia remains unknown. METHODS: The experiment was performed on the bath of isolated rat aortic adventitia, ADM produced and secreted from adventitia stimulated by LPA was detected by using radioimmunoassay, proliferation in adventitia cells was evaluated by the level of [3H]-thymine incorporation, and prepro ADM gene expression was measured by semi-quantitative reverse transcriptase polymerase chain reaction. RESULTS: It was found that LPA stimulated aortic adventitia to secrete ADM and express its mRNA in a concentration-dependent manner. ADM inhibited LPA-induced proliferation in adventitial cells, and attenuated the activity of mitogen activated protein kinase (MAPK) stimulated by LPA. In contrast, the treatment with specific antagonists of ADM receptor potentiated the LPA-induced proliferation in adventitial cells. CONCLUSION: LPA stimulates adventitia to produce and secrete ADM, and in turn, ADM produced by adventitia regulates the vascular biological effects of LPA. [