[Objective]To investigate the efficacy of early Chinese biotype total hip arthroplasty(THA) in clinical application.[Methods]From October 1997 to March 2004,THA was done in 46 patients(49 hips) with early Chinese biotype.The efficacy was evaluated according to the clinical score and X-ray photographs.[Results]Forty-six patients were followed up for 5~11.5 years(average 8.5 year).The mean Harris hip score improved from 38(35~50) points preoperatively to 82(70~90) points at final follow-up.The imaging observation showed that prothesis loosening occurred in 9 cases.There were hip dislocation in 3 cases.One dislocation occurred on the way to the ward after operation,and the other 4 events occurred after the patients were discharged.Close reduction was all successful.There was 1 case of ectopic ossification,Brooker classification was GradeⅠ.One patient had hip pain and limping.The X-ray photographs showed that there was obvious osteoporosis,but no prothesis loosening occurred.No infection was found.The total good to excellent result was 73.9%.[Conclusion]The early Chinese biotype total hip arthroplasty can relieve the pain.However,the design and the moding parts of the domestic prosthesis need to be modified in order to improve the prosthetic efficacy.

Objective To discuss the short-term outcomes of uncemented APL stem hip hemiarthroplasty for unstable intertrochanteric fracture in elderly patients.Methods From July 2008 to December 2011,26 cases of intertrochanteric fractures were treated by hemiarthroplasty using uncemented APL stem.There were 10 men and 16 women with a mean age of 82.5 years (range,75-94 years).According to EvansJensen classification system,16 cases were type Ⅱ fractures,the other 10 were type Ⅲ.Results The mean operation time was 56 min (range,48 to 72 min).The average blood loss during the operation was 360 ml (range,240-600 ml).One of the patients died in the perioperative period,2 died during the follow-up.The other 23 patients were followed up with an average of 21.5 months (range,12-42 months).The patients were encouraged to walk with aid about 2-3 weeks postoperatively.Three months after the operation,the walking ability were almost recovered to pre-injury level in 21 cases.The acetabular wear,the prosthetic loosening and subsidence were not found.The complications included 1 case of cerebral infarction,1 case of deep venous thrombosis,2 urinary infection,1 skin ulcer due to the long-term use of cortical steroid and 2 heterotopic ossifications.According to Harris hip score,12 cases were classified as excellent,10 cases as good and 1 case as fair.Conclusion Hemiarthroplasty using uncemented APL stem is an effective way to treat the unstable intertrochanteric fracture in elderly patients.The quality of life of the elderly patients can be improved due to early mobilization after the surgery.

Objective To explore the mid-term efficacy of biological type,long-stem artificial caput femo-ris replacement operation in the treatment of unstable senile intertrochanteric fracture.Methods 73 patients accepted the treatment of biological type long-stem artificial caput femoris replacement operation,and 64 cases were followed. After 3 months of operation,these 64 patients were divided into four groups which marked as A,B,C and D according to the Berg balance scale(BBS).Accordingly,54 patients that in grade A,B and C would be brought into in long-term follow-up study.54 cases include 25 male patients and 29 female patients with an average age of 81.6 years old who aged from 73 to 94 years old.According to Evans-Jensen classification,28 cases were Evans-JensenⅡand the left 26 cases were Evans -JensenⅢ.Results The follow-up period was in the range of 24 to78 months (mean 42months).During this period,except the 9 death cases,there was no case of femoral trochanteric ununited fracture, femoral prostheses loosening or dislocation of hip joint.In total,3 cases occurred with loss of fixing wire,4 cases occurred with acetabular wear,one case was experienced prosthesis adjacent fracture and three cases of heterotopic ossification.According to the Engh standard,all femoral prostheses got osseous fixation.The rate of excellent and good result were 88.9%with in which excellent in 23 cases and good in 17 cases.Conclusion The application of biological type long-stem artificial caput femoris replacement in the treatment of unstable senile intertrochanteric fracture can achieve satisfactory mid-term efficiency.

Objective　To explore the injurious effect of the serum drawn from patient under cardiopulmonary bypass (CPB) on pulmonary surfacant-associated protein A(SP-A) and the preventive effect of pentoxifylline (PTX) on the protein. Methods　The cultured rat alveolar epithelial cell type Ⅱ(AT-Ⅱ) were incubated with CPB serum to observe the change of the cell morphology, and the expressions of SP-A and SP-A mRNA. Results　Traumatic changes and the decrease of SP-A and SP-A mRNA expressions were found in AT-Ⅱ cells cultured with CBP serum. PTX exerted protective effect on the cells. Conclusion　The serum after CPB can directly injure rat AT-Ⅱ cells in vitro, and inhibit the SP-A expression at transcription and translation levels, which probably is an important reason for the quantitative and qualitative abnormality of pulmonary surfactant after operation. PTX may alleviate the inhibitory effect of CPB serum on SP-A.

Objective:To investigate the effects of different doses of rosuvastatin on blood lipid levels and 1-year outcomes in patients undergoing coronary artery bypass grafting.Methods:A total of 106 patients who underwent coronary artery bypass grafting at the Affiliated Hospital of Jining Medical University from February 2020 to February 2022 were prospectively selected and randomly divided into two groups using a random number table. The high-dose group (53 cases) was treated with 20 mg/d rosuvastatin, while the low-dose group (53 cases) was treated with 10 mg/d rosuvastatin. The two groups were compared after treatment in terms of the clinical efficacy, blood lipid levels [total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C)], cardiac function indicators [left ventricular end diastolic diameter (LVDD), left atrial diameter (LAD), left ventricular ejection fraction (LVEF), one-year follow-up [recurrence, readmission, death, major adverse cardiovascular events (MACE)], and adverse reactions (liver injury, elevated creatine kinase, gastrointestinal reactions, rash).Results:The total effective rate of the high-dose group was 94.34%(50/53) higher than that of the low-dose group, which was 77.36%(41/53) ( P<0.05); After treatment, the levels of TC, TG, and LDL-C in both groups decreased, while the level of HDL-C increased (all P<0.05), and the levels of TC, TG, and LDL-C in the high-dose group were lower than those in the low-dose group, while the level of HDL-C was higher than that in the low-dose group (all P<0.05); After treatment, LVDD and LAD in both groups decreased, while LVEF increased (all P<0.05), and LVDD and LAD in the high-dose group were lower than those in the low-dose group, while LVEF was higher than that in the low-dose group (all P<0.05); After a one-year follow-up, the recurrence rate of the high-dose group was 7.55%(4/53), and the readmission rate was 5.66% (3/53), both lower than those of the low-dose group [26.42%(14/53), 20.75%(11/53)] (all P<0.05). There was no statistically significant difference in case fatality rate, MACE, and incidence of adverse reactions between the two groups (all P>0.05). Conclusions:The use of high-dose rosuvastatin in patients undergoing coronary artery bypass grafting can effectively reduce blood lipid levels, improve cardiac function, and has high safety. It is worthy of clinical application.

OBJECTIVETo discuss the feasibility of terminal intestinal exteriorization (exteriorization without ileostomy) in laparoscopic anterior resection for rectal cancer.

METHODSClinicopathological data of 77 patients undergoing laparoscopic anterior resection for low rectal cancer in our department from January 2011 to December 2013 were retrospectively analyzed. After laparoscopic rectal resection, 32 patients received terminal intestinal exteriorization (exteriorization group) and 45 patients received preventive ileostomy (ileostomy group). Anastomosis-related, stoma-related and intestinal stoma closure-related morbidity was compared between the two groups.

RESULTSThere were no significant differences in operative time, blood loss and overall hospital stay between the two groups (all P>0.05). The total hospital cost was (5.39±1.74)×10(4) yuan in the exteriorization group, and (6.98±1.37)×10(4) yuan in the ileostomy group(P<0.01). The incidences of postoperative anastomotic fistula was not significantly different between the two groups(P>0.05). Three patients(9.4%) developed anastomotic leak in the exteriorization group and 2(4.4%) in the ileostomy group. The anastomotic leak was managed by opening the external intestinal wall and maturating an ileostomy under local anaesthesia. All these 5 patients were cured with nutritional support, antibiotics, continuous local drainage. In the exteriorization group, 5 patients had complications related to stoma and intestinal stoma closure operation(15.6%), which was lower than(42.2%) in the ileostomy group(P=0.013).

CONCLUSIONTerminal intestinal exteriorization in laparoscopic anterior resection is a safe and feasible surgical procedure with little trauma and less hospital cost, which can be an alternative as a prophylactic treatment for patients with high risk of anastomotic leak.

Anastomosis, Surgical ; Anastomotic Leak ; Drainage ; Humans ; Ileostomy ; Laparoscopy ; Length of Stay ; Postoperative Complications ; Rectal Neoplasms ; Retrospective Studies ; Surgical Stomas

Objective To discuss the feasibility of terminal intestinal exteriorization (exteriorization without ileostomy) in laparoscopic anterior resection for rectal cancer. Methods Clinicopathological data of 77 patients undergoing laparoscopic anterior resection for low rectal cancer in our department from January 2011 to December 2013 were retrospectively analyzed. After laparoscopic rectal resection, 32 patients received terminal intestinal exteriorization (exteriorization group) and 45 patients received preventive ileostomy (ileostomy group). Anastomosis-related, stoma-related and intestinal stoma closure-related morbidity was compared between the two groups. Results There were no significant differences in operative time, blood loss and overall hospital stay between the two groups (all P>0.05). The total hospital cost was (5.39 ±1.74) ×104 yuan in the exteriorization group, and (6.98 ±1.37) ×104 yuan in the ileostomy group (P<0.01). The incidences of postoperative anastomotic fistula was not significantly different between the two groups(P>0.05). Three patients(9.4%) developed anastomotic leak in the exteriorization group and 2(4.4%) in the ileostomy group. The anastomotic leak was managed by opening the external intestinal wall and maturating an ileostomy under local anaesthesia. All these 5 patients were cured with nutritional support, antibiotics, continuous local drainage. In the exteriorization group, 5 patients had complications related to stoma and intestinal stoma closure operation (15.6%), which was lower than (42.2%) in the ileostomy group (P=0.013). Conclusion Terminal intestinal exteriorization in laparoscopic anterior resection is a safe and feasible surgical procedure with little trauma and less hospital cost, which can be an alternative as a prophylactic treatment for patients with high risk of anastomotic leak.

Objective To discuss the feasibility of terminal intestinal exteriorization (exteriorization without ileostomy) in laparoscopic anterior resection for rectal cancer. Methods Clinicopathological data of 77 patients undergoing laparoscopic anterior resection for low rectal cancer in our department from January 2011 to December 2013 were retrospectively analyzed. After laparoscopic rectal resection, 32 patients received terminal intestinal exteriorization (exteriorization group) and 45 patients received preventive ileostomy (ileostomy group). Anastomosis-related, stoma-related and intestinal stoma closure-related morbidity was compared between the two groups. Results There were no significant differences in operative time, blood loss and overall hospital stay between the two groups (all P>0.05). The total hospital cost was (5.39 ±1.74) ×104 yuan in the exteriorization group, and (6.98 ±1.37) ×104 yuan in the ileostomy group (P<0.01). The incidences of postoperative anastomotic fistula was not significantly different between the two groups(P>0.05). Three patients(9.4%) developed anastomotic leak in the exteriorization group and 2(4.4%) in the ileostomy group. The anastomotic leak was managed by opening the external intestinal wall and maturating an ileostomy under local anaesthesia. All these 5 patients were cured with nutritional support, antibiotics, continuous local drainage. In the exteriorization group, 5 patients had complications related to stoma and intestinal stoma closure operation (15.6%), which was lower than (42.2%) in the ileostomy group (P=0.013). Conclusion Terminal intestinal exteriorization in laparoscopic anterior resection is a safe and feasible surgical procedure with little trauma and less hospital cost, which can be an alternative as a prophylactic treatment for patients with high risk of anastomotic leak.

Objective:To summarize clinical characteristics of and treatment experience with patients with critical illnesses in a dermatological ward.Methods:All patients with serious or life-threatening conditions, who were hospitalized at the dermatological ward of the Second Xiangya Hospital of Central South University from July 9, 2011 to December 31, 2020, were collected, and their clinical data were retrospectively analyzed. Demographic characteristics, disease types and proportions, main complications, causes of serious or life-threatening conditions, important treatment measures and outcomes were summarized, and causes of death were also analyzed and discussed.Results:A total of 1 057 patients with critical illnesses were collected, with a male-to-female ratio of 1∶1.11, and 64.81% of them aged 18 to 65 years. The types of diseases mainly included drug eruptions (332 cases) , connective tissue diseases (226 cases) , bullous skin diseases (104 cases) , psoriasis (57 cases) , erythroderma (45 cases) , infectious skin diseases (67 cases) , etc. Among them, psoriasis (39 cases) and erythroderma (32 cases) mostly occurred in males, and connective tissue diseases (168 cases) mostly occurred in females. Common complications mainly involved infections, important organ damage or dysfunction, hypoalbuminemia, and fluid, electrolyte and acid-base imbalances. A total of 94 patients were diagnosed with life-threatening conditions, which were found to be mainly caused by primary skin diseases, hematologic abnormalities, respiratory failure, nervous system abnormalities, renal failure, sepsis, fluid, electrolyte and acid-base imbalances, etc. During the management of critical illnesses, 43 patients were treated with high-dose glucocorticoid pulse therapy, 264 were treated with gamma-globulin pulse therapy, 355 were transfused with other blood products, and 34 received special therapies such as hemoperfusion/immunoadsorption therapy, plasma exchange, dialysis, artificial liver support therapy; 42 patients were transferred to the intensive care unit (ICU) , 12 were transferred to the department of surgery for operations, and 12 were transferred to the department of obstetrics and gynecology for delivery or induction of labor. After treatment, 989 patients (93.57%) achieved improvement and were discharged. A total of 14 patients (1.32%) died, of whom 7 died of secondary sepsis, 2 died of severe pulmonary infections, 2 died of asphyxia caused by respiratory mucosa shedding-induced airway obstruction, the other 3 died of gastrointestinal hemorrhage, cerebral hemorrhage and neuropsychiatric systemic lupus erythematosus, respectively.Conclusions:Critical cases in the dermatological ward mainly suffered from serious skin diseases such as severe drug eruptions, connective tissue diseases and bullous skin diseases, as well as complications such as severe underlying diseases, severe organ dysfunction, sepsis or severe fluid, electrolyte and acid-base imbalances. In terms of treatment, it is of critical significance to make a clear diagnosis and assess the severity of disease as early as possible, monitor and prevent possible complications, and to consult with specialists in relevant disciplines in time.

Pulmonary blast injury has become the main type of trauma in modern warfare, characterized by externally mild injuries but internally severe injuries, rapid disease progression, and a high rate of early death. The injury is complicated in clinical practice, often with multiple and compound injuries. Currently, there is a lack of effective protective materials, accurate injury detection instrument and portable monitoring and transportation equipment, standardized clinical treatment guidelines in various medical centers, and evidence-based guidelines at home and abroad, resulting in a high mortality in clinlcal practice. Therefore, the Trauma Branch of Chinese Medical Association and the Editorial Committee of Chinese Journal of Trauma organized military and civilian experts in related fields such as thoracic surgery and traumatic surgery to jointly develop the Clinical treatment guideline for pulmonary blast injury ( version 2023) by combining evidence for effectiveness and clinical first-line treatment experience. This guideline provided 16 recommended opinions surrounding definition, characteristics, pre-hospital diagnosis and treatment, and in-hospital treatment of pulmonary blast injury, hoping to provide a basis for the clinical treatment in hospitals at different levels.