ObjectiveTo investigate the application of intraoperative Computed Tomograph (CT) using in surgery for complex acetabular fractures.MethodsFrom June 2008 to December 2010,14 patients (9 males,5 females; with the mean age of 45.1 years; range,28-62 years) with complex acetabular fractures were operated using intraoperative CT.Preoperative radiotherapy and CT scan were adopted to evaluate the fractures.Three dimensional reconstruction based on CT scan was used to mimic surgery.The surgery approach and the type of internal fixators were noted.Intraoperative C-arm and CT scan were used to evaluate the fractures reduction respectively.Decision of additional reduction was made by surgeons according to above mentioned methods respectively and the results were noted.Comparing to preoperative design,the change of surgery plan were noted.Overall time,frequency and radiation dose of intraoperative CT scan were also noted.ResultsAll patients in this study received average 2.7 times of intraoperative CT scan.Mean time of CT scan was 40.4 min and the overall dose of radiation was 47.2 mGy.Decision of additional reduction was made in 3 cases according to C-arm radiography and 4 cases according to CT scan (above mentioned 3 cases were included).The change of surgery plan was made in one case.In postoperative radiography evaluation according to Matta's score system,anatomical reduction were achieved in 8 cases,imperfect reduction in 3 cases and poor reduction in 3 cases.ConclusionIntraoperative CT scan increases the radiation time and dose of patients dramatically.When used to evaluate fracture reduction intraoperatively,it can't take the advantage of traditional C-arm radiography.When delicate preoperative plan is made with radiography and three dimensional reconstruction based on CT data,the efficiency of intraoperative CT scan for complex acetabular fractures are to be discussed.

OBJECTIVETo observe the clinical results of proximal femoral nail anti-rotation (PFNA) combined with zoledronic acid injection in the treatment of osteoporotic intertrochanteric fractures in the elderly.

METHODS60 elderly patients with osteoporotic intertrochanteric fractures were diagnosed using a dual energy X-ray bone density instrument. Patients were randomly divided into treatment or control groups (30 cases in each group). Patients in both groups were treated by closed/open reduction and internal fixation using PFNA. In the treatment group, patients received one zoledronic phosphonic acid injection of 5 mg/100 ml via intravenous drip, in addition to 600 mg of Caltrate D (qd) and 0.25 mg of alpha ossification alcohol (qd). The control group received 600 mg of Caltrate D (qd) and 0.25 mg of alpha ossification alcohol (qd). The oral drugs were administered for 12 months. Bone pain relief was observed, and changes in the bone mineral density (BMD) of the lumbar and health-side hip were recorded. Clinical results were evaluated using the Visual Analogue Scale (VAS), Harris joint function score, and Osteo- porosis Quality of Life Scale (OQOLS).

RESULTSCompared with the control group, bone pain symptoms were significantly alleviated (p < 0.05) in the treatment group. In the treatment and control groups, both between-group and within-group differences in BMD were significantly increased in L1e4, femoral neck and trochanter (p < 0.05). No significant differences were found between the two groups in regard to the involved hip or the total rate of improvement at the end of the follow-up period, although cases in the treatment group had higher OQOLS scores than those of the controls (p = 0.04). Cases in the treatment group healed more quickly than those in the control group [(13 ± 3.2) weeks vs (15 ± 4.6) weeks, p = 0.02]. During the follow-up period, cases in the treatment group had no new fractures, whereas 2 new cases of hip fracture and 2 cases of distal radial fractures were observed among the controls.

CONCLUSIONZoledronic acid injection combined with PFNA is a favorable treatment option for the elderly patients with osteoporotic intertrochanteric fracture. It can effectively relieve bone pain, increase bone density, improve quality of life, reduce the occurrence of new fractures and promote fracture healing.

Aged ; Aged, 80 and over ; Bone Density ; Bone Nails ; Combined Modality Therapy ; Diphosphonates ; administration & dosage ; Female ; Hip Fractures ; psychology ; therapy ; Humans ; Imidazoles ; administration & dosage ; Injections ; Male ; Middle Aged ; Osteoporotic Fractures ; psychology ; therapy ; Quality of Life

OBJECTIVETo understand the determinants and epidemiology of drug-resistant tuberculosis (TB) in rural area.

METHODSAll the diagnosed TB patients in a county with directly observed treatment (DOTS) short-course program in 2002 and a sample of patients in another county without DOTS program located in northern Jiangsu province were surveyed with questionnaires. Drug susceptibility testing (DST) for positive cultures were performed by standardized proportion method. Univariable analysis and multivariate nonconditional logistic regression modeling were applied for data analysis.

RESULTSAmong the 152 patients with DST results, 32.9% of the cases showed resistance to at least one of the first-line anti-tuberculosis drugs with 26.3% to isoniazid, 18.4% to rifampin and 17.1% to both isoniazid and rifampin respectively. Previous treatments for TB and residence in the county without DOTS program were independent risk factors for isoniazid and rifampin resistance. TB patients showing indifferent to their health and delayed health seeking for more than 1 month were more likely to have rifampin resistance. Independent predictors of multidrug-resistant TB would include delayed health seeking for more than 1 month (OR = 4.66, 95% CI: 1.26 - 17.24), residing in the county without a DOTS program (OR = 3.01, 95% CI: 1.10 - 8.22), indifference to their health condition (OR = 5.13, 95% CI: 1.06 - 24.90) and suffering from chronic diseases (OR = 0.22, 95% CI: 0.05 - 0.87).

CONCLUSIONDrug-resistant TB was quite serious in this rural areas, mainly associated with man-made factors but partly due to the availability of the transmission.

Adult ; Antitubercular Agents ; pharmacology ; China ; epidemiology ; Drug Resistance, Microbial ; Drug Resistance, Multiple ; Ethambutol ; therapeutic use ; Humans ; Incidence ; Isoniazid ; therapeutic use ; Logistic Models ; Male ; Microbial Sensitivity Tests ; Middle Aged ; Rifampin ; therapeutic use ; Rural Health ; Streptomycin ; therapeutic use ; Surveys and Questionnaires ; Tuberculosis, Pulmonary ; epidemiology ; microbiology

We examined the effect of endogenous and exogenous nitric oxide (NO) on protein kinase C (PKC) activity induced by angiotensin II (Ang II) in cultured neonatal rat cardiomyocytes. The results are as follows. The activity of PKC was increased by Ang II (0.01-10 micromol/L) in a dose-dependent manner, but decreased by NO precursor L-arginine (L-Arg) (10 micromol/L-10 mmol/L) in a dose-dependent manner in cultured neonatal rat cardiomyocytes. Pretreatment with L-Arg (100 micromol/L) decreased significantly Ang II -activated PKC activity and PKC activity induced by phorbol 12-myristate 13-acetate (PMA) ( 10 micromol/L), a PKC activator. Pretreatment with N(G)-nitro-L-argingie methyl ester (L-NAME), a nitric oxide synthase (NOS) blocker, may inhibit significantly the role of L-Arg on Ang II - and PMA-activated PKC activity. The activity of PKC was also decreased by NO donor sodium nitroprusside (SNP) (10 micromol/L-1 mmol/L) in a dose-dependent manner in cultured neonatal rat cardiomyocytes. Pretreatment with SNP (10 micromol/L) decreased significantly Ang II - and PMA-activated PKC activity. These results indicate that PKC was controlled by both NO and Ang II. PKC may be a cross talk between Ang II and NO in cardiomyocytes. NO abolished the activity of PKC and impaired PKC downstream signaling transduction pathway cascades.
Angiotensin II ; physiology ; Animals ; Animals, Newborn ; Cells, Cultured ; Female ; Male ; Myocytes, Cardiac ; cytology ; enzymology ; Nitric Oxide ; physiology ; Protein Kinase C ; metabolism ; Rats ; Rats, Sprague-Dawley

Objective To systematically review the efficacy and safety of aspirin for preventing venous thromboembolism (VTE) after major orthopedic surgery.Methods Retrieved from PubMed,Embase and Cochrane Library,randomized controlled trials (RCT) and cohort studies about aspirin used in major orthopedic surgery were collected.Meta-analysis was performed by using Rev Man 5.3 software after data extraction and quality evaluation.Results Totally seven RCTs and five cohort studies were included.Compared with control group,aspirin reduced the incidence of deep vein thrombosis (DVT) [RR=0.69,95％CI(0.54,0.89),P =0.004] and pulmonary embolism(PE) [RR =0.60,95％CI(0.43,0.84),P =0.003].Compared with low molecular weight heparin (LMWH),the incidence ofDVT,PE and hemoglobin drop were [RR =1.06,95％CI(0.96,1.17),P =0.22],[RR =1.04,95％CI(0.93,1.18),P =0.48] and [MD =-7.61,95％CI(-11.73,-3.49),P =0.000 3] respectively in aspirin group.Conclusions Compared with control,aspirin could reduce VTE incidence after major orthopedic surgery.There were no significant differences in VTE incidence between aspirin and LMWH,but hemoglobin drop were lower in aspirin group.For other complications,there were no significant differences between aspirin and control/LMWH.

Purpose :To investigate the relationship of peripheral blood T-lymphocyte subsets with the acuterejection or severe CMV infection in transplanted patients. Methods :T-lymphocytes subsets of peripheral bloodwere consecutively detected by using mice-verse-human T-lymphocytes subsets monoclonal antibody-OKT serialsand flow cytometer. Results:The difference of CD4/CD8 ratios between the no acute rejection group and the acuterejection group, or between the acute rejection remission group and the resistant acute rejection group was signif-icant ( P ＜0.05); In patients with intensive CMV infection, the CD4/CD8 ratios were converse to the acute re-jection group. Conclusions:These results indicated that monitoring of peripheral blood T-lymphocyte subsets wasof much benefit to early diagnosis and differential diagnosis of acute rejection of intensive CMV infection and rea-sonable treatment.

Objective To analyze the risk factors of cognitive impairment after off-pump coronary artery bypass grafting (OPCABG).Methods A total of 102 patients [ male:82,age:(65.7 ± 7.1 ) years ]undergoing OPCABG in our hospital between January 2009 and December 2010 were divided into postoperative cognitive dysfunction (POCD) group and non-POCD group by the MMSE questionnaire survey conducted at 7 days pre- and post-operation respectively.Results The incidence of POCD was 48.0％ ( 49/102 ).Multivariate logistic stepwise regression analysis showed:advanced age (OR =1.32,95％ CI:1.10 - 1.46,P=0.002),smoking (OR=1.26,95％ CI:1.18-1.32,P=0.001),hypertension (OR =1.66,95％ CI:1.36 - 1.78,P =0.023),diabetes ( OR =1.62,95％ CI:1.02 - 2.84,P =0.032),stroke ( OR =3.32,95 ％ CI:1.68 - 6.49,P ＜ 0.001 ),mitral regurgitation ( OR =1.48,95 ％ CI:1.26 - 1.89,P ＜ 0.001 ),and time of wall clamp ( OR =4.84,95％ CI:1.08 - 7.28,P ＜ 0.001 ) were independent risk factors of POCD.Conclusion Advanced age,smoking,hypertension,diabetes,stroke,mitral regurgitation,and prolonged time of wall clamp are major risk factors for POCD in patients undergoing OPCABG.

Ventricular fibroblasts were cultured using conditioned growth medium for ventricular fibroblasts (FCGM). The rate of the total collagen synthesis of ventricular fibroblasts was measured by assaying the incorporation rate of ［3H］-proline, whereas the proliferation of ventricular fibroblasts was assessed by determining the incorporation rate of ［3H］-TdR and the expression of c-fos genes. FCGM significantly increased the ［3H］-proline incorporation rate and ［3H］-TdR incorporation rate of fibroblasts in a dose-dependent manner. Furthermore, FCGM promoted the c-fos gene expression of fibroblasts, which attained its maximum in 1 h. BQ123, an ETA receptor antagonist, partially blocked the above effects of FCGM, but AT1 receptor antagonist CV11974 and α-adrenergic receptor antagoist regitin did not. It is suggested that the ventricular fibroblast has an autorine function in promotion of collagen synthesis and proliferation of fibroblasts by secreting endothelin and other bioactive substances.

Using cell culture, radioimmunoassay for endothelin and RT-PCR, the effect of aldosterone on the endothelin secretion of ventricular fibroblasts was studied. The results showed that aldosterone (1×10－7 mol/L) promoted the expression of ppET-1 mRNA, which began to increase in 2 hours and attained the highest level in 4 hours, thereafter decreased; aldosterone increased the endothelin level in ventricular fibroblasts and fibroblast conditioned growth medium (FCGM) as well, which was blocked by spironolactone (1×10－6 mol/L), an aldosterone receptor antagonist. The results suggest that aldosterone can increase endothelin secretion by ventricular fibroblasts, which can be inhibited by its receptor antagonist spironolactone.

The aim of this study was to examine the effects of L-arginine, a nitric oxide (NO) precursor, on protein expression of endothelial nitric oxide (eNOS), nitrite/nitrate content, protein expression of mitogen-activated protein kinase phosphatase-1 (MKP-1) and the activity of mitogen-activated protein kinase (MAPK) in cardiac tissues in renovascular hypertensive rats (RHR). The Goldblatt renovascular hypertensive model was established by two-kidney one clip method. The rats were divided into four groups, respectively treated with 50, 150 and 450 mg/kg L-arginine and 150 mg/kg L-arginine plus 10 mg/kg L-NAME (an eNOS inhibitor) (ip). Another group did not receive specific treatment from the 5th week after renal artery constriction. Control group was sham-operated. Mean arterial blood pressure (MABP) and the ratio of left ventricular weight to body weight (LVW/BW) were measured 8 weeks after treatment. eNOS protein expression, nitrite/nitrate content, MKP-1 protein expression and MAPK activity in cardiac tissues were detected using Western blot analysis, enzyme-reduction method and substrate in-gel kinase assay, respectively. It was found that L-arginine significantly inhibited the increase of MABP and LVW/BW, attenuated the activity of MAPK, increased protein expression of eNOS and MKP-1 and potentiated production of NO in cardiac tissue with the most effective dosage of 150 mg/kg, and these effects of L-arginine could be inhibited by L-NAME. These results suggest that MKP-1 may play an important role in the NO-induced inhibition of myocardial hypertrophy. The anti-hypertrophic effects of L-arginine may involve increase of eNOS protein expression and NO production, poten- tiation of MKP-1 protein expression, and inhibition of MAPK activity in the cardiac tissue of RHR.