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

OBJECTIVETo analyze the risk factors of cognitive impairment after off-pump coronary artery bypass grafting (OPCABG).

METHODSA 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.

RESULTSThe 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.

CONCLUSIONAdvanced age, smoking, hypertension, diabetes, stroke, mitral regurgitation, and prolonged time of wall clamp are major risk factors for POCD in patients undergoing OPCABG.

Aged ; Cognition Disorders ; etiology ; Coronary Artery Bypass, Off-Pump ; adverse effects ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications ; etiology ; Risk Factors ; Treatment Outcome

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.

OBJECTIVETo investigate the effect of intraluminal administration of ulinastatin (a protease inhibitor) in the intestine on intestinal inflammation in rats with hemorrhagic shock.

METHODSTwenty-eight Wistar rats were randomized into control group (A), intestinal saline perfusion group (B), ulinastatin intestinal perfusion group (C), and intravenous ulinastatin injection group (D) (n=7). The mean arterial blood pressure (MAP) and survival time of the rats were recorded. The changes in human polymorphonuclear cell (PMN) CD11b expression were detected by flow cytometry. The leukocyte count was recorded at different time points after the treatment, and the pathology of the intestinal mucosa was observed comparatively.

RESULTSGroups C and D showed significantly slower reduction of the MAP than groups A and B after hemorrhagic shock (P<0.05). The survival time of the rats was the longest in group C (P<0.05). CD11b expression increased gradually during hemorrhagic shock in all the groups, but the expression level was the lowest in group C (P<0.05). Hemorrhagic shock caused a reduction in leukocyte counts, which remained the highest in group C (P<0.05). Group C also showed the least intestinal pathology among the 4 groups.

CONCLUSIONIntestinal perfusion of ulinastatin can lower the reduction rate of MAP, attenuate plasma activation and intestinal inflammation, and prolong the survival of rats with hemorrhagic shock. These results indicate an important role of protease in intestinal inflammation during hemorrhagic shock.

Animals ; Arterial Pressure ; Disease Models, Animal ; Glycoproteins ; administration & dosage ; pharmacology ; Inflammation ; enzymology ; metabolism ; Intestines ; enzymology ; metabolism ; Plasma ; metabolism ; Rats ; Rats, Wistar ; Shock, Hemorrhagic ; blood ; enzymology ; metabolism ; Trypsin Inhibitors ; administration & dosage ; pharmacology

OBJECTIVETo analyze the risk factors of hemorrhagic cystitis after allogeneic hematopoietic stem cell transplantation for beta-thalassemia in children.

METHODSThe clinical records of 30 children with beta-thalassemia undergoing allogeneic hematopoietic stem cell transplantation between December, 2008 and November, 2009 were analyzed.

RESULTSHemorrhagic cystitis occurred in 8 of the 33 patients with an incidence of 24.24%, including 1 with grade I, 6 with grade II and 1 with grade III hemorrhagic cystitis. The median time of hemorrhagic cystitis onset was 22.9 days (range 6-35 days) and the median duration was 11.9 days(range 3-27 days). Univariate analysis indicated that the different types of transplantation and acute graft-versus-host disease affect the occurrence of hemorrhagic cystitis. The children with Allo-PBSCT had higher incidence than those receiving Allo-PBSCT+Allo-UBT and Allo-BMT (P<0.05). The children at an age >or=6 years had obviously higher incidence of hemorrhagic cystitis than those at younger ages.

CONCLUSIONAge is the major factor that affects the occurrence of hemorrhagic cystitis in children undergoing allogeneic hematopoietic stem cell transplantation for beta-thalassemia.

Age Factors ; Child ; China ; epidemiology ; Cystitis ; epidemiology ; etiology ; Hematopoietic Stem Cell Transplantation ; adverse effects ; Humans ; Incidence ; Risk Factors ; Transplantation, Homologous ; beta-Thalassemia ; therapy

Objective To explore the correlations between monocyte immunodepression andthe levels of C-reactive protein (CRP) and fibrinogen (Fg) in patients with severe acute stroke. MethodsThis prospective study involved 53 consecutive patients admitted in the neurological intensive care unit(NICU) within 24 h after stroke onset. Blood samples were collected serially on days 1, 2, 4, 6 and 14after stroke to determine monocytic HLA-DR expression using flow cytometry. CRP and Fg weredetected on day 2 after the admission, and Graph_Pad PRISM 4.0 software was used to analyze thecorrelations among the variables. Thirty-nine concurrent patients admitted in the general ward, whocomplained dizziness without magnetic resonance imaging evidence of acute stroke, were enrolled toserve as the control group. Results The levels of CRP and Fg in the stroke group were significantlyhigher than those in the control group (P<0.05). The CRP and Fg levels were both found to inverselycorrelate to monocytic HLA-DR expression at different observational points. The correlations of CRP andFg to HLA-DR expression were the most obvious on day 2 and 4 after admission (r=-0.419, P=0.001;r=-0.434, P=0.001), respectively. Conclusion Immunosuppression of the monocytes in patients withsevere acute stroke is probably associated with the inflammatory reaction after stroke.

Using stakeholder involvement analysis to analyze the appeal,position,power and role of stakehold-ers involved in the creation of the no-fault compensation system of medical damage,this paper believes that the gov-ernment,including the health administrative department, is the concrete maker and the important facilitator of the policy implementation,which needs to take advantage of the public power to predominate the creation and trial opera-tion of the system;the medical staffs,patients and their families are the direct beneficiary of the policy,but it is nec-essary to ensure the good operation of the system by establishing diversified financing channels and setting reasonable compensation scope. The judicial appraisal institution and the expert group are the important guarantors of the policy implementation,but the authentication system should be unified and the expert group evaluation mechanism should be introduced. The insurance industry is an important propellant of policy implementation, but it needs to increase its participation by taking measures,such as expanding financing channels. The news media has an important influence on the making and implementation of the policy and should be properly guided to play its positive role.