OBJECTIVETo perform a meta-analysis on clinical outcomes of minimally invasive percutaneous plate osteosynthesis (MIPPO) or open reduction and internal fixation (ORIF) for distal tibial fractures in adults.

METHODSPubmed database (from 1968 to March 2014), Cochrane library and CNKI database (from 1998 to March 2014) were searched. Case-control study on minimally invasive percutaneous plate osteosynthesis (MIPPO) or open reduction and internal fixation (ORIF) for distal tibial fractures in adults were chosen,and postoperative infection, operative time, blood loss, fracture nonunion rate, delayed union,fracture malunion rate were seen as evaluation index for meta analysis. The system review was performed using the method recommended by the Cochrane Collaboration.

RESULTSTotally 5 studies (366 patients) were enrolled. Meta-analysis showed that there were significant meaning in postoperative infection between MIPPO and ORIF [OR = 0.23,95% CI (0.06,0.92), P = 0.04]; fracture nonunion rate in MIPPO was lower than in ORIF group [OR = 0.16, 95% CI (0.03,0.76), P = 0.02]; operative time in MIPPO was shorter than in ORIF group, and had significant difference [MD = -14.42, 95% CI (-27.79, -1.05), P < 0.05]; blood loss in MIPPO was less than in ORIF group [MD= -87.17,95%CI (-99.20, -75.15), P < 0.05]; there was no obviously meaning in delayed union between two groups.

CONCLUSIONFor distal tibial fractures in adults, MIPPO has, advantages of short operative time, less blood loss, lower incidence of infection and fracture non-uniom, but with high fracture malunion rate. MIPPO for distal tibial fractures in adults is better than ORIF, and the best treatment should choose according to patient's condition.

Bone Plates ; Fracture Fixation, Internal ; methods ; Fracture Healing ; Humans ; Minimally Invasive Surgical Procedures ; methods ; Operative Time ; Tibial Fractures ; surgery

OBJECTIVETo investigate the effects of the novel proteasome subunit Adrm1 knockdown by RNA interference on proliferation of colorectal cancer cells.

METHODSThe shRNA eukaryotic expression vector against Adrm1 was constructed and transfected into colon cancer RKO cells. The Adrm1-shRNA stable transfected clones were selected. Experimental cells were divided into 3 groups: the experimental group containing stable Adrm1-shRNA transfected cells, the control group containing only RKO colon cancer cells and stable empty vector transfected control group. The Adrm1 protein expression level was analyzed by Western blot. The colony-forming ability of the three groups was assessed by soft agar assay. The cell proliferation and apoptosis were analyzed by methyl thiazolyl tetrazolium (MTT) method and in situ end labeling (TUNEL) assay. Cell cycle changes were assayed by flow cytometry.

RESULTSAdrm1-shRNA effectively suppressed Adrm1 expression in the experimental group. Silencing of Adrm1 in RKO cells significantly inhibited their anchorage-independent growth, only occasional individual colonies were formed. The apoptosis rate of experimental group was (12.4 +/- 1.1)%, significantly higher than that of the stable empty vector transfected control group. The proportion of G(0)/G(1) and S/G(2) phase cells in the experimental group was (41.2 +/- 1.1)% and (58.8 +/- 1.1)%, respectively. The cells were arrested at G(1) phase. In addition, Adrm1 RNA interference combined with 5-Fu treatment significantly suppressed colorectal cancer cell growth in vitro.

CONCLUSIONSilencing of Adrm1 by RNA interference can significantly suppress proliferation of RKO cells through inducing apoptosis and arresting the cell cycle. The combined application of Adrm1 RNA interference and chemotherapy may become as a novel therapeutic strategy for Adrm1 overexpressed colorectal cancer.

Antimetabolites, Antineoplastic ; pharmacology ; Apoptosis ; Cell Cycle ; Cell Line, Tumor ; Cell Proliferation ; Colorectal Neoplasms ; metabolism ; pathology ; Drug Resistance, Neoplasm ; Fluorouracil ; pharmacology ; Genetic Vectors ; Humans ; Membrane Glycoproteins ; genetics ; metabolism ; Plasmids ; RNA Interference ; RNA, Small Interfering ; genetics ; Transfection

OBJECTIVETo investigate the correlation between the proteasome subunit PSMA7 expression in colorectal cancer and its role in liver metastasis.

METHODSTo identify the PSMA7 protein expression in 62 primary site colorectal cancers, 34 lymph node metastatic sites and 13 liver metastatic sites by immunohistochemistry and clarify the correlation of its expression with the clinicopathological parameters.

RESULTSHigh expression of PSMA7 was detected in 38.7% (24/62) of primary site colorectal cancer, 52.9% (18/34) of lymph node metastatic sites and 100% (13/13) liver metastatic sites but not in the normal colorectal tissue. High expression of PSMA7 was significantly correlated with liver metastasis (P = 0.028). The survival rate was significantly lower in patients with high expression of PSMA7 than in those with low expression of PSMA7 (P = 0.0008). As well, in multivariate analysis, PSMA7 expression demonstrated to be an independent prognostic factor (P = 0.004, relative risk 5.057; 95% confidence interval, 1.682-15.201).

CONCLUSIONPSMA7 may play an important role in the colorectal cancer progression. Evaluation of PSMA7 expression in primary colorectal cancer at the time of surgery might be a valuable test in defining patients with a high risk of developing liver metastasis.

Adult ; Aged ; Colonic Neoplasms ; enzymology ; pathology ; surgery ; Female ; Follow-Up Studies ; Gene Expression Regulation, Neoplastic ; Humans ; Liver Neoplasms ; enzymology ; secondary ; Lymphatic Metastasis ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasm Staging ; Proteasome Endopeptidase Complex ; metabolism ; Rectal Neoplasms ; enzymology ; pathology ; surgery ; Survival Rate ; Young Adult

OBJECTIVETo review the clinical experience of muscle-sparing thoracotomy in intrathoracic surgery.

METHODSThoracotomy was performed in 386 patients from 1998 to 2002, during the procedure lateral-transverse incision, free dissection of muscular flap and entering to the thoracic cavity through certain intercostal space were applied. Two sets of rib retractors were used to ensure the excellent field exposure.

RESULTSIntrathoracic surgery was carried out by this method with the advantage of excellent surgical field exposure, less pain and relative quick recovery.

CONCLUSIONMuscle-sparing thoracotomy has the merits of less injury and the same good exposure as routine thoracotomy and it can be carried out in majority of chest surgery.

Adolescent ; Adult ; Aged ; Child ; Female ; Humans ; Lung Neoplasms ; surgery ; Male ; Middle Aged ; Pectoralis Muscles ; surgery ; Pneumonectomy ; Postoperative Complications ; prevention & control ; Thoracic Surgical Procedures ; methods ; Thoracotomy ; methods

Objectives: To compare the changes in effectiveness of cross-institutional collaboration before and after intervention and non-intervention from medical personnel in order to empirically support promoting cross-institu-tional communication, coordination and cooperation modes for chronic diseases services. Methods: The typical sam-pling and multistage random sampling were used to conduct a questionnaire survey among medical personnel at villa-ges, townships and county levels. The Propensity ( Tendency) Scores were used to match the samples of the baseline and the following year of intervention, and the results were statistically analyzed. Results: After one-year of interven-tion, the county-level hospital doctors manifested higher participation while the sense of identity in work decreased;township medical personnel offered patient-centered provision of chronic disease services at higher level, but they re-ceived limited benefits from training attendance; and village medical institutions benefited a lot from the improved health care services and improved the clinic capability from cross-institutional collaboration on chronic diseases serv-ices. Suggestions: At the level of cross-institutional collaboration model policy development, attention should be paid on the work needs of county-level hospital doctors. It is also necessary to improve incentive mechanism and to work out definite and clear procedures and standards of promotion, establish a sound cross-institutional training mechanism and put knowledge into practice thereby encouraging individual development. For ultimate stand-straight, the roles and responsibilities of multi-level institutions in cross-institutional cooperation should be explored from the perspective of continuous chronic disease services.

BACKGROUNDMagnetic targeting therapy may be a new method for the treatment of malignent tumors. The purpose of this study was to investigate the localization and distribution of ferrofluid microsphere of human serum albumin methotrexate (FM-HSA-MTX) carriers in the brain and to explore the magnetic targeting chemotherapy for malignant brain tumor.

METHODSNinety SD rats were divided into three groups: targeting group, non-magnetic targeting group, and control group. Synthesized FM-HSA-MTX carriers (MTX 25 mg/kg) were injected into the systemic circulation via the caudal vein (magnetic targeting group, n = 30). A 0.6 T magnetic field was placed around the right hemisphere. The non-magnetic targeting group (n = 30) was administered with FM-HSA-MTX without external magnetic field, meanwhile the control group (n = 30) was treated with MTX and a magnetic field. Random serial sacrifices (n = 10) were conducted at 15, 30 and 45 minutes after drug administration. Bilateral hemispheres were collected respectively, and analyzed for total MTX content.

RESULTSMTX content in the right hemisphere of the magnetic targeting group was significantly higher than that in the other two groups at 15, 30 and 45 minutes after drug administration (P < 0.05) No difference was seen between the non-targeting group and control group. In the magnetic targeting group, MTX returned to the peak level [(0.564 +/- 0.018) mg/g, q15-45 = 32.252, P < 0.05] 45 minutes after the injection but it deceased in the other two groups [non-magnetic targeting group: (0.060 +/- 0.015) mg/g, q15-45 = 9.245, P < 0.05, control group: (0.074 +/- 0.045) mg/g, q15-45 = 6.299, P < 0.05]. In the magnetic targeting group, the concentration of MTX in the right hemisphere was significantly higher than that in the left hemisphere (t45min = 21.135, P = 0.000) but no difference was observed between bilateral hemispheres in the other two groups (non-magnetic targeting group: t45min = 0.434, P = 0.670; control group: t45min = 0.533, P = 0.600).

CONCLUSIONIn the presence of the external magnetic field, FM-HSA-MTX can distribute successfully in the targeting areas of the brain.

Animals ; Antineoplastic Agents ; administration & dosage ; Brain ; metabolism ; Drug Carriers ; Magnetics ; Methotrexate ; administration & dosage ; pharmacokinetics ; Microspheres ; Rats ; Rats, Sprague-Dawley ; Serum Albumin ; administration & dosage ; pharmacokinetics

OBJECTIVETo review the experience for the management of hepatocellular carcinoma with tumor thrombus in inferior vena cava.

METHODSFrom July 2003 to May 2005, hepatectomy combined with thrombectomy were performed on 7 cases of hepatocellular carcinoma with tumor thrombus in inferior vena cava. In order to remove the tumor thrombus in inferior vena cava, total hepatic vascular exclusion were adopted on all cases to control the blood flow of IVC. According to the position of extension of tumor thrombus, 5 different procedures were adopted in the cases to control the suprahepatic IVC and extract the tumor thrombus out of IVC and atrium. Procedure 1: Median sternotomy, extracorporeal bypass, cardiac arrest, incision on right atrium and IVC were performed on 1 case for thrombectomy. Procedure 2: Median sternotomy, extracorporeal bypass without cardiac arrest, incision on IVC and (or without) incision on right atrium were performed on 2 cases for thrombectomy. Procedure 3: Abdominal approach to control intrapericardial IVC through an incision on diaphragm was performed on 1 case for thrombectomy. Procedure 4: Abdominal approach to control suprahepatic IVC above diaphragm through a small incision made on vena cava foramen for thrombectomy was performed on 1 case. Procedure 5: Abdominal approaches to control suprahepatic IVC below diaphragm for thrombectomy were performed on 2 cases.

RESULTSAll operations were successfully performed. The postoperative complications included pleural effusion in 1 case, subphrenic fluid collection in 1 case and wound infection in 1 case. The average survival time of 7 cases was 9.8 month. The longest survival time was 26 months.

CONCLUSIONHepatectomy and thrombectomy can be safely performed on the case of HCC combined with tumor thrombus in IVC. Surgical treatment can relieve the patient from the risk of sudden death caused by heart failure and pulmonary.

Adult ; Aged ; Carcinoma, Hepatocellular ; pathology ; surgery ; Embolectomy ; methods ; Female ; Follow-Up Studies ; Humans ; Liver Neoplasms ; pathology ; surgery ; Male ; Middle Aged ; Neoplastic Cells, Circulating ; Vena Cava, Inferior ; pathology

BACKGROUNDLesions at coronary bifurcations always are a big challenge for interventionists even with the advent of drug eluting stents (DES). Even as more clinical trials are published, operators still can not confirm that one strategy is more efficient than another. Selection of patients and short term follow-up contribute to the difficulty in comparing strategies.

METHODSFrom April 2004 to April 2008, 505 consecutive Chinese patients underwent DES implantation for true bifurcation lesions; including 258 using crush strategy (213 male, (56.7 +/- 10.8) years old) and 247 using no crush strategy (206 male, (58.1 +/- 10.1) years old) were analyzed.

RESULTSThe follow-up period ranged from 237 to 1223 days, average (537 +/- 340) days for the crush group and (538 +/- 351) days for the no crush group. There was no significant difference of major adverse cardiac events (MACE) rate between the two groups (10.1% vs 12.1%; P = 0.481), nor in cardiac death, nonfatal myocardial infarction (MI) or in the target vessel revascularization (TVR) (0.4% vs 1.6%; P = 0.207, 2.7% vs 2.8; P = 1.000 and 7.0% vs 7.7%; P = 0.865). The stent thrombosis rate was similar in the two groups (1.6% vs 2.0%; P = 0.409), late and very late stent thrombosis in both groups were very low (0.4% vs 0.4%; P = 1.000). Seven-month angiographic follow-up showed no significant difference of the restenosis rate between the two groups (11.0% vs 13.5%; P = 0.786). During the follow-up, cardiac death, nonfatal MI, TVR and ST free survival rate showed no significant difference between the two groups. The only variant identified as a predictor of MACE was percutaneous coronary intervention (PCI) in the first two years, which accounted for 47% of patients of all cases in four years.

CONCLUSIONCrush technique showed similar long-term clinical effect compared with other two DES techniques for coronary bifurcation lesions, the surgeons' skills are very important for reducing clinical events.

Aged ; Angioplasty, Balloon, Coronary ; adverse effects ; methods ; Coronary Angiography ; Coronary Artery Disease ; mortality ; pathology ; therapy ; Coronary Vessels ; pathology ; Drug-Eluting Stents ; adverse effects ; Female ; Humans ; Male ; Middle Aged ; Survival Analysis ; Treatment Outcome

BACKGROUNDDrug-eluting stents (DES) have revolutionized the field of interventional cardiology by dramatically improving clinical and angiographic outcomes. Patients with diabetes mellitus (DM) are associated with an increased risk of adverse clinical outcomes after a percutaneous coronary intervention (PCI). Available information on the efficacy and safety of DES and bare metal stent (BMS) in diabetic patients remains scarce.

METHODSFrom April 2004 to October 2006, 1565 patients with diabetes, who successfully underwent elective stenting at Fu Wai Hospital in Beijing, China, were enrolled in this study. All enrolled patients were assigned to a drug eluting stent group and a bare metal stent group. We obtained follow-up data: death, myocardial infarction (MI), thrombus, target lesion revascularization (TLR), and target vessel revascularization (TVR) at 30 days and 12 and 24 months, as defined by the Academic Research Consortium (ARC). We calculated and compared all the unadjusted cumulative frequencies of the various adverse events in the two groups. Cox's proportional-hazards models adjusted with the propensity score were used to assess the relative risks of all the outcome measures at 24 months.

RESULTSAt 24 months, all ARC defined stent thrombosis in the two groups were similar; at 30 days, a more definite thrombosis was found in the BES group (0.08% vs 0.81%, P = 0.016). Patients treated with DES showed a significant lower risk of TLR (3.88% vs 10.89%; hazard ratio (HR) 0.159 (95% CI: 0.151-0.444), P < 0.001), TVR (5.48% vs 11.69%; HR 0.383 (95% CI: 0.232-0.633), P < 0.001), and any revascularization (12.47% vs 18.55%; HR 0.555 (95% CI: 0.370-0.831), P = 0.0004) at 24 months. No significant difference was apparent in terms of all-cause mortality, MI, and all-cause mortality/MI.

CONCLUSIONSIn contemporary society's large, diabetic population, the use of DES is associated with long-term significant reductions in the risks of TLR, TVR, and any revascularization. There is no significant difference in all-cause mortality, MI, and thrombosis between DES and BMS in the patients with diabetes at 24-month follow-up.

Aged ; Angioplasty, Balloon, Coronary ; adverse effects ; methods ; Coronary Disease ; therapy ; Diabetes Complications ; therapy ; Drug-Eluting Stents ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Treatment Outcome

BACKGROUNDSurgical aortic valve replacement is the standard treatment for patients with severe aortic stenosis, but some registries have indicated that 30% to 60% of these patients are not treated surgically, usually due to advanced age and/or comorbidities. This single center study in China investigated the current treatment status in the patients with severe aortic stenosis and evaluated the long term clinical outcome in advanced age patients whether or not undergoing aortic valve replacement.

METHODSClinical data of 867 consecutive patients with severe aortic stenosis between January 2000 and December 2006 were retrospectively analyzed. The patients ≥ 65 years old were followed up by telephone or information from medical records. The primary end-point was all-cause mortality.

RESULTSThe patients' average age was (52 ± 19) years (range, 1 - 91 years), and 34% were women. The percentages of the patients aged < 15 years, between 15 and 34 years, between 35 and 54 years, between 55 and 64 years, between 65 and 74 years, and ≥ 75 years who underwent surgical aortic valve replacement were 82.3%, 87.2%, 88.8%, 78.2%, 65.3% and 22.2% respectively. In the patients (n = 256) ≥ 65 years old, 43.4% had New York Heart Association class III and IV symptoms, 39.1% had hypertension, 33.2% had coronary heart disease, and 3.1% had stroke. In the patients not undergoing aortic valve replacement, 1.6% had renal insufficiency, 4.7% had chronic obstructive pulmonary disease, 2.0% had critical hematopathy, and 0.4% had mammary cancer. A total of 186 (72.7%) patients finished the follow-up, and the average duration of the follow-up was (60 ± 26) months. In the patients between 65 and 74 years old, the total deaths and cardiac deaths in the patients undergoing aortic valve replacement decreased significantly compared with those with conservative treatment (10.3% vs. 53.7%, P < 0.001 and 6.3% vs. 50.7%, P < 0.001). Similarly, in the patients ≥ 75 years old, there was a significant difference between patients who had surgery and those who had conservative treatment in the total deaths and cardiac deaths (21.4% vs. 63.3%, P = 0.007 and 14.3% vs. 46.9%, P = 0.033). The total deaths in the patients aged between 65 and 74 years were significantly fewer compared with = 75 years old patients (25.4% vs. 54.0%, P < 0.001). Cox regression revealed that aortic valve replacement was the only independent predictor of mortality (HR 0.183; 95% CI, 0.101 - 0.332, P < 0.001).

CONCLUSIONSThis single centre study showed that surgical aortic valve replacement was still the standard treatment for the patients with severe aortic stenosis and had a satisfying prognosis. However, the high risk patients with advanced age and comorbidities usually selected conservative treatment and had an unfavorable prognosis.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Aortic Valve Stenosis ; surgery ; Child ; Child, Preschool ; China ; Female ; Heart Valve Prosthesis Implantation ; adverse effects ; Humans ; Infant ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Young Adult