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

Adult ; Aged ; Angioplasty, Balloon, Coronary ; Diabetes Complications ; etiology ; Female ; Humans ; Male ; Middle Aged ; Stents ; Treatment Outcome

BACKGROUNDPatients with multivessel coronary artery disease and depressed left ventricular ejection fraction (LVEF) represent a high risk group of patients for coronary revascularization. There are limited data on percutaneous coronary intervention treatment in this population.

METHODSAmong a cohort of 4335 patients with three-vessel disease with or without left main disease undergoing percutaneous coronary intervention, 191 patients had LVEF < 40% (low ejection fraction (EF)) and 4144 patients had LVEF ≥ 40%. In-hospital and long-term outcomes were examined according to LVEF.

RESULTSThe estimated two-year rates of major adverse cardiac events, cardiac death, and myocardial infarction were significantly higher in the low EF group (19.64% vs. 8.73%, Log-rank test: P < 0.01; 10.30% vs. 1.33%, Log-rank test: P < 0.01, and 10.32% vs. 2.28%, Log-rank test: P < 0.01 respectively), but there was no difference in the rates of target vessel revascularization (6.18% vs. 6.11%, Log-rank test: P = 0.96). Using the Cox proportional hazard models, LVEF < 40% was a significant risk factor for cardiac death, myocardial infarction, and major adverse cardiac events (OR (95%CI): 4.779 (2.369 - 9.637), 2.673 (1.353 - 5.282), and 1.827 (1.187 - 2.813) respectively), but was not a statistically significant risk factor for target vessel revascularization (OR (95%CI): 1.094 (0.558 - 2.147)).

CONCLUSIONAmong patients undergoing percutaneous coronary intervention for multivessel coronary artery disease, left ventricular dysfunction remains associated with further risk of cardiac death in-hospital and during long-term follow-up.

Aged ; Angioplasty, Balloon, Coronary ; Coronary Disease ; physiopathology ; therapy ; Female ; Humans ; Male ; Middle Aged ; Ventricular Function, Left ; physiology

OBJECTIVETo compare the procedural and in-hospital outcomes in a large series of diabetic and non-diabetic patients undergoing selective percutaneous coronary intervention (PCI) and to evaluate the influence of diabetes mellitus on the procedural and in-hospital outcomes.

METHODS1294 consecutive patients underwent selective PCI from January to December 2002 in this institution were analyzed retrospectively. Baseline clinical, in-lab and in-hospital outcome information were recorded. Rates of procedural success, device success and clinical success were analyzed and logistic regression was performed to model the association between diabetes status and outcomes.

RESULTSTwo hundred and sixty-nine patients (20.8%) complicated with diabetes. Type C lesion, double and triple vessel diseases were more prevalent in diabetics than those in non-diabetics. The pre-PCI diameter stenosis of diabetics was significantly more severe than that of non-diabetics (91.00 +/- 6.62 vs 89.81 +/- 6.64, P < 0.01). The balloon length, maximum balloon diameter and maximum balloon inflation pressure, maximum inflation duration were larger in diabetics than those in non-diabetics [(17.07 +/- 6.31) mm vs (16.07 +/- 7.28) mm, (2.30 +/- 1.11) mm vs (2.12 +/- 0.94) mm, (9.86 +/- 4.40) atm vs (9.05 +/- 4.75) atm, (20.94 +/- 14.69) s vs (18.26 +/- 14.65) s, respectively, P < 0.05]. The stent diameter was smaller in diabetics than that in non-diabetics [(3.15 +/- 0.47) mm vs (3.23 +/- 0.43) mm, P < 0.05]. The procedural success rate showed no significant difference between two groups (89.6% vs 90.3%, P > 0.05). But a higher incidence of acute/subacute stent thrombosis was observed in diabetics compared with that in non-diabetics (1.9% vs 0.5%, P < 0.05). The rate of clinical success was similar between diabetics and non-diabetics (99.3% vs 99.2%, P > 0.05). Diabetes was not an independent predictor of acute outcomes in the regression model.

CONCLUSIONSA higher incidence of acute/subacute stent thrombosis was observed in diabetics. The incidence of procedural and in-hospital major adverse cardiac events and the rate of clinical success were similar between diabetics and non-diabetics. Diabetes was not an independent predictor of in-hospital outcomes after selective PCI.

Aged ; Angioplasty, Balloon, Coronary ; Coronary Stenosis ; complications ; therapy ; Diabetes Mellitus, Type 2 ; complications ; Drug-Eluting Stents ; Female ; Humans ; Length of Stay ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome