BACKGROUND:Intertrochanteric fractures are often treated with extramedulary fixation and intramedulary fixation. Which internal fixation can better repair intertrochanteric fractures remains controversial. OBJECTIVE: To compare the efficacy and safety of dynamic hip plate and proximal femoral intramedulary nail fixation in treatment of intertrochanteric fracture in adults. METHODS: Al randomized clinical trials relevant to comparing proximal femoral intramedulary nail fixation with dynamic hip plate for intertrochanteric fracture in adults from 1966 to 2013 were identified. The quality of the trials was assessed. The outcomes included length of surgery, operative blood loss, postoperative femoral shaft fracture, cut-out of the implant from the femoral head, non-union of the fracture, reoperation rate, wound infection, postoperative hip pain (hip joint pain and thigh pain), which were extracted and reviewed systematicaly. RESULTS AND CONCLUSION:4 757 trial participants with 4 748 fractures were included in the 31 published trials. There was no significant difference in the length of surgery, reoperation rate, cut-out of the implant from the femoral head, non-union of the fracture, wound infection and postoperative hip pain between the two groups (P > 0.05) between dynamic hip plate and proximal femoral intramedulary nail fixation. Compared with dynamic hip plate fixation, proximal femoral intramedulary nail fixation had less blood loss and significantly higher rate of femoral shaft fractures (P=0.003). Experimental findings show that, in treatment of intertrochanteric fracture, intramedulary nail fixation is associated with significantly lower blood loss. However, the risk of femoral shaft fracture is increased compared with dynamic plate fixation. There were no differences in length of surgery, cut-out of the implant from the femoral head, non-union of the fracture, reoperation rate, wound infection and postoperative hip pain. The results of this systematic review should be explained prudently because of some limitations of included trials. To obtain more reliable conclusions, large-scale randomized controled trials of strict design, uniform index and long-term folow-up are needed.

Objective To explore the application value of gastrointestinal reconstruction by continuous jejunum interposition after total gastrectomy.Methods A retrospective analysis in March 2006 to March 2012 was performed in 60 patients with gastric underwent continuous jejunal interposition after total gastrectomy.Results There were no operation death and anastomotic fistula.Follow-up for 12-24 months,some patients had mild reflux esophagitis,generation of gastric capacity of more than 300 ml,emptying time of 30-100 min.The quality of life was improved after operation.Conclusions Continuous jejunal interposition pouch is safe and reliable,with satisfactory effect of digestive tract reconstruction.

Object The process of seed germination and haustorium formation in Cistanche deserticola Y C Ma was observed Methods Seeds were inoculated on culture medium, the process of seed germination and haustorium formation were observed using light and electron microscopy Results The seedling sprouted after two weeks, then a tube like organ formed, finally the apex expanded to attachment organ The outer papillar surface of the extended apex bears wall protuberances that are encircled with a thick cuticular belt and covered with a thin cuticle Conclusion The seed germination of C deserticola is single pole of racidle The attachment organ adheres host first

Objective To evaluate the therapeutic effectiveness of echo-guided percutaneous radiofrequency ablation(RFA) by using a LeVeen needle electrode combination in the treatment of large liver tumor,and to discuss the relationship between the amount as well as the distribution pattern of the electrodes and the therapeutic effectiveness.Methods During the period of Feb.2006-Dec.2008,echo-guided RFA was performed in 113 patients with large and unresectable liver tumor,with a total of 118 lesions.According to the size of the tumor,the patients were divided into four groups.The tumor’s diameter of Group A(n = 64) was 4.0-5.0 cm,Group B(n = 28) was 5.1-6.0 cm,Group C(n = 11) was 6.1-7.0 cm and Group D(n = 10) was 7.1-9.3 cm.Based on the tumor’s diameter,the amount of the electrodes to be used and the sites to be ablated were determined.After the procedure,the follow-up checks with MRI or CT scanning were carried out to observe the necrotic extent and the local recurrence.Results Two months after the treatment,the complete necrosis rate of the tumor in Group A,B,C and D was 88.4%,78.6%,63.6% and 40.0%,respectively,with an overall necrosis rate of 79.7% in total 118 lesions.During a follow-up period of 3-36 months,the local recurrence rate in Group A,B,C and D was 5.5%,10.0%,28.6% and 50.0%,respectively.Severe complications,including intrahepatic infection(n = 2),puncture passage bleeding(n = 1),symptomatic pleural effusion(n = 4) and biloma(n = 2),occurred in 9 cases.No death related to RFA treatment occurred.Conclusion Echo-guided percutaneous radiofrequency ablation by means of multi-sites superimposition method with a LeVeen needle electrode combination is an safe and effective therapy for the hepatic tumors with the diameter over 4 cm.

OBJECTIVE:To compare the effects of total knee arthroplasty performed with and without patellar resurfacing. METHODS:All randomized clinical trials relevant to comparison of total knee arthroplasty performed with and without patellar resurfacing between 1966 and 2008 were collected. The quality of the trials was assessed. The outcomes data including the prevalence of reoperations,postoperative anterior knee pain,patient satisfaction,and the improvement in various knee scores were extracted and reviewed systematically. RESULTS:1 731 knees were included in the 15 published trials,including 842 knees in the resurfaced group and 889 in the nonresurfaced group. During the four years following surgery,there was no significant difference between the resurfaced and the nonresurfaced groups in re-operation rate (relative risk=0.56,95% CI 0.17-1.85); whereas the re-operation rate of the nonresurfaced group was significantly greater than resurfaced group 4 years after surgery (relative risk=0.46,95% CI 0.25-0.84). On the prevalence of postoperative anterior knee pain,there was no significant difference between two groups (relative risk=0.65,95% CI 0.35-1.21). No significant difference was found in patient satisfaction (relative risk=1.00,95% CI 0.95-1.05). There was no significant difference between the resurfaced and the nonresurfaced groups in the KSS scores (weighing mean difference:-0.41; 95% CI:-3.08 to 2.26). CONCLUSION:The long-term rate of reoperations in total knee arthroplasty performed with patellar resurfacing was lower than that without patellar resurfacing. There were no significant differences in the terms of prevalence of postoperative anterior knee pain,patient satisfaction,and the improvement in various knee scores between the resurfaced and the nonresurfaced groups. The results of this systematic review should be explained prudently because of some limitations of included trials. For more reliable conclusions,more trials with high quality on methodology are needed.

CT data regarding PUMCⅡ d2 adolescent idiopathic scoliosis obtained from one female patient were input into modeling software minics 11.11 to obtain medical simulation model.Then finite element analysis models of AIS patients (T1-S) were created by introducing simulation models into software abaqus 6.7.Finite element models of T6 11 segments were corrected by 5 different correction methods:simple concave bracing,simple convex pressurization,concave distraction and convex compression simultaneously,concave distraction prior to convex compression and concave distraction after convex pressurization.Abaqus software was used to simulate correction of scoliosis with vertebral arch pedicle screw by loading 50 N,100 N,and 200 N distraction forces on the concave side pedicles of the end vertebrae T6 and T11.The displacement of vertebrae T6 in Y-axis (sagittal plane) and Z-axis (coronal plane),which respectively represented the correction effects of kyphosis and scoliosis,was compared between prior to and after correction.Simple concave distraction provided better outcomes in terms of displacement of T6 in Z-axis than the remaining four methods (P ＜ 0.01).Concave distraction and convex compression simultaneously,concave distraction prior to convex pressurization and concave distraction after convex compression produced identical displacements of T6 in Y-axis,which were all better than simple concave distraction (P＜ 0.01).The present findings imply that for curative effects of five methods on correction of scoliosis in the coronal plane:simple concave distraction＞ concave distraction and convex compression simultaneously = concave distraction prior to convex compressio= concave distraction after convex compression ＞ simple convex pressurization;for curative effects of five methods on correction of kyphosis in the sagittal plane:simple convex compression ＞ concave distraction and convex compression simultaneously = concave distraction prior to convex compression= concave distraction after convex compression＞ simple concave bracing.Simple concave distraction could not produce obvious corrective effects on kyphosis rather than lead to worsened kyphosis to some extent.Simple convex compression could not produce obvious corrective effects on scoliosis rather than result in aggravated scoliosis to some extent.

Objective To investigate the MRI features of hepatic IgG4?related inflammatory pseudotumor (IPT). Methods Nine patients with 11 histopathologically proven IgG4?related hepatic IPTs were retrospectively analyzed. The clinical, morphological and MRI signal features on T1WI, T2WI, dynamic?enhanced, and diffusion?weighted imaging were assessed in detail and correlated with pathological findings. The paired t test was used to compare the ADC values of the tumors and the hepatic tissue. Results Hepatic IgG4?related IPT displayed certain MRI features. The dominant lesions were subcapsularly distributed (n=7) with a clear boundary (n=8), which typically showed hypointensity on T1WI (n=11), mild hyperintensity on T2WI (n=8), progressive (n=5) or persistent (n=4) enhancement pattern. Accompanied signs included delayed capsule?like enhancement (n=6) and central nonenhanced areas (n=7). Two lesions showed atypical wash?out pattern with iso or hypointensity on portal and delayed phases. In diffusion weighted imaging, all lesions were hyperintense, and the mean ADC value of the lesions [(1.42 ± 0.36) × 10?3mm2/s] was mildly lower than that of surrounding liver [(1.55±0.31)×10?3mm2/s], although no statistical differences were found(t=0.78, P=0.46). Conclusions Hepatic IgG4?related IPTs display various MRI manifestations. The lesions normally show progressive enhancement pattern with diffuse homogeneous or heterogeneous hyperintensity, accompanied by delayed capsule?like enhancement and central nonenhanced areas.

BACKGROUND: Recently, trans-pedicle screw internal fixation has markedly improved the rigidity of spinal fixation and hence the fusion rate. But when placed incorrectly, the pedicle screw can injure the spinal cord and/or nerve roots, resulting in serious complications.OBJECTIVE: To evaluate the application value of preoperative CT scans-based navigation technique in the spinal pedicle screw internal fixation surgery.DESIGN, TINE AND SETTING: A prospective, randomized, and controlled observation was performed at the Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences between January 2006 and December 2008.PARTICIPANTS: A total of 95 patients who underwent pedicle screw internal fixation due to spine diseases were randomly assigned to a navigation group (n = 45) and a conventional group (n = 50).METHODS: In the navigation group, patients were subjected to pedicle screw insertion with the assistance of computer navigation technique and while in the conventional group, patients underwent pedicle screw insertion using the conventional anatomic landmark combined with fluoroscopy.MAIN OUTCOME MEASURES: Screw channel preparation time, excellent and good rate of screw position, and postoperative complications.RESULTS: In the navigation group, totally 206 pedicle screws were inserted under navigation guidance, with an excellent and good rate of 96.1%; and navigation could not be continued in 9 patients for a three-dimensional registration error. In the conventional group, altogether 285 pedicle screws were inserted, and the excellent and good rate was 100%. No significant difference was found between the two groups (P > 0.05). The navigation group exhibited longer screw channel preparation time than the conventional group [(360±22) seconds vs. (56+8) seconds, P < 0.01]. No postoperative complications were found in each group.CONCLUSION: The preoperative CT scans-based navigation technique produces similar accuracy of pedicle screw insertion, but markedly prolonged operation time, compared with the conventional anatomic landmarks, exhibiting limited application value in the spinal pedicle screw internal fixation.

Objective To estimate curative effect of reconstruction of rabbit knee joint cartilage defect with the homogeneitic tissue engineered cartilages.Methods The chondrocytes were isolated and collected from articular cartilages of eight New Zealand white rabbits.The tissue engineered cartilages after culturing chondrocytes and atelocollogen for two days.Cartilage defects were created in both keen joint of twenty-six rab- bits.Complexes of chodrocytes and atelocollagen was grafted into the defect of left knee joint at once as experi- mental group,and no implantation were served as control.General and histological examination were respec- tively performed in both group at four weeks and eight weeks after surgery.Results After implantation,the defects were filled with cartilaginous tissue in experiment group,while there were only tissue in control group. Histologically,defective areas were filled with chondrocytes in experiment group,but only fibroblast in control group.Conclusion The implantation of the tissue engineered cartilages contenting with chondrocytes and atelocollogen can effectively improve reconstruction of rabbit knee joint.

Objective To compare the clinical curative effect of endoscopic retrograde cholangio-pancreatography (ERCP) and percutaneous transhepatic cholangial drainage (PTCD) in treatment of malignant obstructive jaundice. Methods Clinical data of 97 patients with malignant obstructive jaundice were collected and analyzed retrospectively, includs 54 patients in ERCP group and 43 patients in PTCD group. The clinical curative effect, postoperative complications, comfort score and hospitalization time and costs were compared between the two groups. Results The symptoms improved compared with preoperative. The total remission rate of jaundice in ERCP group and PTCD group was 77.78％ vs 79.07％, and the remission rate of high obstructive jaundice was 55.00％, vs 89.29％, and the remission rate of low obstruction jaundice was 91.18％, vs 60.00％.There was significant difference between the two groups (P < 0.05); The incidence of postoperative complications in ERCP group and PTCD group was 37.04％ vs 16.28％. There was significant difference between the two groups (P < 0.05); The comfort scale of ERCP group and PTCD group was (15.13 ± 3.89) points vs (16.60 ± 3.15) points. There was significant difference between the two groups (P < 0.05); The hospitalization time of ERCP group and PTCD group were (8.74 ± 4.94) days vs (11.12 ± 4.82) days, and the hospitalization costs were (22.70 ± 6.30) thousand yuan vs (21.90 ± 3.40) thousand yuan. Conclusion Satisfactory clinical curative effect for patients with malignant obstructive jaundice can be derived from both ERCP and PTCD. The treatment of ERCP has more advantages than PTCD in patients with low obstruction, while PTCD is better than ERCP in patients with high obstruction. But ERCP group is better than PTCD in comfort score and shorter in hospitalization time. There is no obvious difference on hospitalization costs.