BACKGROUND:Osteoporosis-induced unstable intertrochanteric fracture has a high failure rate and incidence of complications, and treatment is stil controversial. OBJECTIVE:To compare the clinical effects of proximal femoral nail anti-rotation and modified proximal femoral nail anti-rotation II for treating intertrochanteric fractures in the elderly. METHODS: Data of 26 patients with intertrochanteric fracture who were treated with surgery in the Department of Orthopedic Surgery, Pingguo County People’s Hospital were retrospectively analyzed. Of them, 13 cases received proximal femoral nail anti-rotation, and 13 cases received modified proximal femoral nail anti-rotation II. RESULTS AND CONCLUSION:The patients in both groups were folowed-up for 12 months, no drop out. Hip function restored perfectly after implantation in both groups. No significant difference in Harris score and fracture healing time was detected between the two groups. The incidence of pain in the lower limbs was lower in the proximal femoral nail anti-rotation II group than in the proximal femoral nail anti-rotation group (P < 0.05). Results verified that the therapeutic effect of modified proximal femoral nail anti-rotation II was better than proximal femoral nail anti-rotation, and it is safe and reliable.

AIM: To observe the efficacy, feasibility and safety of endovascular stent-grafts in treating aortic dissection.METHODS: Six patients with aortic dissecting aneurysm (3 males and 3 females, aged 32-67 years, average of 50 years old) were selected from Department of Cardiology, First Affiliated Hospital of Gannan Medical College between March 2005 and March 2006. They were diagnosed by transthoracic magnetic resonance imaging (MRI) and aortic angiography, and as type Ⅲ aortic dissecting aneurysm according to Debakey typing. The tumor diameter was ranged from 3.2 to 4.3 cm. The informed consent was obtained from all patients. Two weeks after the onset, the blood pressure was control between 90-110 and 60-70 mm Hg and heart rate at 60-65 times/min, then the straight circular and bifurcated stents, the product of Yuhengjia Company, composed of single naked membrane, straight circular and bifurcated stents made of nickel-titanium memory alloy, and cover of domestic artificial blood vessel were implanted with the patients generally anesthetized. The aortic dissection and general condition of patients after operation were observed with angiography, and the patient recovery condition was examined by spiral CT at postoperative months 3 and 12.RESULTS: All 6 cases were involved in the result analysis.①The diameters of stents for the patients were appropriate. The angiography showed that the thoracic aortic dissection in 4 cases disappeared, and thrombogenesis was found in false lumen; the thoracic aortic dissections in 2 cases disappeared, however, a little contrast agent was found in false lumen, but the blood flow was very slow. The general condition of all patients was good with stable vital signs, all patients discharged after 7-10 days.②CT results at 3 month after operation suggested that the original false lumen significantly contracted, and the true lumen restored to normal level. In case 3, there was mural thrombus in the distal stent that connected with stent vessel wall, and the thrombus hyperplasia was not obvious during follow up. At 12 months after operation, there was no distinct alteration in the stent location and appearance, and the life quality of patients was significantly improved.CONCLUSION: Endovascular stent-grafts are effective and safe in treating aortic dissection.

The effect of 17?-estradiol ( 17?-E2 ) on expression of estrogen receptor ?( ER?) was observed in cultured MC63 cells and human osteoblast-like (HOB) cells. The results show that the expression of ER* is in a dose-dependent manner with 17p-E2 (0-1?10-6 mol/L) in MC63 cells and has an optimal 17?-E2 concentration (1?10-8 mol/L) in HOB cells resulting in maximum expression of ERp protein.

Daxx is found in the nucleus where it localizes to PML oncogenic domains (PODs). Its multiple domains can interact proteins involved in transcriptional regulation and apoptotic signal transduction. In addition, Daxx is associated with viral infection、tumorigenesis and embryonic development.

Objectives To investigate the relationship between the insertion and deletion (I/D) polymorphism of human angiotensin converting enzyme (ACE) gene and the vascular complications in type 2 diabetes. Methods The I/D polymorphism of ACE gene was detected by polymerase chain reaction in 120 type 2 diabetic patients and 100 healthy controls. Results The frequency of DD genotype was significantly higher, while frequency of II genotype was lower in diabetic nephropathy patients (DN) than those in control group. The frequency of ID genotype was significantly higher, while frequency of II genotype was lower in type 2 diabetic patients with coronary heart disease (CHD), when compared to those without CHD. The frequencies of ACE genotypes in patients with diabetic retinopathy (DR) or hypertension (HP) were not different from those in control group and non-DR or non- HP patients. Conclusions ① There were relationships between the I/D polymorphism of ACE gene and DN and CHD in type 2 diabetes. ② The DD genotype and D allele of ACE gene might be as markers in predisposing DN, while II genotype and I allele as protective factors for DN in diabetes. The ID genotype might be as a marker in predisposing CHD, while II genotype as a protective factor for CHD in diabetes.③ There was no relationship between I/D polymorphism of ACE gene and HP or DR in diabetes in Guangxi region.

Objective To investigate the application effect of pelvic rocking with balloon bionic midwifery in head dystocia. Methods Prospective research method was selected, and 400 pregnant women with head dystocia were divided into 2 groups by random digits table method with 200 cases each. The observation group was given pelvic rocking with balloon bionic midwifery delivery, and the control group was given gauge and comfortable posture with manual rotation fetal head delivery. The labor stage and delivery outcome were observed in two groups. Results The rate of successfully correct the fetal position was 91.00%(182/200) in observation group and 65.00%(130/200) in control group,and there was significant difference between 2 groups, χ2=39.394,P<0.01. The cesarean section rate was 7.00%(14/200) in observation group and 27.00%(54/200) in control group,and there was significant difference between 2 groups, χ2=113.119,P<0.01. The first, second and total labor stage were (8.86 ±2.20), (0.72 ±0.52), (9.78 ±2.82) h in observation group and (12.60±2.10), (1.02±0.82), (13.83±3.01) h in control group, and there were significant differences between 2 groups, t=15.684,4.058,12.609, P<0.01. The incidence of episiotomy, perineal laceration of Ⅱ degree, fetal distress, neonatal asphyxia and postpartum hemorrhage were 17.20%(32/186), 6.45%(12/186), 1.00%(2/200), 0, (150.80 ±43.54) ml in observation group, and 42.47%(62/146), 41.48%(61/146), 9.00%(18/200), 3.00%(6/200), (254.60±83.50) ml, and there were significant differences between 2 groups, P <0.01 or 0.05. Conclusions Pelvic rocking with balloon bionic midwifery can effectively correct the fetal position, reduce head dystocia and cesarean section rate, shorten the first labor stage, the second labor stage, reduce the occurrence of complication of mother and infant.

Objective To observe the impact of the diverse caloric energy intake on the outcomes and occurrence rate of complications in septic patients.Methods A prospective single-blind randomized controlled trial was conducted.158 cases of septic patients in intensive care unit (ICU) were enrolled and randomly assigned to three groups according to their different target value of nutrition:group A [measurements of resting energy expenditure (MREE)＜90％],B (MREE 90％-110％) and C (MREE ＞ 110％).The caloric intake,mechanical ventilation duration (MVD),nosocomial infection rate,28-day and 60-day mortality were analyzed.Results Daily energy intake in 7 days after ICU admission was as follows:the difference in target value of nutrition(kJ/d:7 075.0 ± 1 046.5,5 667.8 ± 1 908.8,4 428.8 ± 1 377.8),calory intake (kJ/d:4 671.6 ± 1 205.6,5 655.3 ± 1 373.0,6 053.0 ± 1 557.2),enteral nutrition value (kJ/d:2 051.1 ± 1 046.5,3 980.9 ± 1 586.5,5 337.1 ±2 921.8) and average intake rate [(66.0 ± 15.8)％,(100.0 ± 5.7)％,(134.0 ± 19.7)％],and they were statistically significant difference among A,B,C groups (all P＜0.05).The parenteral nutrition in group C were much higher than that in group A and group B (kJ/d:2 055.3 ± 273.4vs.427.0 ± 273.4,473.0 ± 332.0,both P＜0.05).The calories provided by glucose and diprivan were similar among three groups.The MVD and ICU stay were shorter in group B than that in groups A and C [MVD (days):8.4 ± 6.3 vs.11.0 ± 8.2,17.8 ± 13.0,P＞ 0.05 and P＜ 0.05 ; ICU stay (days):11.0 ± 6.4 vs.14.9 ± 9.6,17.8 ± 13.0,respectively,P＞0.05 and P＜0.05].The total hospital stay (days:32.0 ± 22.5,26.8 ± 7.0,30.4 ± 21.4) and nosocomial infection rate [91.1％ (51/56),84.0％ (42/50),90.4％ (47/52)] were similar among A,B,C groups (all P＞0.05).There was no difference in survival rate at 28 days among three groups as shown by the Kaplan-Meier survival curve (F=3.145,P=0.076).The survival rate at 60 days showed a tendency of lowering in groups A and C,especially in group C (F=9.284,P=0.010).Conclusion Both higher and lower caloric energy intake may be associated with an adverse impact,but appropriate caloric intake would improve the outcome and reduce the complication rate in septic patients.

Objective To explore the clinical curative effect of micro anchor combined Kirschner wire for treatment of mallet finger.Methods Fifteen patients with mallet finger were treated with operation therapy of micro anchor combined with Kirschner wire fixation,postoperative the distal interphalangeal joint dorsiflexion,proximal interphalangeal joint flexion splint fixation for 4 weeks,pulling Kirschner wire 6 weeks later,and active and passive functional exercise of distal interphalangeal joint.Results Fifteen patients incisions healed well,with no complications.Fifteen patients were followed up for 6-12 months.At last follow-up,9 cases were excellent,5 cases were good,and 1 case was poor.Conclusion The micro anchor combined with Kirschner wire for treatment of mallet finger is simple and effective.

Objective To investigate the effect of Mepilex on pressure sores in patients at lateral position after craniocerebral surgery.Methods Toally 60 patients lying at lateral position after craniocerebral surgery were randomized into two groups in equal number with random digit table:the control group and experiment group.In the control group,Gel pad was used to prevent and treat the pressure sores and in the experiment group Mepilex was used between the compressed skin and operation table before setting the position.The skin conditions of the two groups were observed after operation.Result The prophylactic effect of pressure sore in the experiment group was significantly better than that in the control group (P＜0.05).Conclusion Mepilex can prevent the skin pressure sores in the patients at lateral position after cerebral surgery.

Objective To evaluate the value of GeneXpert MTB/RIF assay in the clinical diagnosis of tuberculosis and tuberculosis associated rifampin resistance. Methods A total of 851 patients admitted to the Guangxi Longtan Hospital from September 22, 2015 to May 25, 2016 were enrolled. The smear microscopic examination, solid culture test, and GeneXpert MTB/RIF assay was performed on each patient. Drug sensitivity test of rifampicin using proportion method was done on patients infected with mycobacterium tuberculosis isolated by solid culture, and rifampicin resistance detection was performed on GeneXpert MTB/RIF positive patients. Bacteriological positive consistency test was performed on GeneXpert MTB/RIF and solid culture, and rifampicin resistance detection was compared bwtween GeneXpert MTB/RIF and drug sensitivity using proportion method. Culture and drug susceptibility testing were used as the gold standard, and the MTB sensitivity and specificity of smear microscopic examination, solid culture, and GeneXpert MTB/RIF assay was compared. Results Culture was used as the gold standard. Compared with culture, the sensitivity, specificity, positive predictive value, and negative predictive value of GeneXpert MTB/RIF was 95.48%(211/241), 94.91%(559/569), 87.55%(211/241), and 98.24%(559/569) respectively. The sensitivity of Xpert MTB/RIF for culture positive smear positive specimens and culture positive smear negative specimens was 98.78% (162/164) and 85.96%(49/57) respectively. Drug susceptibility testing was used as the gold standard. Compared with drug susceptibility testing, the sensitivity, specificity, positive predictive value, and negative predictive value of rifampin resistance measured by GeneXpert MTB/RIF was 98.70%(152/154), 92.98%(53/57), 97.44%(152/156) and 96.36%(53/55) respectively. The consistency rate of GeneXpert MTB/RIF and solid culture was 93.83% (Kappa = 0.847), and that of GeneXpert MTB/RIF rifampin resistance detection and proportion method for drug sensitivity was 96.38% (Kappa = 0.904). Conclusions The GeneXpert MTB/RIF detection is easily operated with high sensitivity and specificity compared with smear microscopic examination and solid culture, and it also possesses good consistency with solid culture and traditional drug sensitivity. Moreover, it could also be applied to diagnose the resistance to rifampin, which is very promising in application.