ObjectiveTo compare the outcomes and indications between exchange nailing (EN) and augmentation plating (AP) with a nail left in situ for femoral shaft hypertrophic nonunion after femoral nailing. MethodsFrom April 1998 to June 2009, 20 patients with femoral shaft hypertrophic nonunions after femoral nailing were treated with EN (11 patients) and AP (9 patients) respectively. There were no significant differences between the two groups with respect to the patient's age, gender, associated injuries, anatomical location and type of femoral fracture. Patients were evaluated by imaging and clinical function at 1, 2, 3, 4,6, and 12 months after surgery, and then every year postoperatively, to observe the callus and the recovery condition of the affected limb function. Fisher exact test and t'-test were performed to compare the outcome and complications respectively. ResultsAn unpaired t'-test showed no significant differences with respect to follow-up time, operating time, intraoperative blood loss, postoperative drainage, length of stay, time to radiographic union, time to clinical union, and AAOS score between the two groups. The cost of hospitalizations in the EN group was higher than in the AP group(t'=16.4, P=0.013). Four nonunions in the EN group failed to achieve union, which 3 patients were subsequently treated with AP and simultaneous autogenous bone grafting and 1 patient was treated with nail dynamization. All 9 hypertrophic nonunions in the AP group obtained osseous union. Fisher exact test showed a higher nonunion rate of EN compared with AP (χ2=6.01 ,P=0.008). ConclusionEN has been an excellent choice for aseptic isthmal femoral nonunion without a large bone defect subsequent to intramedullary fracture fixation, and AP can be an effective solution in cases of nonisthmal femoral nonunion and bone defect and failed exchange nailing.

Objective To investigate the operative indications and operation techniques for augmentative plate fixation in treatment of femoral shaft atrophic nonunions subsequent to intramedullary fixation. Methods Twelve femoral nonunions after internal fixation with intramedullary nailing were treated with augmentative plate internal fixation and bone graft from June 1999 to June 2008. All femoral nonunions were caused by insecure fixation of the intramedullary nailing, in which a rotational instability of the fracture site was verified in all the patients during operation. Minimally invasive removal of the granulation tissue at fracture site and the sclerotic bone was dccorticated. The adequate lilac bone was tiled longitudinally on the nonunion gap and the cortical bone bed. The fixation involved the limited-contact dynamic titanium plate with 5-6 holes, 3.0 mm Kirschner wire and 4-6 double cortex cortical screw fixation.Protective weight-bearing was given after surgery and the tunction was evaluated at 1,3, 6 and 12 months with imaging. Results All patients were followed up for 7-26 months ( average 17.4 months), which showed radiological solid union (7-12 months, average 9.4 months) and clinical union (5-9 months, average 7.1 months ). The operation lasted for 50-120 minutes ( average 77.5 minutes), with blood volume of 150-350 ml ( average 252 ml). There were nine patients with bone pain, of whom the pain was relieved within one month in seven patients and three months in two. No infection, hardware loosening or breaking were found. Conclusion The plate augmentation and cancellous bone grafting leaving the nail in situ can be an effective solution for nonisthmal femoral nonunion, bone defect and failed exchange nailing.

OBJECTIVE:To investigate the role of clinical pharmacists on drug therapy for a chemotherapy patient with drug-induced liver injury (DILI).METHODS:Clinical pharmacists participated in the therapy for a patient with colorectal cancer and suggested that ondansetron+metoclopramide+promethazine were given before chemotherapy for stopping vomiting because chemotherapy drugs might lead to gastrointestinal reaction.The patient suffered from DILI before second chemotherapy.According to the history of drug use and the characteristics of drug effects,clinical pharmacists estimated that DILI may be related to Chinese patent medicine (Guben yichang tablets) and TCM formula granules taken during the two chemotherapy periods.Clinical pharmacists recommended Polyene phosphatidylcholine injection 465 mg,ivgtt,qd+Reduced glutathione for injection 1 g,ivgtt,qd for protecting liver tissue,and additionally recommended Compound glycyrrhizin injection 60 mL,ivgtt,qd for inhibiting inflammation and regulating immune function.After liver function of the patient had been recovered,it was suggested to stop polyene phosphatidylcholine,reduced glutathione and compound glycyrrhizin,etc.Pharmaceutical care was also provided,including efficacy evaluation,ADR monitoring,medication education,telephone follow-up,etc.RESULTS:The physicians adopted the suggestions of clinical pharmacists.The liver function indexes of the patient recovered to normal,and then completed chemotherapy smoothly for 3 times.CONCLUSIONS:When tumor patients suffer from DILI during chemotherapy,clinical pharmacists should help physicians fmd and judge the drug factors leading to DILI based on the history of drug use and the characteristics of drug effects,and assist physicians to formulate and adjust medication plan so as to relieve the degree of DILI and guarantee the smooth development of chemotherapy.

OBJECTIVE: To determine the clinical characteristics and cognitive dysfunction of bipolar depression and unipolar depression. METHODS: Fifty patients with unipolar depression, 48 bipolar depression, and 50 normal controls were assessed with Hamilton Depression Scale, Hamilton Anxiety Scale, Life Events Scale, and The Wisconsin Card Sorting Test. General demographic data, clinical data, and the scores of recognitive function in the 3 groups were compared. RESULTS: The patients with bipolar depression occured at young age and had obvious family history compared with those with unipolar depression. The patients with bipolar or unipolar disorders had lower scores in most neuropsychological tests than those in the control group (P<0.05). The patients with bipolar depression in understanding memory and Wisconsin card sorting test were worse than those with unipolar depression (P<0.05). CONCLUSION There is cognitive dysfunction in patients with bipolar or unipolar disorder. Understanding memory and executive function damage may be cognitive features in bipolar disorder.
Adolescent ; Adult ; Bipolar Disorder ; complications ; diagnosis ; physiopathology ; China ; Cognition ; physiology ; Cognition Disorders ; complications ; physiopathology ; Depressive Disorder ; complications ; diagnosis ; physiopathology ; Female ; Humans ; Male ; Neuropsychological Tests ; Young Adult

Objective:To investigate the clinical effect of minimally invasive plate osteosynthesis (MIPO) through anterolateral approach in treatment of middle-distal humeral shaft fracture.Methods:A retrospective case series study was conducted to analyze the clinical data of 21 patients with middle-distal humeral shaft fracture admitted to 7th Medical Center of Chinese PLA General Hospital from August 2015 to March 2018, including 12 males and 9 females, aged 18-68 years [(31.3±3.6)years]. All were closed fracture. According to AO classification, the fracture were classified as type A in 6 patients, type B in 10 and type C in 5. All patients were treated with anterolateral minimally invasive plate fixation. The operation time, intraoperative blood loss and hospital stay were recorded. The fracture healing was observed after operation. The visual analogue scale (VAS), University of California at Los Angeles (UCLA) shoulder rating scale, and Mayo elbow performance score (MEPS) were used to evaluate the effectiveness before operation and at 2 weeks, 3 months and 12 months after operation.Results:All patients were followed up for 12-26 months [(18.2±2.4)months]. The operation time was 50-82 minutes [(68.2±19.4)minutes], with intraoperative blood loss of 40-95 ml [(60.2±21.3)ml]. The hospital stay was 6-16 days [(6.8±1.2)days]. There was no iatrogenic vascular or nerve injury during operation. The patients with radial nerve injury before operation were all adventitia contusion. The nerve function returned to normal within 3 months after operation. All fractures were healed within 5-10 months [(5.3±1.2)months]. At 2 weeks, 3 months and 12 months after operation, the VAS [(3.6±0.8)points, (2.1±0.4)points, (1.8±0.3)points] was lower than that before operation [(8.3±1.6)points] ( P<0.05); UCLA shoulder rating scale [(31.2±1.5)points, (33.6±0.8)points, (34.6±0.5)points] was higher than that before operation [(28.4±2.3)points] ( P<0.05); and MEPS [(80.2±3.4)points, (93.4±2.2)points, (96.4±3.5)points] was higher than that before operation [(60.5±4.5)points] ( P<0.05). At the last follow-up, the UCLA shoulder rating scale and MEPS showed excellent results. Conclusion:For middle and lower humeral shaft fracture especially for the fracture line relatively distal to the shaft, MIPO technique through anterolateral approach can attain satisfactory results in terms of pain, range of motion of shoulder and elbow joint, and joint function.

Objective:To investigate the prognosis of hip fracture in elderly patients with dementia.Methods:From January 2012 to December 2017, 91 dementia patients aged (82.7±6.6)y (21 males and 70 females) with hip fracture were enrolled in the study; 91 non-dementia patients matched by age, gender and fracture type were selected as controls. There were 54 cases of intertrochanteric fracture and 37 cases of femoral neck fracture. The length of hospital stay, mortality within 30 days and 1 year, walking ability and risk of reoperation were compared between the two groups. The effect of dementia on the mortality after surgery was analyzed by adjusting confounding factors through multivariate logistic regression analysis.Results:There was no significant difference in the length of hospital stay between dementia group and non-dementia group [(13.95±7.33) vs.(12.63±8.68)d, t=1.12, P=0.266]. The incidence rate of perioperative complications in dementia group was higher than that in non-dementia group [63.7%(58/91) vs. 23.1%(21/91), χ 2 = 44.59, P<0.001]. The incidence of delirium in dementia group was higher than that in non-dementia group [35.3%(42/91) vs.13.2%(12/91), χ 2 = 5.71, P=0.017]. The incidence of pulmonary infection in dementia group was higher than that in non-dementia group [11.0%(10/91) vs. 2.2%(2/91), χ 2= 11.989, P<0.001]. There was no significant difference in 30-day fatality rate [7.7%(7/91) vs. 1.1%(1/91), χ 2= 3.27, P=0.071] between two groups; while the 1-year fatality rate in dementia group was higher than that in non-dementia group [27.5%(25/91) vs. 14.3%(13/91), χ 2= 4.79, P=0.029]. After adjusting for the differences of confounding factors between the two groups, dementia was an independent risk factor for 1-year mortality after hip fracture surgery ( OR = 1.852, 95 %CI:1.048-3.043, P= 0.022). For walking ability of 1 year after operation, 22 (33.3%) patients in dementia group walked independently, 38 (57.6%) patients partially walked independently, 6 (9.1%) patients were in bed; while in non-dementia group, 45 (57.7%) patients walked independently, 27 (34.6%) patients partially walked independently, 6 (7.7%) patients were in bed; there was significant difference between the two groups (χ 2= 8.82, P=0.012). There was no significant difference in reoperation rate between two groups [6.6%(6/91) vs. 5.5%(5/91), χ2=0.10, P=0.756]. Conclusion:Compared to non-dementia patients, dementia patients with hip fracture have poorer prognosis, higher incidence of perioperative complications, pulmonary infection and delirium, higher risk of mortality 1 year after operation, and poorer ability of independent walking.

OBJECTIVE: To determine the long-term effect and security of refractory schizophrenia with brain stereotaxis multi-target therapy technique. METHODS: A total of 87 patients with refractory schizophrenia were treated with brain stereotaxis multi-target therapy and were followed up over 2 years. The scores of Clinical Global Impression, Brief Psychiatric Rating Scale, Positive and Negative Symptom Scale, Wechsler Adult Intelligence Scale, Wechsler Memory Scale, Actives of Daily Living, and Social Disability Screening Schedule were compared before and after the operation. RESULTS: Of the 87 patients, 40 obviously improved, 24 improved, 12 improved little, 7 did not change. None grew worse, 1 died, and 3 shed. There was a significant difference in the scales before and after the operation (P<0.01). No severe complications and sequelae occurred. CONCLUSION Stereotaxic multi-target therapy is effective and safe for refractory schizophrenia. After the operation, drug therapy should be maintained and recovery of social function is helpful.
Adult ; Brain ; surgery ; Brief Psychiatric Rating Scale ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Psychiatric Status Rating Scales ; Schizophrenia ; surgery ; Stereotaxic Techniques ; Young Adult

Objective:To compare the failure risks between restricted and unrestricted cephalomedullary nail sliding during InterTAN intramedullary nail fixation for intertrochanteric fractures in the elderly patients.Methods:A retrospective study was conducted to analyze the data of 192 elderly patients with intertrochanteric fracture who had been admitted to Department of Orthopaedics, The Seventh Medical Center, General Hospital of the People's Liberation Army from January 2021 to December 2022. The patients were divided into 2 groups based on whether the set screws were tightened or not during surgery. In the observation group of 78 cases, there were 31 males and 47 females with an age of (80.2±7.7) years, and 23 cases of type 31-A1 and 55 cases of type 31-A2 by the AO classification. Their set screws were not tightened during surgery to allow the cephalomedullary nail sliding. In the control group of 114 cases, there were 40 males and 74 females with an age of (81.6±7.8) years, and 42 cases of type 31-A1 and 72 cases of type 31-A2. Their set screws were tightened during surgery to restrict the cephalomedullary nail sliding. The incidence of postoperative fixation complications and sliding distances of the cephalomedullary nail within 1 year after surgery were compared between the 2 groups in the total fractures and in the stable and unstable fractures as well.Results:There was no statistically significant difference in the preoperative general data between the 2 groups of patients, indicating comparability ( P>0.05). The incidence of fixation complications within 1 year after surgery was 5.1% (4/78) for the observation group and 12.3% (14/114) for the control group, showing no statistically significant difference between the 2 groups ( P>0.05). The sliding distance of the cephalomedullary nail in the observation group [7.05 (6.00, 8.25) mm] was significantly larger than that in the control group [5.65 (3.55, 7.00) mm] ( P<0.05). For stable fractures, the incidence of fixation complications within 1 year after surgery was 7.1% (2/28) for the observation group and 7.0% (3/43) for the control group, showing no statistically significant difference ( P>0.05), and the sliding distance of the cephalomedullary nail in the observation group [6.00 (5.25, 7.00) mm] was significantly greater than that in the control group [3.05 (2.00, 5.00) mm] ( P<0.05). For unstable fractures, the incidence of fixation complications within 1 year after surgery for the observation group patients [4.0% (2/50)] was significantly lower than that for the control group patients [15.5% (11/71)], and the sliding distance of the cephalomedullary nail in the observation group [8.00 (6.70, 10.00) mm] was significantly greater than that in the control group [6.00 (4.87, 7.57) mm] ( P<0.05). Conclusions:In the InterTAN intramedullary nail fixation for intertrochanteric fractures in the elderly patients, tightening of set screws is crucial because it not only increases the stability but also limits compression at the fracture site. It is recommended not to tighten the set screws for unstable fractures, but further observation is needed before it can be determined whether the set screws should be tightened or not for stable fractures.

OBJECTIVE: To compare the effect of 7 antipsychotic drugs on the life quality of schizophrenia patients including chlorpromazine, sulpiride, clozapine, risperidone, olanzapine, quetiapine, and aripiprazole. METHODS: A total of 1,227 stable schizophrenic patients within 5 years onset who took 1 of the 7 study medications as maintenance treatment were followed up for 1 year at 10 China sites. Patients were evaluated by the short form-36 health survey (SF-36) at the baseline and at the end of 1 year. RESULTS: The life quality was improved obviously at the end of the follow-up. There was significant difference in body pain, vitality, and mental health (P<0.05) among these antipsychotic drugs. CONCLUSION All 7 antipsychotic drugs can improve the life quality of schizophrenia patients. Atypical antipsychotic drugs, especially olazapine and quetiapine, are superior to typical antipsychotic drugs in improving life quality.
Adolescent ; Adult ; Antipsychotic Agents ; therapeutic use ; Benzodiazepines ; therapeutic use ; Dibenzothiazepines ; therapeutic use ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Olanzapine ; Quality of Life ; Quetiapine Fumarate ; Schizophrenia ; drug therapy ; Surveys and Questionnaires ; Young Adult

OBJECTIVE: To investigate the role of N-methyl-D-aspartate receptor(NMDAR)/cyclic adenosine monophosphate(cAMP)/protein kinase A(PKA) signaling pathways in regulating 2-chloroethanol-induced aquaporin-4(AQP4) expression in astrocytes(AS). METHODS: i) AS in logarithmic growth phase were treated with 2-chloroethanol at the doses of 0.0, 7.5, 15.0 and 30.0 mmol/L for 12 hours, and the cells were collected for detection. ii) The AS in logarithmic growth phase were divided into blank control group, inhibitor control group, 2-chloroethanol group, and inhibitor intervention group. The inhibitor included dizocilpine(MK-801) and N-(2-[p-bromocinnamylamino-]ethyl)-5-isoquinolinesulfonamide(H89). The blank control group did not receive any treatment. The inhibitor control group was treated with a concentration of 10.0 μmmol/L MK-801 or 15.0 μmmol/L H89. The MK-801 intervention group was pretreated with MK-801 at a concentration of 10.0 μmmol/L for 30 minutes. The H89 intervention group was pretreated with H89 at a concentration of 15.0 μmmol/L for 1 hour. After the intervention, the AS in 2-chloroethanol group and MK-801, H89 intervention group were stimulated with 2-chloroethanol at a dose of 30.0 mmol/L for 12 hours. iii) The AS in each group were collected and used for Western blotting and real-time fluorescence quantitative polymerase chain reaction analysis to detect the protein and mRNA expression of AQP4, NMDAR receptor main subunit(NR1), NMDAR receptor 2 B subunit(NR2 B) and calmodulin dependent protein kinaseⅡ(CaMKⅡ). The Western blotting was adopted to detect the expression of phosphorylase-CaMKⅡ(p-CaMKⅡ) and PKA. Colorimetric method was used to detect the concentration of calcium(Ca~(2+)) in AS. The enzyme-linked adsorption test was used to measure adenylate cyclase(AC) activity and cAMP levels. RESULTS: i) The relative expression of protein and mRNA of AQP4, NR1 and NR2 B, PKA at protein level and CaMKⅡ at mRNA level, and the ratio of p-CaMKⅡ/CaMKⅡ protein, the concentration of Ca~(2+), AC activity and cAMP level in 30.0 mmol/L group were higher then those of 0.0 mmol/L group in AS(P<0.05). The relative protein expression of PKA and the concentration of Ca~(2+) increased with the increase of 2-chloroethanol(P<0.05). ii) The relative protein expression of AQP4 and the concentration of Ca~(2+) in the 2-chloroethanol group were higher than that of the blank control group and MK-801 control group(P<0.05). The relative protein expression of AQP4 and the concentration of Ca~(2+) in MK-801 intervention group were lower than that in 2-chloroethanol group(P<0.05). The relative protein expression of AQP4 and PKA in 2-chloroethanol group were higher than that of the blank control group and H89 control group(P<0.05). The relative protein expression of AQP4 and PKA in H89 intervention group was lower than that in 2-chloroethanol group(P<0.05). CONCLUSION: The 2-chloroethanol timulation induces the expression of AQP4 by activating NMDAR/cAMP/PKA signaling pathway in AS.