Objective To investigate the surgical treatment for ipsilateral fractures of femoral neck and shaft. Methods 26 cases of ipsilateral fractures of femoral neck and shaft treated from January 1996 to December 2002 were retrospectively reviewed. There were 22 males and 4 females, with an average of 28 years (range 17-50 years). The causes of fractures were traffic accident in 17 and fall in 9. The femoral neck fractures were diagnosed in emergency in 16 cases, and delayedly in 10 cases. The delayed time was 3-75 days, with an average of 13.1 days. All cases were divided into three types according to the site of femeral shaft fracture. Type Ⅰ: the proximal 1/3 femoral shaft fracture combined with neck fracture, in 3 cases; Type Ⅱ: the middle 1/3 femoral shaft combined with neck fracture, in 18 cases; Type Ⅲ: the distal 1/3 femoral shaft fracture combined with neck fracture in 5 cases. All cases were undergone surgical reduction and internal fixation. The femoral shaft fractures were stabilized with dynamic compression plate (DCP) in 13, with antegrade intramedullary locking nail in 2 cases, with retrograde intramudullary locking nail in 5 cases. The femoral neck fractures of these 20 patients were stabilized with cannulated lag screw. The femoral neck and shaft were stabilized with dynamic hip screw system (DHS) in 2, with constructive nail in 4. Results All of the patients were followed up for 3 to 9 years, with an average of 4.4 years. The femoral shaft fractures obtained rigid union at the latest follow-up study in 25. The duration for bone union ranged from 16 to 32 weeks, with an average of 20 weeks. The femoral neck fractures were united at the latest follow-up study in 25. The duration for bone union ranged from 12 to 28 weeks, with an average of 16 weeks. The complications included infection in 1, hardware failure in 1, nonunion of femoral neck fracture in 1 and osteonecrosis of femoral head in 1. Conclusion The ipsilateral fracture of femoral neck and shaft is rare, and the neck fracture is easy to miss diagnosis. The surgical treatment for ipsilateral fractures of femoral neck and shaft depends on the position of femoral shaft, and the situation of femoral neck.

Objective To evaluate the application of 3D printing technology in the treatment of displaced acetabular fractures ( DAF ) complicated with unstable injury to the posterior pelvic ring. Meth-ods A retrospective study was conducted of all the 19 DAF patients complicated with unstable posterior pelvic ring who had been treated from August 2009 to June 2015 in our hospital. They were 12 men and 7 women, aged from 24 to 62 years ( average, 39. 8 years ) . Twelve DAFs were complicated with ipsilateral unstable injury to the posterior pelvic ring, 5 with contralateral unstable injury to the posterior pelvic ring, and 2 with bilateral unstable injury to the posterior pelvic ring. Preoperatively, 3D digital models of the pelvis were reconstructed for the 19 patients using their CT scanning data. Their pelvic models were printed using 3 D printing technology for visual evaluation of their fractures and design of individualized surgical proce-dures. Results With the help of their 3D printing models, the 19 patients obtained successful operations within a mean time of 3. 2 hours. Their intraoperative blood loss averaged 658. 5 mL. They were followed up for an average of 10. 7 months ( range, from 8 to 24 months ) . According to Matta′s criteria for pelvic reduc-tion, 14 cases achieved anatomical reduction, 2 satisfactory reduction and 3 unsatisfactory reduction. Ac-cording to Mears's criteria for reduction of the posterior pelvic ring, 13 cases achieved anatomical reduction, 4 satisfactory reduction and 2 unsatisfactory reduction. The 19 acetabular fractures healed after 9 to 18 weeks ( average, 14. 5 weeks ) . The pelvic fractures healed after 8 to 17 weeks ( average, 13. 5 weeks ) . According to the Merle d'Aubigne-Postel criteria at the last follow-ups, the hip functions were excellent in 7, good in 9, fair in one, and poor in 2 cases. According to the Majeed's functional evaluation, the pelvic functions were excellent in 10 cases, good in 7, fair in one, and poor in one. Complications were incision infection in one, heterotopic ossi-fication in 2, avascular necrosis of the femoral head in one and traumatic arthritis in one. Conclusion In thetreatment of DAF complicated with unstable injury to the posterior pelvic ring, application of 3D printing technology can provide direct visualization of the pelvic and acetabular fractures which facilitate preoperative evaluation and design of individualized surgical protocols, leading to fine outcomes.

Objective To investigate the effects of different doses of dexmedetomidine and propofol on electrocorticography (ECoG)during epileptic resection.Methods One hundred cases of epileptic patients undergoing epileptic resection were randomized into five groups (n=20 cases).Af-ter exposure of the cortex,patients were allocated to propofol group or dexmedetomidine group,the propofol were injected intravenously with different target-controlled-infusion (TCI)concentrations at 1.5 μg/ml (group C1),5.0 μg/ml (group C2)respectively.The dexmedetomidine were injected with a loading dose of 0.5 μg/kg within 1 5 min,then followed by a speed of 0.25 μg·kg-1 ·h-1 (group D1 ),0.5 μg·kg-1 ·h-1 (group D2),and 1.0 μg·kg-1 ·h-1 (group D3)respectively.After 1 5 min of steady infusion,the characteristics of ECoG were recorded.Results Compared with the other four groups,the epileptic spike-wave,αandβwaves were significantly decreased,whileδwave was significantly increased in group C2 (P < 0.05 ).Sometimes burst-suppression-patterns were recorded under propofol. With the dose of dexemedetomidine increasing in groups D1,D2,D3,the epileptic spike-wave,αwave andβwave gradually decreased,while δwave gradually increased (P <0.05).Conclusion Propofol produces dose-dependent inhibition on ECoG,but the epileptic spike-wave still can be differentiated if the plasma con-centration lower than 1.5 μg/ml.Compared with propofol,dexmedetomidine injected with 0.25-0.5 μg· kg-1 ·h-1 ,has few disturbance on epileptic spike-wave differentiation and location during ECoG monito-ring,and is more eligible for epileptic resection anesthesia.

Objective To investigate the clinical characteristics, treatment and prognostic factors of postoperative recurrent-metastatic gastrointestinal stromal tumors (GIST). Methods The clinical data of 56 patients with postoperative recurrent-metastatic GIST between January 1997 and December 2007 were analyzed retrospectively , and the prognostic factors were evalutated. Results Initial recurrence-metastasis was diagnosed after a median of 17.3 months from primary resection. Of the 56 cases, 19 cases received resection, 8 cases received imatinib targeted therapy,14 cases were treated by imatinib targeted therapy and surgery, the 3 year survival rates were 65% ,66% ,89% respectively. The rate of recurrence-metastasis after reoperation is 76%. Univariate analysis revealed that surgery, targeted therapy and age were related to the survival rates, multivariate analysis demonstrated that surgery and targeted therapy were the independent prognostic factors for survival. Conclusions For recurrent-metastatic GIST, a multimodal approach including surgery and targeted therapy improves survival.

Objective:To analyze the feasibility, safety and clinical efficacy of laparoscopic side-to-side jejunoileal anastomosis in the treatment of non-obese type 2 diabetes patients (BMI≤32.5 kg/m 2). Methods:The clinical data of 135 patients who underwent laparoscopic side-to-side jejunoileal anastomosis at our hospital from Jan 2018 to Oct 2018 were retrospectively analyzed. They were followed up for 12 months until the end of Oct 2019. SPSS software was used to compare patients′ fasting blood glucose, glycosylated hemoglobin, c-peptide, insulin, body weight, BMI with the values after 12 months of the surgery, and then evaluate factors affecting the prognosis.Results:135 patients successfully completed laparoscopic side-to-side jejunoileal anastomosis without conversion to open surgery. After 12 months of the operation, the patients′ fasting blood glucose was (5.80±0.18)mmol/L, glycosylated hemoglobin was 5.9%±0.4%, fasting c-peptide was(1.32±0.21) nmol/L, and fasting insulin was (42±54) mU/L ( t=10.654, 12.657, 11.214, 10.698, all P<0.05). The body weight was (72.4±9.9)kg, BMI was( 25.6±2.8)kg/m 2, and the difference was not statistically significant ( t=7.658, 6.958, P>0.05). In patients with preoperative glycosylated hemoglobin controlled below 8% and the duration of T2DM less than 10 years, the chances being cured was better than that of those with glycosylated hemoglobin>8% and the medical history >10 years. Conclusion:Laparoscopic side-to-side jejunoileal anastomosis in the treatment of non-obese type 2 diabetes is effective, safe and reliable.

Renal cancer with multiple differentiation and multiple components is rare in clinic. It has the character of high malignancy, early metastasis, and poor prognosis. A patient with multiple differentiated renal cell carcinoma was diagnosed in our hospital mainly because of emaciation, fatigue and loss of appetite. CT scan showed the 6.5 cm×6.0 cm mass in the lower pole of right kidney with unequal enhancement and necrosis. The chest CT scan showed multiple enlarged lymph nodes in the mediastinum and right superior clavicle. The patient accepted the laparoscopic retroperitoneal right nephrectomy and right supraclavicular lymph node biopsy. Postoperative pathology showed multiple differentiated renal cell carcinoma with localized sarcomatoid leisions, including clear cell carcinoma, collecting duct-like carcinoma and medullary carcinoma combined with right supraclavicular lymph node metastasis. Targeted therapy was performed at 1 month after surgery. Liver and lung metastasis occured at 6 months and the patient died of multi-organ failure at 12 months after surgery.