ObjectiveTo evaluate the applicable value of attitude control system combined with attitude controllable intelligent capsule endoscope for stomach examination.MethodsA total of 15 patients were recruited to the study.Manipulability of movement and posture change of capsule endoscope,diagnostic efficacy for such locations as gastric cavity,bulb and descending duodenum,image quality and patients'compliance were assessed.ResultsThe procedure was completed in 14 patients.One failed due to downfall of the endoscope to duodenum within 5 min. Mean operation time was ( 23.7 ± 6.5 ) min ( from 5 to 30 min).Ten cases of superficial gastritis,one case of superficial gastritis with bile regurgitation and 1 case of ulceration of the duodenal bulb were diagnosed.No abnormalities were found in 3 others.Endoscopic images were of high quality and only a few were influenced by gastrointestinal peristalsis.All patients showed compliance with no discomfort.Capsule endoscopes were discharged within 2 or 3 days.ConclusionAttitude control system combined with attitude controllable intelligent capsule endoscope in stomach examination is feasible and valuable in clinic.

Objective To explore clinical results of arthroscopically assisted treatment for tibial plateau fractures.Methods Thirty-eight cases of tibial plateau fractures were treated under arthoscope.According to the Schatzker classification,there were 8 cases of type Ⅰ, 10 cases of type Ⅱ,11 cases of type Ⅲ,4 cases of type Ⅳ,3 cases of type Ⅴ,and 2 cases of type Ⅵ,respectively.Routine arthoscopic examination of the knee found 15 cases of meniscus injury,12 cases of partial or complete rupture of anterior cruciate ligament(ACL),and 7 cases of medial collateral ligament (MCL) injury.Fracture reduction and fixation was performed under arthroscopic surveillance.The tibia plateau fracture was fixed with the cancellous bone screws(Schatzker Ⅰ~Ⅲ) or minimally invasive plate osteosynthesis(Schatzker Ⅳ~Ⅵ).Results The operation time was 30~72 min(mean,40 min) and the intraoperative blood loss was less than 20 ml.A follow-up was carried out in 36 cases for 4~36 months(mean,15 months).The X-ray findings at the 3 postoperative month showed bone union in all the 36 cases.There were no wound or joint infection,skin necrosis,or delayed union.The Hospital for Special Surgery(HSS) knee scores 3 months after operation revealed excellent results in 28 cases,good in 6 cases,and fair in 2.The main untoward manifestations at this period were lacking of muscle force and limited extension and incurvation of the knee joint.The HSS scores 6 months after operation showed excellent result in 33 cases and good in 3 cases. Conclusions Arthroscopically assisted treatment of tibial plateau fractures has advantages of accurate reduction and fixation and early detection and management of associated intraarticular injuries.Different methods of internal fixation should be chosen according to different types of facture.

[Objective]To investigate the effect of minimally invasive treating proximal humeral fracture with PHILOS plate under acromial anterior lateral deltoid splitting approach.[Method]A retrospective analysis was done on 31 patients treated with minimally invasively with Philos plate under modified approach from April 2005 to March 2009.There were 17 males and 14 females,12 of them were injured in a traffic accident and 19 in daily life,with their ages ranging from 42 to 89 years.According to Neer classification,there were 5 cases of two-part fractures,11 cases of three-part fractures,and 15 cases of four part fractures.[Result]The postoperative radiographs verified good position of all screws,with satisfactory bone fracture reduction.Follow-up for 8-36 months(average 18.8 months) showed no necrosis of head of humerus and injury of axillary nerve and all patients gained bone union,supficial infection occurred in two patients but relieved by care.According to Neer scoring,the excellent to good result rate was 87.1%.[Conclusion]Philos plate for proxima humeral fracture using acromial anterior lateral deltoid splitting approach possesses such advantages as better individuation,less disturbance of the blood supply,stable fixation of the fracture.It is an new method to treat proximal humeral fractures.

BACKGROUND: The extramedulary fixation system including dynamic hip screw (DHS) is commonly used in treatment of Intertrochanteric fracture. However, in patients with unstable intertrochanteric fracture, extramedulary fixation system often leads to the failure of fracture fixation. Intramedulary fixation system including both proximal femoral nail antirotation (PFNA) and InterTan nail has been widely used in the treatment of unstable intertrochanteric fractures. OBJECTIVE:To compare the therapeutic effects of extramedulary fixation system containing DHS, PFNA and InterTan nail in the treatment of intertrochanteric fracture. METHODS:Literatures were searched in Wanfang, PubMed, Embase, Medline, the Cochrane library to screen literatures published from January 1990 to November 2014. Relevant studies addressing extramedulary fixation system containing DHS, PFNA and InterTan nail were screened. RESULTS AND CONCLUSION: 346 articles were screened, and 13 of them were in accordance with the inclusion criteria. 1 271 patients with different types of intertrochanteric fracture were assessed in this study. Compared to DHS group, patients treated with PFNA and InterTan nail had shorter operation time and less blood loss. No significant difference in rehabilitation time and Harris score was detected among three kinds of fixation methods. Additionaly, PFNA and InterTan nail had a similar effect. These findings verify that compared with DHS, PFNA and InterTan nail can optimize the surgery, but cannot elevate postoperative outcomes.

BACKGROUND:It remains controversial in term of efficacy for the lightweight mesh and heavyweight mesh in inguinal hernia repair.
OBJECTIVE:To compare the clinical therapeutic effects of lightweight mesh and heavyweight mesh in open methods of inguinal hernia repair with Meta-analysis.
METHODS:Comprehensive electronic search strategies were developed using the fol owing electronic databases:PubMed, Cochrane Library, EMBASE, Medline, Ovid, CNKI, VIP, Wanfang and FMJS. The Literature published before February 2013 was searched. The randomized control ed trials about comparing lightweight mesh and heavyweight mesh in open methods of inguinal hernia repair were included. A data-extraction sheet was developed based on the preset standards. The data from eligible studies were pooled using RevMan5.1 software through Meta-analysis.
RESULTS AND CONCLUSION:Eighteen trials with a total of 4 450 hernias met the inclusion criteria. The meta-analysis showed that there was a statistical difference between lightweight mesh group and the heavyweight mesh group on short-term pain [odd ratio (OR)=0.57, 95%confidence interval (CI) (0.43, 0.74), P<0.05] and a reduced risk of developing foreign body sensations [OR=0.49, 95%CI (0.35, 0.69), P<0.05]. No significant differences were found between the two groups in recurrence rate, testicular atrophy, seroma, hematoma, wound infection, urine retention (P>0.5). According to limited evidence, there are some findings as fol ows:the lightweight mesh is of feasibility, safety and effectiveness for inguinal hernia repair. Because of the limits of sample and quality, more large-sample and high-quality trials are required to make a definite clinical evidence to use lightweight mesh for inguinal hernia repair.

Objective To study the clinical value of serum SA,EMA and GPDA in the diagnosis of gastric cancer.Methods To detect serum SA,EMA and GPDA in 30 patients with gastric cancer patients,25 patients with gastric precancerous lesions and 35 patients with non-atrophic gastritis with electronic gastroscope and pathological examination confirmed,compared the differences betwwen the groups,and analyze the relationship between the expressions of them and clinical biology of gastric carcinoma.Results The serum concentrations of SA and GPDA in gastric carcinoma are remarkably higher than those in non-atrophic gastritis and gastric precancerous lesions(P0.05).The concentrations of GPDA in non-atrophic gastritis group are age-related(P0.05).Conclusion It has an important reference value for the diagnosis of gastric cancer to detect serum SA and GPDA.SA and GPDA together can improve the accuracy of the diagnosis of gastric cancer.EMA serum possibly has no diagnostic value for gastric cancer.The expressions of SA,GPDA in serum are related to the biology behaviors of gastric carcinoma,and the concentrations of SA,GPDA in serum is helpful in judging metastasis and recrudescence,and monitoring prognosis.

BACKGROUND:Patients with elder hip fracture has more complications, poor affordability and high perioperative risk, so the preoperative ful preparation and evaluation are needed.
OBJECTIVE:To predict the accuracy of the prognosis of elderly patients with hip fracture through comparing the difference between American Society of Anesthesiologists score and Daping orthopedics operation risk scoring system for senile patients.
METHODS:A retrospective study was performed on 300 cases with elderly hip fracture selected from January 2011 to December 2012 from Department of Orthopedics, Gongli Hospital of Pudong. American Society of Anesthesiology score and Daping orthopedics operation risk scoring system for senile patients were conducted before treatment, and the predictive values of two scoring systems on the incidence of complications and mortality were compared.
RESULTS AND CONCLUSION:According to the American Society of Anesthesiology score and Daping orthopedics operation risk scoring system for senile patients, 148 cases and 97 cases had complications respectively. On the contrary, the actual number of complications was 89. The former predicted value was significantly higher than the actual value, and there was no significant difference between the latter forecast value and the actual value. The numbers of death predicted by American Society of Anesthesiology score and Daping orthopedics operation risk scoring system for senile patients were 27 cases and six cases, but the actual number of death was three cases, indicating that former predicted value was significantly higher than the actual value, and there was no significant difference between the latter predicted value and the actual value. The American Society of Anesthesiology score has a certain errors in predicting the postoperative complications and mortality of patients with elderly hip fractures, but it is simple and useful in clinic. The Daping orthopedics operation risk scoring system for senile patients can accurately evaluate elderly hip fracture operation risk, and can predict the postoperative complications and mortality more objective when compared with the American Society of Anesthesiology score.

BACKGROUND:Proximal humeral internal locking system fixation for complex humeral fractures via deltoid splitting approach provides good clinical results, but certain complications stil existed.
OBJECTIVE:To explore the postoperative complications and the related risk factors for displaced three-part and four-part fractures of proximal humerus treated with proximal humeral internal locking system fixation via deltoid-splitting approach, and to propose the corresponding countermeasures.
METHODS:106 cases with displaced three-part and four-part fractures of proximal humerus were retrospectively analyzed. The relationship between postoperative complications and the related risk factors was analyzed with Logistic regression analysis.
RESULTS AND CONCLUSION:A total of 81 patients were fol owed-up for 12 to 30 months. The mean Constant score at 12 months after operation was (76.57±4.70) points. The postoperative complications occurred in 31 patients (38.3%) of which impingement syndrome involved in 16 cases (19.8%), head-shaft angle loss in six cases (7.4%), head-shaft angle loss combined with screws cut-out in two cases (2.5%), pure screws cut-out in two cases (2.5%), humeral head necrosis in two cases (2.5%), fat liquefaction in five cases (6.2%). Single factor analysis showed that there were significant differences in the superiorly located greater tuberosity, superiorly located plate and Neer classification between impingement group and un-impinged group (P<0.05). There were statistical y significant differences in age, postoperative medial cortical defects and Neer classification between head-shaft angle loss group and un-loss group (P<0.05). By means of logistic regression analysis, the superiorly located greater tuberosity, superiorly located plate and Neer classification were the individual predictors for postoperative impingement syndrome;postoperative medial cortical defect and Neer classification were the individual predictors for postoperative head-shaft angle loss.

BACKGROUND:Repair programs of posterolateral tibial plateau fracture included posterior plate screws, lateral plate screw and anterior and posterior lag screw fixation. To choose which fixation methods depends on clinical experiences of physicians. Study results are mainly clinical reports, and lack of mechanical evidence.
OBJECTIVE:To compare biomechanical changes in three fixed manners (lateral plate screw group, posterior plate screw group and anterior and posterior lag screw group) in the repair of posterolateral fracture of tibial plateau from the angle of biomechanics.
METHODS:A total of tibial specimens of six adult male antisepsis corpses (12 samples) were used for measuring bone mineral density of metaphysis. 1/2 posterolateral tibial plateau fracture model was established by electric pendulum saw. The model was randomly divided into three groups:lateral plate screw group, posterior plate screw group and anterior and posterior lag screw group. Finite element method and biomechanics were used to test axial displacement value and the maximal displacement distribution area under the axial loads of 250, 500, and 1 000 N.
RESULTS AND CONCLUSION:There was no significant difference in average bone density in three groups of metaphysis (P>0.05). The minimum axial displacement of the fracture fragments was in the anterior and posterior lag screw group (0.013 521 mm), fol owed by posterior plate screw group (0.016 991 mm), and the maximum was visible in the lateral plate screw group (0.138 200 mm) under 250 N load. Displacement value was similar to the 250 N under 500 and 1 000 N. According to the results of biomechanics, displacement values of anterior and posterior lag screw was obviously less than the lateral plate screw group and posterior plate screw group (P<0.05). There was no significant difference between the lateral plate screw group and posterior plate screw group (P>0.05). The maximal displacement distribution area was proximal tibiofibular joint border zone in two methods. These data indicated that the biomechanical stability was most advantageous in the anterior and posterior lag screw group, and poorest in the lateral plate screw group. In the clinic, anterior and posterior lag screw fixation can be used as a first choice for repair of posterolateral tibial plateau fracture.

Objective To assess the safety and efficacy of hypertonic saline in traumatic hypovolemic shock with Meta-analysis.Methods Comprehensive electronic search strategies were developed using the following electronic databases:PubMed,EMBASE,Medline,Ovid、Clinical Trials,CNKI,Wan Fang,CBM and FMJS.The Literature published before August of 2017 was searched.The randomized controlled trials (RCTs) about hypertonic saline in traumatic hypovolemic shock were included.A data-extraction sheet was developed based on the preset standards.The data from eligible studies were pooled through Meta-analysis.Results 9 trials with a total of 1600 patients (741cases in observation group,859 cases in control group) met the inclusion criteria.The meta-analysis showed that the hypertonic saline group displayed remarkable increase in the systolic blood pressure and decrease in hemoglobin level,compared with the isotonic saline group [MD =6.43,95％ CI(1.16,11.70),P ＜0.05],[MD =-5.99,95％ CI (-9.04,-2.95),P ＜0.05].The level of serum sodium [MD =7.94,95％ CI(7.39,8.50),P ＜0.05],serum chloride [MD =9.67,95 ％ CI(8.77,10.57),P ＜ 0.05] and osmolality [MD =18.11,95％ CI (10.73,25.49),P ＜ 0.05] in the hypertonic saline group was increased significantly but acceptable.No significant difference in mortality was found between the hypertonic saline group and the isotonic saline group [OR =0.88,95％ CI(0.69,1.11),P ＞ 0.05].Conclusions Available evidence shows that small volume hypertonic Sodium Chloride saline is safe and effective for resuscitation in patients with traumatic hemorrhagic shock.Since the quality of the inclued studes were not high,more high-quality,multicenter randomized controlled clinical studies need to provide better evidence for the above conclusion.