BACKGROUND:No international reports had shown that statins were effective for the treatment of vascular cognitive impairment. However, Chinese studies concerning effects of statins on vascular dementia had a smal sample size, so no definite conclusion was obtained.
OBJECTIVE:To perform a meta-analysis on effects of statins on vascular cognitive impairment, the methods recommended by the Cochrane Col aboration were used.
METHODS:The databases such as China National Knowledge Internet, Wanfang, VIP, Chinese Biological and Medical Database and PubMed Medline were searched by computer and manual y for randomized control ed trials about the effect of statins on vascular cognitive impairment. Retrieval time was from foundation to January 2013. The studies were screened according to the inclusion and exclusion criteria and then the data were extracted. The methodological quality of included studies was assessed and meta-analysis was performed by Revman 5 software.
RESULTS AND CONCLUSION:This study final y included 15 randomized control ed trials, a total of 1 203 patients, including 616 in statins group and 587 in control group. The fixed and random effect models were used to analyze mini-mental state examination and activity of daily living scales including 14 scoring method and the Barthel index score. Compared with the control group, mini-mental state examination scores in the patients of statins group (14 randomized control trials, 1 112 patients) were, mean difference (MD)=3.02, 95%confidence interval (CI):2.26 to 3.77, P<0.000 1;activity of daily living scores (14 scoring method, 7 randomized control ed trials, 513 patients) were, MD=-4.14, 95%CI:-6.11 to-2.18, P<0.000 1;the Barthel index scores (2 randomized control ed trials, 171 patients) were, MD=11.62, 95%CI:9.78 to 13.46, P<0.001. Our study mentioned a total of 14 cases of adverse reactions. One case was in control group, and the other 13 cases were in statins group which were al caused by atorvastatin. There were no serious adverse reactions in statins group and the rate of adverse reactions was 2.1%. The current evidence suggested that statins can improve cognitive function in patients with vascular cognitive impairment, with good safety. However, further conclusion stil requests higher quality of randomized control ed trials.

Objective To discuss the techniques of tumor resection, pelvic reconstruction and postoperative management by reviewing the patients with malignant pelvic tumors in recent years. Methods 76 patients with primary malignant pelvic tumors were treated operatively between July 1997 and July 2003. The series comprised 47 males and 29 females. 31 cases were diagnosed as chondrosarcoma, 15 as Ewing sarcoma, 7 as osteosarcoma, 3 as lymphoma, 3 as malignant fibrohistiocytoma (MFH), 1 as hemangiopericytoma, 2 as myeloma, 13 as giant cell tumor(GCT). According to Enneking's division, the most common region of the primary pelvic tumor involved was region Ⅱ (51 cases), followed by region Ⅰ (16 cases) and region Ⅲ (9 cases). 16 cases were reconstructed with threaded pins and cement after resection of the ilium. 9 patients had local resection of pubis and ischium. 21 patients had hemipelvectomy. Among 30 patients with periacetabular tumors, 8 were reconstructed with hemipelvic prosthesis, 7 with saddle prosthesis, 6 with replantation of cauterized tumor bone and total hip arthroplasty, 9 with cemented total hip replacement after curettage of lesion. Results After 16 months to 6 years follow-up, among the 21 patients with hemipelvectomy, 4 patients had local relapse because the sacrum invaded by the tumors. 7 of 25 patients with lesions in regionⅠ or region Ⅲ had local relapse postoperatively due to the marginal incision to the acetabula. Among the 21 patients who had tumor resection and reconstruction in region Ⅱ, 4 had local relapse, 3 of which reconstructed with cauterized hemipelvis. As for functional recovery, all of the 25 patients with lesions in region Ⅰand region Ⅲcould walk postoperatively without assistance of a cane. 21 patients with acetabular reconstruction after resection of lesions in region Ⅱ could sit and stand normally and walked with a cane, some of them even had normal gait. Conclusion The major principle of treatment for primary pelvic tumor is that en bloc resection, only then the functional reconstruction of pelvic ring can be considered. Operators should be acquainted with advantages and shortcomings of different reconstructive methods of acetabulum to prevent the complications.

[Objective]To observe the clinical results of percutaneous vertebroplasty in the treatment of painful osteoporotic thoracolumbar vertebral body compression fractures in old people.[Method]Six cases of PVP and 2 cases of kyphoplasty were performed with polymethylmethacrylate(PMMA) through unipedicular or bipedicular under C-arm fluoroscopy.[Result]No leakage of PMMA was found in the operation,the pain was clearly relieved or disappeared postoperatively,no severe complication occurred.[Conclusion]PVP is safe,effective and enconomical in the treatment of painful osteoporotic thoracolumbar vertebral body compression fracture.

Objective:To explore the clinical value of chest multi-slice computed tomography angiography (MSCTA) as a preoper-ative examination for lung cancer patients undergoing pulmonary lobectomy. Methods: Sixty lung cancer patients formed the study population and were randomly divided into 2 groups of 30 cases each. In the experimental group, CTA images of the tumors and pulmo-nary artery, bronchial artery, pulmonary vein were acquired, analyzed, and post-processed using VR to determine the anatomical rela-tionship between vessels and tumors. Pulmonary lobectomy followed. Cases in the control group underwent pulmonary lobectomy with-out guidance by chest MSCTA. Operation times and amounts of operative blood loss were compared between the two groups. Results:Significant differences between groups in terms of operation time (study group vs. control group, 199±55.7 vs. 231.5±51.2(min);P=0.02) and amount of operative blood loss (study group vs. control group, 318.33±99.6 vs. 431.7±89.5(mL), P<0.01) were observed. Val-ues of operation time and amount of contrast agents in the study group were consistently lower than those in the control group. Conclu-sion:Chest MSCTA can shorten the operation time and reduce the amount of operative blood loss during pulmonary lobectomy. Thus, the technique has significant clinical value.

Objective To evaluate perioperative nutritional support for patients with acute abdomen in enhanced recovery after surgery (ERAS) programme.Methods A total of 490 patients with acute abdominal disease were collected,287 in ERAS group and 203 in conservative perioperative management (CPM) group.Biochemical and clinical markers of the 2 groups were compared.Results ERAS group had higher plasma albumin level,quicker bowel function recovery,lower postoperative complications,shorter hospital stay,and a lower WHO pain rating scale (all P ＜ 0.05).Conclusion With perioperative nutritional support,ERAS programme can accelerate recovery after emergency surgery,reduce the rate of overall complications,promote bowel function recovery,and decrease morbidity in the perioperative period for patients with acute abdominal disease.

The clinical features of 120 severe cases with hand-foot-mouth disease (HFMD) were retrospectively analyzed compared with those of the regular cases. Clinical data showed that the age of mostsevere cases ranged from 1-3 years. Sustained high fever ( 55% ) , hypertension ( 40% ) , fewer rash (73.3%) were important clinical features. Lethargy, somnolence or restlessness (70. 8% ), vomiting (30. 8% ) were early signs of central nervous system ( CNS) ; and the CNS involvement in severe cases was characterized by body trembling or muscle spasm (80% ). High white cell count(75. 8% ) and high blood glucose levels(32. 5% ) were important makers to diagnose the severe HFMD at early stage. There were significant differences in presentation of above features between severe cases and regular cases of HFMD ( P < 0. 01 or P < 0. 05 ) . Early treatment with mannitol, gamma globulin and glucocorticoids were effective, no death was reported and no side effects were found in this case series.

Objective To evaluate the application of flexible thoracoscopy in the diagnosis of pleural effusion.Methods Thoracoscopy was performed in 20 pleural effusion patients in our hospital from May to December 2007.Biopsies were performed in 16 patients,not in the other 4 patients since difinite diagnosis had been reached before thoracoscopy.Results Rate of accurate diagnosis via thoracoscopy was 93.75%(15/16).Results Of biopsy were as follows:adenocarcinoma 8 cases,squamous carcinoma 1 case,adenosquamous carcinoma 1 case,malignant pleural effusion 1 case,tuberculous pleuritis 4 cases,malignant mesothelioma 3 cases,chronic suppurative pleuritis 1 case,failed diagnosis 1 case.Presentations of lesions under thoracoscope were as follows:diffused miliary nodules 10 cases(10/20),multiple mass 7 cases(7/20),fibrous compartmentation or conglutination 9 cases(9/20).There were no severe complications.Conclusion Flexible medical thoracoscopy is a safe and efficient method of etiologic diagnosis of pleural effusion.

Objective: To discuss the treatment, pathological subtypes and recurrence of sinonasal chondrosarcoma, and to identify the prognostic factors. Methods: Between January 1994 and May 2018, 47 patients with sinonasal chondrosarcoma who were treated in Eye, Ear, Nose and Throat Hospital, Shanghai Medwal College, Fudan University were retrospectively reviewed, including 19 males and 28 females, aging from 7 months to 71 years old, with a median age of 38 years old. The clinical symptoms, location of tumor, surgical method, pathological subtype, recurrence and prognosis were collected and analyzed. Kaplan-Meier method was used to calculate the disease-specific survival rate, disease-free survival rate and draw survival curve. Log Rank was used to analyze the prognostic factors. Cox regression was used for multivariate analysis. Results: Except for one patient who gave up treatment after tumor biopsy, other 46 patients underwent radical resection, including 31 cases of endoscopic resection and 15 cases of extranasal approach resection. Thirty-nine patients were diagnosed as conventional intramedullary chondrosarcoma with pathological grade Ⅰ of 24 cases and grade Ⅱ of 15 cases. Six cases were diagnosed as mesenchymal chondrosarcoma while 2 cases were diagnosed as myxoid chondrosarcoma. During an average follow-up period of 56.1 months (17-156 months), 23 patients had recurrence (54.8%, 23/42), among whom 9 patients had re-operations and 5 patients died. Thirty-seven patients survived, including 25 patients survived without tumors. In addition, 5 patients were lost to follow-up, including the patient who gave up treatment after tumor biopsy. Five-year overall survival rate and disease-free survival rate was 84.7% and 34.3%, respectively. Multivariate analysis showed that invasion of skull base was an independent risk factor affecting disease-free survival rate (95% confidence interval: 1.089-5.825, P=0.031). Conclusions Radical resection is the primary treatment for sinonasal chondrosarcoma. The most common pathological subtype is conventional intramedullary chondrosarcoma. Sinonasal chondrosarcoma has a high local recurrence rate. The long-term prognosis is well after complete excision of the lesion. The most important cause of death is uncontrollable local disease and invasion of adjacent key structures.

Objective To evaluate the effect of enhanced recovery after surgery (ERAS) on immune function and clinical signs in patients with acute abdomen.Methods From March 2016 to March 2017,patients with acute abdominal admitted in the Emergency Care Center of the First Affiliated Hospital of Zhengzhou University were collected and randomized into ERAS group and conventional peri-operative management group (CPM group).In addition to clinical signs (the time of bowel movemtn recovery,the time of first postoperative ingestion and ambulation,hospital stay,complication rates),the celluar immunity (CD4 +,CD8 +,CD4 +/CD8 +) were determined during peri-operation period.Results A cohort of 240 patients were in ERAS group and 192 patients in CPM group.There was no significant difference in general condition between the two groups (P ＞ O.05).On the first day after operation,the levels of CD4 +,CD4 + /CD8 + decreased in both groups (P ＜ 0.05),but the CPM group had lower levels of CD4 +,CD4 +/CD8 +than the ERAS groups.On the 3rd and 7th days after surgery,the ERAS groups had higer levels of CD4+,CD4+/CD8+ than the CPM groups,(the levels of CD4+,CD4+/CD8+ recovery on the 3rd and 7th day after operation,and the ERAS group was significantly better than the CPM group) (P ＜ 0.05).Compared with CPM group,the recovery of bowel movement appeared earlier after operation in ERAS group with sooner resuming ingestion and ambulation after operation,shorter hospital stay,and lower WHO pain rating scale and complication rates (P ＜ O.05).Conclusions ERAS for patients with acute abdomen can alleviate postoperative suppression of immunity,preserving immune function intact and accelerating postoperative rehabilitation.

BACKGROUND:With social progress,the incidence rate of knee osteoarthritis is getting higher and higher in the face of the rapidly developing aging problem in the social population,and the number of total knee replacement operations is gradually increasing. OBJECTIVE:To study the relationship between prosthesis size and stress shielding by improving the tibial prosthesis base. METHODS:A female patient with severe knee osteoarthritis was selected.Based on Mimics,through extracting the bone structure of the knee joint and simulating the total knee replacement surgery,osteotomy,positioning,and implantation operations were carried out to establish the geometric modeling of the total knee replacement prosthesis(including the femoral prosthesis,tibial bracket,and tibial pad),and improve the design of the tibial prosthesis base,analyze the effect of different tibial prosthesis bases on stress shielding of surrounding bone tissue. RESULTS AND CONCLUSION:(1)Compared with single-stem tibial intramedullary stem prosthesis,the design of four-post tibial intramedullary stem prosthesis created a certain degree of stress shielding around the short stem.However,compared with a thicker single long stem,this stress shielding effect was significantly reduced,and the load was evenly distributed among the four short stems,so there was no stress concentration at the bottom of the pile.(2)The design with a rectangular hole in the middle not only provided relatively good stability,but also helped to reduce stress shielding of cancellous bone to a certain extent,with a reduction rate of 77.5%.(3)Compared with a single-stem tibial intramedullary stem prosthesis,both the four-post tibial intramedullary stem prosthesis and the four-post tibial intramedullary stem prosthesis with a hole in the middle have good stability,which can reduce stress shielding to a certain extent without causing stress concentration,providing theoretical guidance for the design of the tibial intramedullary stem.