Objective To evaluate the early therapeutic effect of flail chest with pulmonary contusion by using different mode of mechanical ventilation. Methods Twenty-nine patients of flail chest with pulmonary contusion were analysed retrospectively. All the patients were treated with the ventilator Bear1000. Two groups were established: invasion group was treated with SIMV+PEEP(8 cases) and CPAP+PSV (7 cases), noninvasion group was treated with NIPPV(14 cases). Results There was no death in all the patients. CPAP+PSV was more effective than SIMV+PEEP not only in decreasing breath rate and improving hypoxemia but also in decreasing peak inspiratory pressure(P

Objective To retrospectively study the value of ultrasonography in diagnosing breast lymphoma and compare with mammography and MRI. Methods Imaging characteristics of 26 patients who were pathologically comfirmed as breast lymphoma were reviewed, including ultrasonography,mammography and MRI, and compare the diagnostic accuracy among the three. Results Twenty-four patients underwent ultrasonography and 32 lesions were found, with longest diameters averaged 30 mm.Tumors were mostly hypoechoic or very hypoechoic (81.3％), some were lobular (25.0％) or oval (21.9 ％ ) in shape, the margins were most frequently circumcribed (62. 5 ％ ), and a few tumors showed an echogenic boundary (18.8 ％ ). Color Doppler imaging showed hypervascularity in most tumors (59.4 ％ ).Ninteen patients undewent mammography, 15 solitary lesions were identified in 12 patients, asymmetric density in five,punctate calcification in one,and no abnormality in one. Eleven lesions were identified in MRI of 10 patients, 10 lesions showed hypointensity on T1-weighted images and hyperintensity on T2-weighted images, and heterogeneous enhancement after contrast. The diagnostic accuracy of ultrasonography,mammography and MRI was 83％, 52％ and 100％, respectively. Conclusions The sonograms of breast lymphoma have some distinct features, the combination of ultrasonography and MRI might benefit the diagnosis of breast lymphoma.

ObjectiveTo discuss treatment experiencing in femur periprothetic fracture after hip arthroplasty in pre-, intra- and post-surgery.Methods From March 2005 to May 2011, 27 patients (11 males, 16 females) aged ＞75 years with femur periprothetic fracture after hip replacement were studied. The mean time from primary hip replacement to femur perprosthetic fracture was 63 months(ranging from 7 to 83 months). According to vanconver classification, type A applying steel wire of character for 8 bind technique was 5 cases, type B applying prolonging stem technique locking compress plate (LCP)technique surrounding instrument technique was 19 cases and type C applying bone graft and plate fixation technique was 3 cases. All patients were followed up from 9 to 25 months (average, 16 months). The results of treatment were evaluated by Harris score and X rays. Results Bony heal was obtained in 22 patients and was not obtained in five cases among whom bony heal occurred in 3 cases and 2 patients could only keep prothetic and limb stable after receiving the bone graft once more. Walking was free in 14 cases,9 cases needed assistant walking instrument,and only 4 cases stayed in the bed freely. Harris score for last follow-up was 52 to 93 (mean 76).Conclusions Based on the patient general status, the fracture types and practical and stable principle, the effective methods can get good results in the treatment of femur periprosthetic fracture in aged patient.

Objective To study ultrasound features of breast cancer before and after neoadjuvant chemotherapy,and its correlation with histopathology. Methods One hundred and nine patients with breast cancer underwent paclitaxel plus carboplatin neoadjuvant chemotherapy, the change of the primary lesions and axillary lymph nodes were studied by ultrasound,and compared with histopathology. Results Seventeen patients achieved complete remission under ultrasound, the rest measurable lesions became significantly shortened in maximum diameter [ ( 22.46 ± 11.50) mm vs (34. 71 ± 13.67) mm, P ＜ 0. 001 ], and showed decrease both in longitudinal-transverse ratio (0. 80 ± 0. 23 vs 0. 86 ± 0. 22, P ＞0. 05) and grades of blood flow (0. 51 ± 0.80 vs 1.23± 1.05, P ＜0. 001 ). 44. 83% (44/92) of metastatic axillary lymph nodes disapeared after treatment. Comparing with histopathology, the sensitivity and specificity of ultrasound assessing complete remission were 57. 89 % ( 11 / 19) and 93.33 % (84/90), respectively. The moderate concord between ultrasound with histopathology might be attributed to the pathologic change of breast tissue and stroma after treatment, nevertheless grades of blood flow might be more meaningful. Conclusions Ultrasound assessment of neoadjuvant chemotherapeutic response might be of reference value,and studying corresponding ultrasonic manifestation of different kinds of pathological changes would help with better evaluation.

Adenoviridae ; genetics ; Cell Death ; Genetic Vectors ; HT29 Cells ; Humans ; Interleukins ; biosynthesis ; genetics ; RNA, Catalytic ; biosynthesis ; genetics ; RNA, Messenger ; metabolism ; Recombinant Proteins ; biosynthesis ; genetics ; Transfection ; Vascular Endothelial Growth Factor A ; metabolism

Humans ; Pulmonary Embolism ; diagnosis ; therapy ; Venous Thromboembolism ; diagnosis ; therapy

BACKGROUND:Three-dimensional (3D) printing technology exhibits a broad future in the orthopedics,especially exhibiting good guidance and auxiliary in the treatment of tibial plateau fractures.However,the related researches are few,and there is a lack of evidence-based medicine to confirm its application values.OBJECTIVE:To compare the efficacy of 3D printing-assisted surgery and traditional surgery in the treatment of tibial plateau fractures through a meta-analysis.ME=THODS:MEDLINE,Cochrane library,Embase,CBM,CNKI and WanFang databases were searched by computer and the relevant literatures were retrieved manually,to collect the controlled trials concerning the efficacy of 3D printing-assisted surgery versus traditional surgery for tibial plateau fractures.Methodology quality of the trials was assessed critically and relative data were extracted,followed by analysis on Stata 11.0 (Stata Corporation,College Station,TX) software.RESULTS AND CONCLUSION:(1) Seven controlled trials involving 362 patients were included.(2) Meta-analysis results showed that the 3D printing-assisted surgery had shorter operation time (SMD=-2.411,95％C/=-2.718-2.104,P=-0.00) and less intraoperative blood loss (SMD=-1.579,95％C/=-1.842--1.316,P=-0.00) than those in the traditional surgery.The excellent and good rate in Rasmussen and Hospital for Special Surgery knee scores showed no significant differences between two growps (P ＞ 0.05).(3) To conclude,compared with the traditional surgery,the 3D printing-assisted surgery can significantly shorten the operation time and reduce the intraoperative blood loss in the treatment of tibial plateau fractures.

Objective To investigate the diagnostic values of direct lymphangiography for the thoracic duct outlet obstruction.Methods The image data of direct lymphangiography were retrospectively analyzed in 124 patients with lymphedema,Chylothorax,chylous ascites,chyluria and intestinal lymphangiectasis,and compared with the results of neck thoracic duct surgical exploration,2 radiologists reviewed DLG DSA images in a double blind manner.The number of neck stem,subclavian stem,bronchialmediastinal stem and TD terminal into blood obstruction on the operation side showed by DLG were assessed using Kappa analysis.Results Of 124 patients,80 patients had the left cervical lymphatic stem reflux on DLG,75 patients with the left subclavian lymphatic stem reflux,30 patients with the left bronchial-mediastinal lymphatie stem reflux,118 patients showed the thoracic duct outlet barrier into the blood.The consistency rate of DLG were 89.9％ (80/89),92.6％ (75/81),90.9％ (30/33) and 95.2％ (118/124) compared with the neck thoracic duct surgical exploration.Tow radiologists had a high degree of diagnostic consistency (K =0.82,P ＜ 0.05).In addition,114 patients (91.9％) had tortuous,dilated waist lymphatic stem,only 10 patients (8.1％) were normal.The cisterna chyli reflux were found in 92 patients (74.2％),intestinal stem reflux in 16 patients (12.9％),reflux to the kidney area in 11 patients (8.9％),to the pericardium reflux in 5 patients (4.0％),vaginal lymphatic leakage in 7 patients (5.6％),retroperitoneal lymph leakage in 2 patients (1.6％),pleural lymphatic leakage in 3 patients (2.4％),tracheal lymph leakage in 1 patient (0.8％).Conclusion Direct lymphangiography has a high consistency with the cervical thoracic duct surgical exploration in displaying thoracic duct outlet obstruction.

BACKGROUND: Many researchers at home and abroad think that interlocking intramedul ary nails may be more suitable for comminuted fractures of the tibia with severe soft tissue injury. Plate fixation is more advantageous for distal tibial fractures. OBJECTIVE: To compare the effects of multifunctional locking intramedul ary nail and locking plate in treatment of extraarticular proximal tibial fractures. METHODS: 156 patients with extraarticular proximal tibial fractures were included and divided into intramedul ary nail group (n=78) and the locking plate group (n=78) according to repair method. Curative effects and healing time were compared between the two groups. At 3 months after treatment, Johner-Wruh tibial fracture scores were used to assess the repair effect in both groups. In addition, operation time, blood loss, healing time and complications were compared between the two groups.RESULTS AND CONCLUSION: Mean healing time was 9.3 months in the locking plate group and 9.2 months in the intramedul ary nail group. At 3 months after treatment, the repair effect was significantly better in the intramedul ary nail group than in the locking plate group (P < 0.05). Blood loss and time were less in the intramedul ary nail group than in the locking plate group (P < 0.05), and surgical difficulty was high. At 3 months after treatment, the incidence rates of tibia eversion/inversion, neurovascular injury and nonunion/infection were significantly lower in the intramedul ary nail group than in the locking plate group (P < 0.05). These findings confirmed that the multifunctional locking intramedul ary nailing for extraarticular proximal tibial fractures obtained reliable efficacy, exact effect, reduced blood loss and low incidence of complications. Thus, it is better than locking plate.

Coronary Disease ; complications ; Erdheim-Chester Disease ; complications ; Humans ; Male ; Middle Aged