The article put across Meta-analysis well by giving its definition and analyzing its development. It empha-sized its effect in the clinical medicine and dwelled on dealing with the problems encountered when meta-analysis wasapplied and the solutions to the problems. It also pointed out its significant role in raising the level of clinical medicine,teaching and scientific research.[

Objective To explore the clinical efficacy of proximal femoral locking compression plate (LCP)fixation in elderly intertrochanteric fractures patients. Methods 30 cases of intertrochanteric fracture fixed with LCP were collected,and the functional recovery of all hip joints was observed. Results The average follow-up and healing time of all cases was 10 months(6 to 14 months)and 3.5 months respectively. Hip joint function of 27 cases was excellent( Harris scoring≥90) ,that of the other 3 cases was good ( Harris scoring:80 ～ 89). Conclusion The proximal femoral LCP fixation had a good clinical value in treatment of elderly intertrochanteric fracture patients. It had many advantages, such as simplicity, rigid fixation, less trauma and bleeding, shorter operative time, less complications, high heal rate, etc.

Objective To establish virtual three-dimensional instrument and cerebral aneurysm models by using three-dimensional moulding software,and to explore the effect of the models in interventional preoperative simulation.Methods The virtual individual models including cerebral arteries and aneurysms were established by using the three-dimensional moulding software of 3D Studio MAX R3 based on standard virtual cerebral aneurysm models and individual DSA image.The virtual catheter,guide wire,stent and coil were also established.The study of interventional preoperative simulation was run in personal computer,and included 3 clinical cases.Results The simulation results of the working angle and the moulding angle of the head of catheter and guide wire in 3 cases were identical with that of operation results. The simulation results of the requirement of number and size of coil in 1 case of anterior communicating aneurysm and 1 case of posterior communicating aneurysm were identical with that of operation results.The simulation results of coil for aneurysmal shape in 1 case of giant internal carotid artery aneurysm were more than 2 three-dimensional coils with size of 3mm?3 cm from the operation results,and the position of the second coil in aneurysmal neck was adjusted according to the results of real-time simulation.The results of retrospective simulation of operation procedure indicated that the simulation methods for regular and small aneurysms could become a routine simulation means but more simulation experience was needed to build up for the giant aneurysms.Conclusions The virtual three-dimensional instrument and cerebral aneurysm models established by the general software provided a new study method for neuro-interventional preoperative simulation,and it played an important guidance role in developing neuro- interventional operation.

Objective To compare the clinical efficacy of extramedullary fixation system,intramedullary fixation system and hip arthroplasty in treatment of intertrochanteric fractures in the elderly.MethodsThe retrospective study involved 184 patients treated between January 2007 and January 2011,which were assigned to dynamic hip screw (DHS) group (n =99),locking plate group (n =19 ),intramedullary fixation group (n =25) and joint replacement group (n =41 ).There were 80 males and 104 females,at age range of 60-99 years,mean (72.4 ± 3.9) years.According to the modified Evan classification,the fractures included type Ⅰ A in 20 patients,type Ⅰ B in 21,type Ⅱ in 75 and type Ⅲ in 68.The preoperative conditions,postoperative weight-bearing time,fracture heating time,hip function and complications were comparatively studied among four groups.ResultsThe patients were followed up for 7-22 months (mean 12 months).The four groups showed no significant differences regarding the gender,age,fracture types and medical complications.The postoperative weight-bearing time of the joint replacement group was significantly shorter than that of the other three groups,with statistical significance.The fracture healing time was insignificantly different among the four groups.The postoperative complications were found in 24 patients (13％),including 11 patients in the DHS group,six in the locking plate group,five in the intramedullary fixation group and two in the joint replacement group.Harris score was the highest in the joint replacement group,with statistical significance in comparison with the other three groups. ConclusionsIntramedullary fixation should be the treatment of choice for the patients with unstable,or severe osteoporosis fractures and with intolerance of joint replacement.Artificial bipolar femoral head replacement is suitable for the elderly patients with unstable or severe osteoporosis fractures,capability of walk or tolerance of operation.

ObjectiveTo evaluate the anticancer activity of 5'-dexoxy-fluorouridine on colon cancer experimental models in BALB/C mice,compared with 5'-fluorouracil,an anticancer agent widely used in clinic,meanwhile,examined the conversion of 5'-Dexoxy-fluorouridine to 5' -fluorouracil in cancer tissues and serum of mouse models.MethodsThe xenografts of mouse colon cancer cell line CT 26 were transplantated to cecum in 60 male BALB/C mice.Three days lated,these mice were divided into 3 groups and intro- peritoneally injected:( 1 ) 5' - dexoxy- fluorouridine 0.1 mg/g,(2) 5' - Fluorouracil 0.02 mg/g,(3)0.9％ sodium chloride 0.4 mL (as a control),respectively.Two and three weeks later,6 mice were sacririced in every group respectively to measure the weight of tumors and bodies,to examine the Hb,RBC,WBC,PLT,AST,ALT,UREA,and CREA in blood.The rest 8 mice in each group were fed generally,and the survival time from operation to natural death was recorded.In addition,14 mice with xenografts of CT 26 about 2 weeks,were divided into 2 groups averagely,5' -dexoxy-fluorouridine 0.1 mg/g and 5' -fluorouracil 0.02 mg/g were intro-peritoneally injected respectively.Fifteen min later,the converted 5' -fluorouracil was detected from the blood and tumor tissues in sacrificed mice.ResultsThe lest tumor average weight was found in the mice injected 5 '-dexoxy-fluorouridine,being (0.07 ± 0.12) g and (0.24g ±0.29) g for the mice sacrificed at 2 and 3 weeks later,respectively.The average survival time for rest mice was ( 32.6 ± 8.9) d.The average tumor weight in 5' - fluorouracil group was (0.74 ± 0.43 ) g and ( 1.13 ±0.75) g at 2 and 3 weeks later,and the average survival time for the rest was (22.8 ±5.9)d,respectively.The average tumor weight in the control group was (0.70 ±0.47) g and ( 1.93 ±0.83) g at 2 and 3 weeks,and the average survival time for the rest was ( 17.5 ± 2.8 ) d.Either the average tumor weight or average survival time in the mice of 5 ' -dexoxy-fluorouridine group was significantly differen from either 5' -fluorouracil group or control (P ＜ 0.05 ).However,there was no significant difference for the numbers of WBC,PLC,Hb,and some function examination of liver and kidney among 3 group mice,besides the loss of weights in 5'-fluorouracil group mice after operation and medicine therapy which was significantly obvious than that in 5' -deoxy-fluorouridine and control groups ( P ＜ 0.05 ).In addition,( 54.71 ± 12.82) μg/g 5' -fluorouracil was detected in xenografts of mice injected 5' -dexoxy-fluorouridine 15 min later,which was the 6.20 folds of 5' -fluorouracil detected in serum from sthe ame group,P ＜0.05.However,( 133.35 ±20.69) μg/m 5'-fluorouracil were detected in serum of mice after 5' -fluorouracil were injected 15 min later,which was the 1.55 folds of 5' -fluorouracil detected in the xenografts from same group ( P ＜ 0.05 ).ConclusionsIn colon cancer tissues of mouse experimental models,5' - dexoxy- fluorouridine could be converted effectively to 5'-fluorouracil,an obvious high concentration being detected in serum of mice than in cancer tissues.The anticancer effect of 5'-dexoxy-fluorouridine on mouse colon cancer models was more effective than 5'-fluorouracil,resulting in a longer survival duration,less side effect and no significant injury on liver and kidney functions.However,the mechanism of 5' -dexoxy-fluorouridine converted to 5' -fluorouracil in cancer tissue is needed further investigation.

Inositol requiring enzyme 1 alpha (IRE1α), a widespread transmembrane protein in mammals, is an endoplasmic reticulum stress (ER stress) receptor. Among the three signaling pathways of the unfolded protein response (UPR), the IRE1α pathway is the most conservative. And there is a growing body of evidence that the occurrence and development of tumors is closely related to the over-expression of IRE1α. Therefore, the study of the IRE1α inhibitors is of great significance to the discovery of new anti-tumor drugs and has been attracting more and more attention. In the hope of providing ideas for the research of targeting IRE1α for cancer therapy, this paper reviewed the data of representative IRE1α inhibitors, including inhibitory activity, the mechanism of action, structural characteristics, and so on.

Objective To investigate the basic status of healthcare-associated infection(HAI)in a hospital,and provide evidence for strengthening HAI management.Methods A cross-sectional study was conducted to investi-gate the prevalence rates of HAI in all hospitalized patients at 0 ∶00 -24∶00 of May 7,2014.Results A total of 2 262 patients were supposed to be investigated,while 2 253 (99.60%)patients were actually investigated,586 of whom (26.01%)came from pulmonary hospital(specialized in tuberculosis)affiliated to the general hospital.53 patients devel-oped 58 times of HAI,prevalence rate and case prevalence rate was 2.35% and 2.57% respectively;1 073 patients devel-oped 1 265 times of community-acquired infection (CAI),prevalence rate and case prevalence rate was 47.63% and 56.15% respectively.Rates of HAI and CAI were high in intensive care unit(ICU,21.28%)and pulmonary hospital (99.49%)respectively;the main infection site was lower respiratory tract,which accounting for 46.55%(n =27)and 69.72%(n=882)respectively.The major pathogens causing HAI were gram-negative bacteria(n = 19),and the major pathogens causing CAI were Mycobacteria(n=141)and fungi (n=89).The rate of antimicrobial usage and etiological ex-amination was 34.80%(n=784 )and 81.48%(n=550 )respectively.Conclusion In order to prevent cross infection of tuberculosis and reduce the incidence of HAI,lower respiratory tract and ICU should be one of the key infection sites and departments of HAI surveillance,treatment and management of patients with tuberculosis should be stand-ardized,professional precaution of health care workers should be enhanced.

Objective To explore the diagnostic performance of susceptibility weighted imaging (SWI) in distinguishing malignant from benign parotid lesions.Methods We prospectively evaluated preoperative SWI findings of 41 patients with 12 malignant and 29 benign parotid lesions by surgical pathology, and explore the intravenous distribution, the largest diameter of veins (dv-max), the number of veins per unit area (N/Svein) and the graduation of intratumoral susceptibility signal intensity (ITSS).The parameters was analyzed by Chi-square test, Independent t-test, Mann-Whitney U rank test and receiver operating characteristics (ROC) curves with SPSS 16.0 software.Results (1) For intravenous distribution, the benign ones mainly distributed around peripheral areas, accounting for 89.7％ (26/29), while the malignant ones were centrally distributed, making up 10/12.There were significant difference (x2=20.882, P=0.000) between benign and malignant ones.(2) The largest diameter of veins (dv-max) of benign and malignant lesions were (1.1±0.5) mm and (2.5 ± 1.0)mm respectively.There were significant difference (t=4.633, P=0.000) between benign and malignant ones.(3) The N/Svein of benign lesions were (0.80±0.92) per cm2, while that of malignant ones are (1.07±0.69) per cm2.The N/Svein (t=0.9143, P=0.367) was statistically insignificant.(4) For the graduation of ITSS,among benign lesions, there were 3 cases of grade 0, 22 cases of grade 1, 2 cases of grade 2 and 2 cases of grade 3.Meanwhile, there were 2 cases of grade 1, 5 cases of grade 2 and 5 cases of grade 3 among malignant lesions.When the Youden index reached the highest point, the optimal diagnostic threshold of dv-max and ITSS values were 1.75 mm and 1.5 mm, the corresponding area under the ROC curve (AUC) were 0.924 and 0.856 respectively.The sensitivity of d and ITSS ondiagnosis were 10/12 and 10/12, and the specificity of that were 96.6％ and 86.2％ respectively.The table shows that the sensitivity and specificity of intravenous distribution in diagnosis of malignant lesions are 10/12 and 89.7％.Conclusions The results provided evidence that SWI may be helpful in distinguishing malignant from benign parotid lesions, and it is worth to be generalized in clinical medicine.

Objective To analyze the effect of mesporous calcium silicate (m-CS)/calcium sulfate cement (CSC),m-CSC for short,in bone defect repair.Methods Setting time and compressive strength of the m-CSC (15 m-CSC as group Ⅰ and 30 m-CSC as group Ⅱ) were tested.CSC was used as the control.Cement samples were immersed in Tris-HCl solution,andin vitro degradation of the m-CSC was measured.Cell morphology and cell proliferation as well as differentiation on the samples were assessed.The cements were implanted into the traumatic femoral defects in rabbits,and the in vivo degradability and osteogenesis of the cements were investigated by histological evaluation after implantation for 4,8 and 12 weeks.Results Addition of m-CS into CSC prolonged the setting time (7.8 min in group Ⅰ and 10.5 min in group Ⅱ),obviously longer than 3.7 min in control group and did not have obvious effect on compressive strength of the cements.Weight loss of m-CSC solution was obviously lower (61.8 wt％ in group Ⅰ and50.3 wt％ in group Ⅱ),compared to70.4 wt％ in control group,pH value in group Ⅱ decreased from 7.40 to 7.26,while decreased from 7.40 to 6.86 in control group,m-CSC could promote cell proliferation and differentiation compared to CSC.At postoperative 12 weeks,histological sections showed massive new bony tissue (55.2％) in group Ⅱ,obviously higher than 25.6％ in control group.Conclusion m-CSC exhibits good biocompatibility,degradability and osteogenesis,and can promote bone regeneration in bone defect repair.

ObjectiveTo analyze the clinical outcome of locking plate and hemiarthroplasty in treatment of Neer three- and four-part proximal humeral fractures.Methods A totalof 63 consecutive patients aged over 55 years with Neer three- and four-part proximal humeral fractures were treated surgically from June 2006 to June 2010.In the retrospective study,36 patients were treated by open reduction and locking plate fixation ( locking plate fixation group) and 27 patients treated by hemiarthroplasty (hemiarthroplasty group).Clinical outcomes including operation time,blood loss,visual analog scale ( VAS),Constant-Murley score and complications were evaluated.ResultsThe average 19.7 months follow-up showed complication rate of 28％ in the locking plate group,including one patient with varss malunion,one with axillary nerve injury,one with humeral head necrosis,one with heterotopie calcification and four with impingement syndrome.The complication rate was 24％ in the hemiarthroplasty group,including two patients with tuberosity nonunion,one with tuberosity migration,one with impingement syndrome and one with joint semiluxation.The mean Constant-Murley score of three-part fractures in the locking plate group was ( 76.5 ±5.8) points,better than (69.2 ±7.2) points in the hemiarthroplasty group (P ＜0.05 ).While the two groups showed no significant differences with regards to operation time,blood loss and visual analog scale (VAS).As for the four-part fractures,the mean operation time was shorter and the mean blood loss was less in the hemiarthroplasty group compared with the locking plate group (P ＜0.05),while there were no obvious differences in VAS score and Constant-Murley score between the two groups. Conclusions Both locking plate and hemiarthroplasty are the reliable methods for the three- and four-part proximal humeral fractures.The patients' age,bone quality,fracture type,comminution degree and evaluation of osteonecrosis possibility,are critical for surgery decision.