Objective To evaluate the value of computed tomography(CT) and magnetic resonance imaging(MRI) in diagnosis of avascular necrosis of the femoral head(ANFH). Methods The literatures of ANFH diagnosed with CT and MR imaging published in the last ten years were collected by searching. Of that,21 literatures were correspond for the standards in this study and were select-ed. These literatures in diagnosing ANFH with CT and MR imaging were analysed with Meta-analysis by the sofeware of StataSE10.1. Results MRI was more effective than CT in diagnosing ANFH. There was significantly different in statistics between them [OR=0.13,95%CI(0.03～0.51)]. Conclusion In comparison with CT,MRI is the better method in diagnosing ANFH.

Objective To evaluate the diagnostic value of ultrasonography and MRI in the diagnosis of placenta accrete.Methods First,the relevant literatures about placenta accrete were retrieved at home and abroad,then the data were extracted and Meta-analysis was performed.The combined sensitivity and specificity of ultrasound and MRI and AUC were obtained.Results The combined sensitivity of ultrasonography was 0.80,specificity was 0.88,AUC was 0.88;combined sensitivity of MRI was 0.86,specificity was 0.90,AUC was 0.93.Conclusion Ultrasound and MRI are very valuable in the diagnosis of placenta accrete.However,MRI is a useful complement of ultrasound,and the diagnostic value is slightly better than that of ultrasound.The diagnostic value will be higher when they combined together.

Objective:To compare the clinical outcomes between OTA/AO-C open and closed fractures of the distal humerus treated by open reduction and internal fixation.Methods:The clinical data were retrospectively analyzed of the 70 patients who had been treated at Department of Traumatology and Orthopedics, Beijing Jishuitan Hospital for OTA/AO-C fractures of the distal humerus from January 2014 to June 2017. Of them, 22 suffered from open fractures (Gustilo types Ⅰ/Ⅱ) and 48 closed fractures. There were 18 males and 4 females with an age of (42.6±13.0) years in the open group and 21 males and 27 females with an age of (42.2±17.1) years in the closed group. Analyzed were interval from injury to surgery, hospitalization time, injury energy and functional outcomes which included range of motion (ROM) in elbow flexion and extension, ROM in elbow rotation, Mayo elbow performance score (MEPS), Disabilities of the Arm, Shoulder and Hand (DASH), complications and rate of secondary surgery.Results:There was no significant difference between the 2 groups in age, injury energy or interval from injury to surgery ( P>0.05), but there were significantly more males in the open group than in the closed group ( P=0.011). The follow-up time for all the patients averaged 34.0 months (from 25 to 54 months). There were no statistically significant differences between the 2 groups in hospitalization time [9.5(6.0, 13.0) d versus 8.5 (6.0, 11.0) d], ROM in flexion and extension [120.0° (100.0°, 137.8°) versus 128.5° (110.0°, 140.0°)], ROM in rotation [155.0° (151.3°, 155.0°) versus 155.0° (155.0°, 155.0°)], MEPS [95.0 (80.0, 100.0) versus 95.0 (80.0, 100.0)] or DASH [2.6 (0.63, 9.2) versus 1.7 (0.0, 8.5)] ( P>0.05). There were no statistically significant differences between the 2 groups either in rate of secondary surgery [36.4% (8/22) versus 33.3% (16/48)], ulnar nerve symptoms [54.5% (12/22) versus 60.4% (29/48)], local irritability in the region of internal fixation [9.1% (2/22) versus 6.3% (3/48)] or elbow stiffness [13.6% (3/22) versus 10.4% (5/48)] ( P>0.05). Conclusion:Open reduction and internal fixation can lead to similar clinical outcomes in the treatment of both open (Gustilo types Ⅰ/Ⅱ) and closed distal humeral fractures of OTA/AO-C, with no significant differences in postoperative ROM, functional scores or complications.

OBJECTIVE:To investigate the development of related TCM evidence-based researches in China.METHODS:The literatures titled"Meta-analysis"and those with Chinese Library Classification Number of"R2(Chinese Medicine)"were searched from CJFD by computer. The retrieval time limit ranged from database establishment to Dec. 2017. Bibliometrics analysis was performed in respects of year of publication,source journals,publishers,authors,co-authors,funding and research content. RESULTS:A total of 1 540 papers from 321 journals were included,and the first paper was published in 1997;the first author came from 494 institutions which mainly distributed within the mainland institations of China. Guangzhou University of TCM had the largest number of publications. According to Price's law,there were 25 core authors who published 157 literature in total;the co-authoring rate was 95.1% and the collaborating degree was 4.00. 32.3% of the papers were obtained by the fund support, involving 236 literatured founded by National Science Foundation of China. There were 5 types of papers,including 1 512 applied research papers,14 quality evaluation papers,6 methodological studies;there were 17 categories of diseases involved in applied research. CONCLUSIONS:Meta-analysis of TCM research in China has developed rapidly,but related theoretical research is relatively lack. It is necessary to further strengthen the methodology research so as to promote the development of evidence-based research of TCM.

OBJECTIVETo explore the influences of di-(2-ethylhexyl)phthalate (DEHP) and its principle metabolite mono(2-ethylhexyl)phthalate (MEHP) on spermatogenic cell apoptosis in young male Wistar rats.

METHODSNinety-eight 2-week-old male Wistar rats were randomly divided into 14 equal groups to receive daily intragastric administration of 0.2 ml/kg normal saline for 3 weeks (normal control), 100 mg/kg cyclophosphamide (CTX) for 1 week (positive control), 100, 200, and 300 mg/kg DEHP or MEHP for 1 week, or 100 mg/kg DEHP or MEHP for 1, 2, and 3 weeks. After the treatments, the pathological changes of the testicular tissues were examined, spermatogenic cell apoptosis was detected, and serum sex hormones levels were measured using TUNEL assay or radioimmunoassays.

RESULTSCTX, DEHP, and MEHP all caused shrinkage, development retardation and quantitative reduction of spermatogenic cells with and mitochondrial swelling vacuolar changes. The damage of spermatogenic cells increased significantly with the increment of DEHP and MEHP doses and exposure time. Both DEHP and MEHP treatments resulted in significantly increased cell apoptosis index (AI) in close correlation with the exposure doses and duration (P<0.01). DEHP and MEHP treatments also significantly increased serum levels of follicle stimulating hormone and luteinizing hormone and decreased testosterone levels in a dose- and time-dependent manner (P<0.05).

CONCLUSIONDEHP and MEHP can induce obvious apoptosis of spermatogenic cells in young male rats with a dose- and time-dependent effect.

Animals ; Apoptosis ; drug effects ; Diethylhexyl Phthalate ; analogs & derivatives ; toxicity ; Dose-Response Relationship, Drug ; Environmental Exposure ; Male ; Rats ; Rats, Wistar ; Spermatozoa ; cytology ; drug effects

Objective To compare the function outcome and complication of emergency operation and staged operation with enhanced recovery after surgery (ERAS) for Gustilo type Ⅰ &Ⅱ open distal humeral fractures.Methods Retrospective analysis of 22 patients with Gustilo type Ⅰ & Ⅱ open distal humeral fractures who were treated in Department of Orthopeaedic Trauma,Beijing Jishuitan Hospital from July 2013 to June 2017 was conducted.There were 18 males and 4 females,aged (42.5± 13.0) years,with an age range of 14-65 years.According to different treatment methods,all patients were divided into two groups:emergency operation group (n =6),direct internal fixation after emergency debridement;staged operation group (n =16),emergency debridement and suture,performed the second period of fixed treatment after the soft tissue condition to improve.Patient's waiting time from emergency to surgery,fasting time,surgery time,intra-op blood loss,hospital stay time,elbow range of motion,Mayo elbow performance score (MEPS),secondary surgery rate and complication at the last outpatient visit at 1,3,6,12 and June 2018,post-operatively were recorded.The measurement data of normal distribution and homogeneity of variance were expressed as mean ± standard deviation (Mean ± SD),and the independent sample t test was used for comparison between the two groups;the measurement data not conforming to the normal distribution were expressed as [M(P25,P75)].The rank sum test was used for comparison between the two groups.Comparison of count data between the two groups was performed by x2 test or Fisher exact probability method.Results The time from emergency to surgery of emergency group and staged group was [5.1(4.5,7.3) h],[160.0(102.9,221.2) h],respectively,P ＜0.001.Fasting time was [5.1(4.5,7.3) h],[12.1(9.7,13.2)h],P＜0.001.Hospital stay time was [5.5(5.0,6.5) d],[11.5(9.0,13.0) d],P=0.001.These differences were significant.Surgery time was [3.0 (2.0,3.6) h,2.6 (2.0,3.4) h].Intra-op blood loss was [75.0(25.0,225.0)ml,100.0(100.0,200.0)ml].Elbow range of motion was [155.0(141.3,155.0)°,155.0 (143.8,155.0) °].MEPS was [95.0 (83.8,100.0) scores,90.0 (80.0,100.0) scores].Secondary surgery rate was(33.3％ vs.31.2％).Complication rate was (83.3％ vs.68.7％).These differences were not significant (P ＞0.05).Conclusions ERAS's quick emergency surgery for Gustilo type Ⅰ&Ⅱ open distal humeral fractures significantly reduces the waiting time from emergency to surgery,fasting time and hospital stay time.Function outcome is comparable to the staged group.Therefore,emergency surgical procedures are recommended for patients with Gustilo typeⅠ&Ⅱ open distal humeral fractures.

Objective To investigate the current perioperative management of geriatric hip fractures in China.Methods The survey was performed between 15th to 21st of November,2017.An electric questionnaire was delivered to the orthopedic surgeons attending the 12th International Congress of Chinese Orthopedic Association (COA) and the orthopedic fellows attending grand round at Department of Orthopaedic Trauma,Beijing Jishuitan Hospital.The questionnaire addressed the current perioperative management of geriatric hip fractures (≥ 65 years) at the departments where the participants worked,covering preoperative examination and preparation,postoperative rehabilitation and multidisciplinary collaboration.Results 171 valid questionnaires were collected for this study.Of the 171 orthopedic surgeons from 28 provinces in China,106 (62.0％) came from a tertiary hospital and 65 (38.0％) from a secondary hospital.In 74.3％ (127/171) of the hospitals,more than 100 geriatric hip fractures were treated annually.63.2％ (108/171) of the hospitals treated 100 to 500 cases annually,5.9％ (10/171) 500 to 1,000 cases and 5.3％ (9/171) more than 1,000 cases.Multidisciplinary collaboration was not established in most hospitals (71.9％,123/171) for geriatric hip fractures.Pulmonary function test (61.4％,105/171),Holter (38.0％,65/171) and ambulatory blood pressure monitoring (53.8％,92/171) were indicated as routine preoperative investigations.In 56.3 ％ (96 / 171) of the hospitals,traction was performed before operation.In 80.1％ (137 / 171) of the hospitals,the interval between admission to surgery was more than 48h for the patients.In 36.3％ (62/171)of the hospitals,patients were allowed to ambulate within one week after surgery.In 4.1％ (7/171) of the hospitals,patients were allowed full weight-bearing within one week after surgery.Conclusion Significant gaps exist in perioperative management of geriatric hip fractures between current practice in China and worldwide guidelines and consensus.

Objective To investigate the current perioperative fasting management by Chinese traumatic surgeons for elective patients and the related awareness in Chinese traumatic surgeons.Methods Traumatic surgeons were interviewed through questionnaires which addressed the current pre-and post-operative fasting time for liquid and solid food in their hospitals,the postoperative practice to keep the patients in recumbent position without pillow,their reasons to choose perioperative fasting management and their knowledge of the current related guidelines.The associations between surgeons' information and their reasons to choose fasting management and their knowledge of the related guidelines were analyzed.Results A total of 187 valid questionnaires were collected.The percentages of the surgeons who indicated perioperative fasting time for liquid for at least 2 hours and for solid food for at least 6 hours were only 3.74％ and 27.27％,respectively.Nil by mouth from midnight for liquid or for solid food was actually indicated by 29.95％ and 31.55％ of the surgeons,respectively.64.71％ of the surgeons still required their patients to fast for liquid for at least 6 hours postoperatively,even longer for solid food.Only 1.6％ of the surgeons did not ask their patients to keep in recumbent position without pillow postoperatively whatever the anesthesia types were.Only 6.95％ of the surgeons chose a perioperative fasting protocol based on the related guidelines.Only 9.09％ of the surgeons knew the related guidelines very well.The reasons of the surgeons to choose a perioperative fasting protocol and the knowledge of the surgeons about the related guidelines were not associated with the professional ranks of the surgeons,hospital ranking or hospital location (P ＞ 0.05).Conclusions The current management of perioperative fasting is backward in the Chinese communities of traumatic orthopedics,and the related guidelines are not well implemented due to the poor awareness of them.

Objective:To analyze the risk factors of medical adhesive-related skin injury (MARSI) in preterm infants to establish a nomogram model to predict the risk of MARSI.Methods:From July to September 2018, 268 premature infants who were hospitalized in NICU were enrolled in this study. Their clinical data were analyzed and univariate analysis was used to detemine the risk factors related to MARSI, The significant variables were included in the multivariate logistic regression analysis to analyze the independent risk factors for MARSI. Then the R software was used to establish a predictive nomogram model, Bootstrap method was used to validate the nomogram model and the consistency test of the correction curve was used to explore the predictive efficacy of the model in predicting the MARSI.Results:A total of 64 cases out of 268 premature infants had MARSI. The prevalence rate was 23.9 % (64/268). Birth age (28 to 32 weeks) ( P value was 0.021, OR value was 2.736, 95 % CI 1.163-6.435), edema ( P<0.01, OR value was 33.782, 95 % CI 10.510-108.583), maternal diabetes ( P value was 0.039, OR value was 16.011, 95 % CI 1.146-223.692), easy to tear tape ( P value was 0.027, OR value was 13.567, 95 % CI 1.340-137.311) were all independent risk factors for MARSI. The nomogram model showed a conformance-index of 87.29 %, while the consistency test of the correction curve showed that the prediction probability is consistent with the actual occurrence probability. Conclusions:The nomogram built based on the indexes of fetal age, skin state, maternal disease, mucous product has good discrimination and accuracy which could be helpful for screening the patients with high risk, with potentially high clinical application value.

Objective:To evaluate the effect of oropharyngeal colostrum administration on building adequate enteral feeding process of very low birth weight neonates and extremely low birth weight neonates.Methods:A total of 62 very/extremely low birth weight neonates in NICU were selected from a tertiary hospital in shandong province. They were randomly assigned to the observation group ( n=32) and the control group ( n=30) according to the random number table. The observation group was given oropharyngeal colostrum administration. The control group was given oral care with 0.9% sodium chloride solution, and the wiping method and frequency was the same as the observation group. Gastric retention, enteral feeding time, adequate enteral feeding time, the weight at the time of discharge, etc. were compared between two groups. Results:Gastric retention times on the 10th day in the observation group (1.90±1.30) was significantly lower than that in the control group (2.77±1.50), and the two groups were statistically significant ( t value was -2.449, P<0.05). The duration of 100 ml·kg -1·d -1 enteral feeding and adequate enteral feeding (150 ml·kg -1·d -1) in the observation group [(24.63±9.42) days, (29.75±10.15) days] were significantly shorter than those in the control group [(33.90±2.73) days, (35.13±9.29)days], and the two groups were statistically significant ( t value was-4.621, P<0.01; t value was -2.362, P<0.05). The weight of the observation group was higher than that in the control group at the time of discharge ( t value was 4.677, P<0.05). Conclusion:Oropharyngeal colostrum administration can reduce gastric retention times, shorten the adequate enteral feeding time, promote growth and development in very low birth weight neonate and extremely low birth weight neonate.But it had not been proved to reduce the incidence of related infection indicators.