Objective To investigate the superiority of proximal femoral nail anlirotafion(PFNA) fixation in the treatment of intertrochanteric fractures.Methods 106 patients with intertrochanteric fracture were included in the study.According to different intemal fixation methods,they were divided into PFNA group and 2 dynamic hip screw (DHS) group,53 cases in each group.The intraoperative conditions,the postoperative Harris score and the incidence of complications of the two groups were observed and compared.Results The length of incision in the PFNA group was significantly shorter than that in the DHS group [(4.50 ± 1.35) cm vs.(12.63 ± 2.50) cm],the operative time in the PFNA group was significantly shorter than that in theDHS group [(68.50 ± 10.22) min vs.(102.36 ± 17.55) min],the amount of blood loss in the PFNA group was significantly less than that in the DHS group[(152.40 ±35.08) mL vs.(298.33 ± 70.11) mL],there were statistically significant differences between the two groups (t =20.832,12.138,13.551,all P＜0.05).The fracture healing time in the PFNA group was slightly shorter than that in the DHS group[(9.70 ± 2.45)weeks vs.(10.22 ± 2.38)weeks],but there was no statistically significant difference between the two groups(t =1.108,P ＞ 0.05).The excellent and good rate of Harris score in the PFNA group was slightly higher than that in theDHS group (94.34％ vs.86.79％),the incidence rate of postoperative complications in the PFNA group was slightly less than that in the DHS group(5.66％ vs.9.43％),but there were no statistically significant differences between the two groups (x2 =1.767,0.541,all P ＞ 0.05).Conclusion PFNA internal fixation has characteristics of less surgical trauma,less bleeding,shorter operation time and less complications.It is easy to fracture healing and functional recovery of bone and joint.

Objective To evaluate the relationship between CD4+ T lymphocyte count and results of enzyme-linked immunospot (ELISPOT) assay in human immunodeficiency virus (HIV)-Mycobacterium tuberculosis (M.tb) coinfected patients.Methods A total of 193 HIV-infected individuals in Yunnan Province and Shanghai were enrolled.T-SPOT.TB assay was employed to detect M.tb specific T lymphocyte in the peripheral blood mononuclear cells (PBMC).CD4+ T lymphocyte in PBMC from the enrolled subjects was detected by flow cytometry.Data were analyzed using t test.ResultsThe incidence of latent tuberculosis in HIV-infected individuals was 30.6％.The CD4+ T lymphocyte counts in HIV-infected individuals with active tuberculosis were 190×106/L,which were significantly lower than those in HIV-infected individuals with latent tuberculosis (484×106/L; t=6.665,P＜0.01).The HIV-infected individuals were stratified according to CD4+ T lymphocyte counts of ＞500×106/L,200×106-500×106/L,and ＜200×106/L and the constituent ratios of active tuberculosis/latent tuberculosis were 1∶16.2,1∶1.3 and 5.6∶1,respectively.Among 79 subjects with positive T-SPOT.TB results,20 were coinfected with active tuberculosis,in which 14 had CD4+ T lymphocyte counts of ＜200 ×106/L,5 had 200×105-500×106/L and 1 had ＞500×106/L.Fifty-two in 59 HIV/latent tuberculosis patients individuals had CD4+ T lymphocyte counts of ＞200×106/L.ConclusionsThe prevalence of latent tuberculosis in HIV-infected individuals is high in China.Cellular immunity in HIV-infected individuals with active tuberculosis is severely impaired.With the decrease of CD4 ′ T lymphocyte counts,patients with latent tuberculosis are prone to develop active tuberculosis in HIV-infected individuals.The negative predictive value of T-SPOT.TB is significantly diminished in patient with low CD4+ T lymphocyte counts,especially less than 200×106/L.

Objective To observe the clinical curative effect of locking plate and anatomical plate for the treatment of complex tibial plateau fractures. Methods Retrospective analyzed clinical data of 80 cases of complex tibial plateau treated in our hospital from January 2013 to January 2014, according to the different internal fixation methods and di-vided into observation group (n=40, locking plate fixation) and control group (n=40, normal anatomical steel plate treatment), through the review and analysis home visits, telephone follow-up, and review records of two groups were compared, the operation time, blood loss, operation group and control group in the amount, full weight bearing time, HSS score, complications, and the healing time of fracture by X-ray and clinical examination judgment were compared. Results The average operation time of observation group was(112.3±16.1)min, intraoperative blood loss(285.9±21.8)mL, the average operation time of control group was(130.8±22.3)min, blood loss(321.6±37.9)mL. All fractures were healed, the healing time of observation group was(13.0±1.2) weeks, full weight bearing time (14.1±1.7) weeks, the control group of fracture healing time (15.4±2.7)weeks, full weight bearing time was(16.5±2.9) weeks; HSS score of the ob-servation group was (88.3±7.2)points, the control group was (83.1±6.3)points. Comparison of two groups of patients with the above indexes, with significant difference (P<0.05 or P<0.01), the excellent rate 1 year after the operation of observation group was 90.0%, significantly higher than that in control group, the excellent and good rate was 80.0%, excellent rate of two groups with knee joint function, the difference was significant (P<0.05); the complication rate of observation group was 7.5%, the control group was 22.5%, with significant difference (P<0.05). Conclusion Compared with normal anatomical plate, the complex tibial plateau fracture locking has less bleeding, fast fracture healing, less complications and other advantages of steel plate, and can significantly improve the knee joint function of patients, is worthy of popularization and application.

Objective:To investigate the rates of low disease activity and clinical remission in patients with systemic lupus erythematosus(SLE)in a real-world setting,and to analyze the related factors of low disease activity and clinical remission.Methods:One thousand patients with SLE were enrolled from 11 teaching hospitals.Demographic,clinical and laboratory data,as well as treatment regimes were collec-ted by self-completed questionnaire.The rates of low disease activity and remission were calculated based on the lupus low disease activity state(LLDAS)and definitions of remission in SLE(DORIS).Charac-teristics of patients with LLDAS and DORIS were analyzed.Multivariate Logistic regression analysis was used to evaluate the related factors of LLDAS and DORIS remission.Results:20.7％of patients met the criteria of LLDAS,while 10.4％of patients achieved remission defined by DORIS.Patients who met LLDAS or DORIS remission had significantly higher proportion of patients with high income and longer disease duration,compared with non-remission group.Moreover,the rates of anemia,creatinine eleva-tion,increased erythrocyte sedimentation rate(ESR)and hypoalbuminemia was significantly lower in the LLDAS or DORIS group than in the non-remission group.Patients who received hydroxychloroquine for more than 12 months or immunosuppressant therapy for no less than 6 months earned higher rates of LLDAS and DORIS remission.The results of Logistic regression analysis showed that increased ESR,positive anti-dsDNA antibodies,low level of complement(C3 and C4),proteinuria,low household in-come were negatively related with LLDAS and DORIS remission.However,hydroxychloroquine usage for longer than 12 months were positively related with LLDAS and DORIS remission.Conclusion:LLDAS and DORIS remission of SLE patients remain to be improved.Treatment-to-target strategy and standar-dized application of hydroxychloroquine and immunosuppressants in SLE are recommended.