OBJECTIVETo compare the efficacy of internal fixation (including PFNA and PFN) versus hip replacement (including FHR or THA) in the treatment of trochanteric fractures in adults.

METHODSReports of studies using randomized controlled trials (RCT) to compare internal fixationg with hip replacement in the management of intertrochanteric fractures were retrieved (up to January 1, 2013) from the Cochrane Library, PUBMED Data, CNKI (China National Knowledge infrastructure), Elsevier, the Chinese Biomedical Database, Wanfang Data, and manually. Methodological quality of the trials was critically assessed, and relevant data were extracted. Statistical software RevMan 5.0 was used for data-analysis.

RESULTSSeven articles were included in the meta-analysis. The results showed that,compared internal fixation with hip replacement,there were statistical significance in the duration of surgery time [WMD = -2.66, 95% CI (-5.25,-0.06), P = 0.05], intra-operative blood loss [WMD = -24.20, 95% CI (-30.38, -18.02), P < 0.000 01], hospital stays time [WMD = -4.72, 95% CI (-5.18, -4.25), P < 0.000 01], bearing load time [WMD = -29.54, 95% CI (-30.77, -28.31), P < 0.000 01], total complications rate [WMD = 0.15, 95% CI (0.11, 0.22), P < 0.000 01], the good rate of Harris scores [WMD = 1.09, 95% CI (0.54,1.32), P < 0.05]. However, there were no statistical significance in the rate of deep venous thrombosis [WMD = 1.09, 95% CI (0.47, 2.55), P > 0.05]. CON- CLUSION: Hip replacement (containing FHR or THA) for the treatment of intertrochanteric fractures is superior to internal fixa- tion in regards to the duration of surgery time, the mean duration of hosipital stays, mean post-operative down time, intra-opera- tive blood loss, the rate of post-operative good Harris scores. But there is not enough evidence to show any difference between hip replacement (containing THA or FHR) and internal fixation in regards to the rate of deep venous thrombosis. However, internal fixation for the treatment of intertrochanteric fractures is superior to hip replacement (containing FHR or THA) in regards to total complications rate.

Arthroplasty, Replacement, Hip ; methods ; Fracture Fixation, Internal ; methods ; Hip Fractures ; surgery ; Humans

Objective To develop an interlocking-style vascular shunt device for the treatment of distal limb ischemia resulting from vascular disconnection and defect.Methods A one-way interlocking buckle was designed with the space between the clamping teeth being 0.5 mm,which prevented the device from moving backwards and fixed the vessel and shunt tube conveniently.The interlocking buckle combined with silicone tube was used to connect the two ends of the defected vessel,which was compared with conventional method by suture ligation and silicone tube by the tests on vessel bursting pressure and tensile biomechanics.Results The vessel repaired with the developed device behaved better than that by the conventional method in the tests on vessel bursting pressure and tensile biomechanics (P＜0.05).Conclusion The vascular shunt device can be used for the treatment of distal limb ischemia resulting from vascular disconnection and defect,and thus facilitates the vascular graft in rear hospital after evacuation.

Objective To investigate the spinal stability reconstruction and related complications after total spondylectomy for thoracolumbar tumors. Methods From January 1997 to December 2009, 34 cases with thoracolumbar tumors treated with total spondylectomy, including 20 males and 14 females with an average age of 43 years. The tumors were located in thoracic vertebra in 27 cases and lumbar vertebra in 7, including 6 spinal metastases and 28 primary tumors. The total spondylectomy was piecemeal in 23 cases and en bloc in 11. The reconstruction methods included posterior short-segment fixation in 19 cases, multi-segmental fixation in 13, anterior intervertebral fixation in 2, titanium mesh with auto-bone graft in 20 cases, titanium mesh with bone cement in 7, bone cement filling in 2, auto-bone strut graft in 2, titanium mesh with strengthened rings in 1, artificial vertebral body replacement in 2, posterior massive bone bridging graft in 8 and bone particles graft in 26. Results The mean follow-up time was 43 months. Seven patients died, 5 suffered recurrence. Poor grafted bone fusion was found in 5 cases. The intervertebral sagittal Cobb angle of adjacent vertebra was ??after operation, 9.3?at the end of follow-up or before revision operation. The average lost angle was 14.1?for cases with multi-segmental fixation, and 21.5?with short-segment fixation. Complications included internal fixation broken (5) and loosening (2), titanium mesh subsidence (6) and displacement (3). There were 5 revision surgeries. Conclusion There are relative more complications about spinal stability reconstruction after total spondylectomy. To achieve temporary stiff fixation and long-term fusion, the posterior multi-segment fixation and massive bone bridging graft combined with the anterior artificial vertebral body replacement are effective.

Objective To investigate technique of reservation and reconstruction of the extensor mechanism in extraarticular total knee resection.Methods There were 6 cases of fresh total knee joint specimen for anatomical observation.After meglumine diatrizoate was injected into the joint capsule and the deep infrapatellar bursa,the CT examination of the knee specimen was performed.The specimens were detached according to the requirement of extraarticular knee resection,after methylene blue was injected into the joints capsule.The relationships between articular capsule,infrapatellar fat pad and deep infrapatellar bursa were observed,as well as feasibility of extraarticular total knee resection.Four patients with malignant bone tumor around the knee were performed extraarticalar total knee resection.The patellar ligament was reserved completely in 2 patients whose infrapatellar fat pads were not be involved by tumor confirmed by deep infrapatellar bursa radiography.However,the patellar ligament was split along the coronal plane in 2patients who had not undergone deep infrapatellar bursa radiography.The patients were followed up to observe results of tumor control and function of the affected knees.Results Through anatomical observation,some bursas around the knee joints,such as the suprapatellar bursa and popliteal bursa,communicated with the joint cavity,while the deep infrapatellar bursa did not.Furthermore,the infrapatellar fat pad located between the patellar tendon and joint cavity to form a good barrier to tumor invasion.So the patellar tendon could be reserved completely if the infrapatellar fat pad was not involved.Four patients were followed up for 10 to 28 months (average,19 months).At final follow-up,there was no local recurrence and metastasis in all 4 patients.The range of flexion of the affected knees ranged from 95° to 118 ° (average,105 °),and the average extension lag was 22 ° (range,10° to 40 °).The MSTS score was 72.5％.Conclusion For patients with malignant bone tumor involving the knee,the deep infrapatellar bursa radiography should be performed routinely.The patellar ligament could be reserved completely in the extraarticular total knee resection when the deep infrapatellar bursa doesn't communicate with the joint cavity combined with presence of the infrapatellar fat pad.Sometimes,only reserving the superficial half of the patellar ligament also could meet the need of extension.The short-term result of tumor control and function of the affected knee are satisfactory.

To observe a PPAR-alpha agonist effect of N-oleoylethanolamine (OEA) on CB2 (cannabinoid receptor 2), an anti-inflammatory receptor in vascular endothelial cell, healthy HUVECs and TNF-alpha induced HUVECs were used to establish a human vascular endothelial cell inflammatory model. Different doses of OEA (10, 50 and 100 micromol x L(-1)) had been given to HUVECs, cultured at 37 degrees C for 7 h and then collected the total protein and total mRNA. CB2 protein expression was detected by Western blotting and CB2 mRNA expression was assayed by real-time PCR. As the results shown, OEA (10 and 50 micromol x L(-1)) could induce the CB2 protein and mRNA expression, but not 100 micromol x L(-1). To detect if anti-inflammation effect of OEA is partly through CB2, CB2 inhibitor AM630 was used to inhibit HUVEC CB2 expression, then the VCAM-1 expression induced by TNF-alpha was detected, or THP-1 adhere to TNF-alpha induced HUVECs was examined. OEA (50 micromol x L(-1)) could inhibit TNF-alpha induced VCAM-1 expression and THP-1 adhere to HUVECs, these effects could be partly inhibited by a CB2 inhibitor AM630. The anti-inflammation effect of OEA is induced by PPAR-alpha and CB2, suggesting that CB2 signaling could be a target for anti-atherosclerosis, OEA have wide effect in anti-inflammation, it may have better therapeutic potential in anti-inflammation in HUVECs, thus achieving anti-atherosclerosis effect.

Retroperitoneal laparoscopic live donor nephrectomy offers an intrinsic advantage over conventional transperitoneal laparoscopic nephrectomy because of the potentially lower risk for early and late donor intraperitoneal complications. Herein we presented our experience performing retroperitoneal laparoscopic live donor nephrectomy in 105 donors. All donor nephrectomy was successful. There were no donor deaths and no conversion to open surgery. Mean operation time was 112 min (range, 70-200 min). Intraoperative blood loss was 10-150 mL with an average of 30 mL. Warm ischemia time was 1.3 to 6 min with an average of 3.1 min. Postoperative retroperitoneal hematoma occurred in only one case and there were no other surgical complications. Donors were discharged from the hospital 5 to 10 days postoperation. Average postoperative hospital stay was 6.4 days. One graft was removed due to acute rejection. Delayed graft function occurred in two recipients but renal function returned to normal within four weeks. The other recipients had normal renal function in two weeks except three recipients in four weeks. We believe that retroperitoneal laparoscopic live donor nephrectomy is safe, reliable, and less invasive.

Humans ; Influenza, Human ; mortality ; Regression Analysis

OBJECTIVETo observe the effect of Xiaoyao Nose Drops (XYND) in stopping episode of migraine.

METHODSAdopted was the randomized double-blinded placebo-controled method, with the 126 patients equally assigned to two groups, the treated group treated with XYND and the control group with placebo, and the therapeutic course was 30 days for all. The clinical total effective rate and effect in alleviating headache were observed. And hemorrheological parameters as well as the blood flow of the anterior cerebral artery (ACA), median cerebral artery (MCA) and posterior cerebral artery (PCA) were measured before and after treatment.

RESULTSThe clinical total effective rate and headache alleviating rate in the treated group were 93.33% and 96.67% respectively, while those in the control group were 18.33% and 20.00% respectively, and comparison between the two groups showed significant difference (all P < 0.01). The blood viscosity (high, middle and low shear), plasma viscosity and fibrinogen got lowered significantly in the treated group after treatment, showing significant difference in comparison either with those before treatment or with those in the control group after treatment (P < 0.05 or P < 0.01). The velocity of blood flow in all cerebral arteries lowered significantly, also showing significant difference in comparison either with those before treatment or with those in the control group after treatment (P < 0.05 or P < 0.01).

CONCLUSIONXYND is effective in stopping the headache of patients with migraine, and worth applying in clinical practice.

Administration, Intranasal ; Adolescent ; Adult ; Aged ; Blood Flow Velocity ; drug effects ; Blood Viscosity ; drug effects ; Cerebrovascular Circulation ; drug effects ; Double-Blind Method ; Drugs, Chinese Herbal ; administration & dosage ; pharmacology ; therapeutic use ; Female ; Fibrinogen ; analysis ; Humans ; Male ; Middle Aged ; Migraine Disorders ; drug therapy

OBJECTIVETo investigate the results and indication of differently internal fixation for intertrochanteric fracture and prevent for complication.

METHODSOne hundred and two patients of intertrochanteric fracture of femur from January 1997 to December 2007 were reviewed and analysed. There were 46 males and 56 females, with an average age of 76.5 years ranging from 60 to 93 years. There were 34 cases of stability fractures and 68 of instability fractures. The methods of internal fixation included dynamic hip screw in 82 cases, proximal interlocking nail in 5, multi-screw fixation in 9, dynamic codylar screw in 6.

RESULTSThese patients were followed up for 6 to 72 months (36 months in average). The time of fracture healing was from 8 to 12 weeks. According to evaluation criterion of effect, the results were excellent in 72 cases, good in 20, fair in 10. After operation, there were 3 cases of coax vara, 2 cases of lag screws cutting out, 1 case of breakage of screw, 2 cases of avascular necrosis of the femoral head, 1 case of postoperative infection, 1 case of delayed union.

CONCLUSIONSuitable implant selection according the type of fracture, health condition is an important factor to reduce the incidence of complication for unstable fracture in aged patients. DHS is a main treatment of intertrochanteric fracture. PFN is recommended for serious osteoporosis or unstable intertrochanteric fracture. Compression screws is a choice for the fixation of type I and type II fracture of bad health condition.

Aged ; Aged, 80 and over ; Bone Screws ; Female ; Fracture Fixation, Internal ; methods ; Fracture Fixation, Intramedullary ; methods ; Fracture Healing ; physiology ; Hip Fractures ; complications ; surgery ; Humans ; Joint Instability ; physiopathology ; Male ; Middle Aged ; Postoperative Complications ; prevention & control