Objective To observe the outcomes of hip arthroplasty with modular S-ROM prosthesis for failed internal fixation of intertrochanteric fracture.Methods Fifteen patients who had been admitted for failed internal fixation of intertrochanteric fracture from January 2013 to May 2015 were reviewed retrospectively in this study.They were 9 men and 6 women,aged from 55 to 86 years (average,72 years).Their primary internal fixation methods included dynamic hip screw (DHS) in 7 patients,proximal femoral nail anti-rotation (PFNA) in 5 and proximal femoral locking plate in 3.The causes for internal fixation failure were implant loosening in 5 patients,screw breakage in 6,and cutting-out of screws in 4.All the patients received hip arthroplasty with modular S-ROM prosthesis to treat their fracture nonunion or displacement.Harris hip scores were measured before operation and at the final follow-up.Results Their average operative time was 156 min (from 118 to 180 min) and average intraoperative blood loss 432 mL (from 230 to 700 mL).No fracture or neurovascular damage occurred during operation.The 15 patients were followed up for 13 to 35 months (mean,24 months).Postoperative dislocation of the artificial joint happened in one patient and nonunion of the greater trochanter due to massive bone defects was observed in 2 patients.Follow-ups showed none of the patients had such severe complications as infection,deep vein thrombosis or peri-prosthesis fracture.At the last follow-up,15 patients obtained Harris hip score of 90.6 (from 78 to 95),with 11 excellent,3 good and one fair cases.Conclusion Hip arthroplasty with modular S-ROM prosthesis is a safe and effective treatment for failed internal fixation of intertrochanteric fracture.

Optimizing the salary system of general practitioners and establishing a compensation incentives mechanism fitting its needs, would contribute effectively to the development of the general practitioner system in China. Fully leveraging the salary incentive system, the United Kingdom(UK) effectively improved the working enthusiasm of general practitioners and its quality of primary medical services, and limited its medical expenses as well. The authors expounded the incentive mechanism of general practitioners′ salary in the UK from such dimensions as salary model and salary structure, and introduced the implementation effect. Based on Robbins′ comprehensive incentive theory, the authors introduced the internal logic of the UK′s general practitioners′ salary incentive mechanism. Based on the UK experiences, along with existing problems in China, the authors recommended on setting up value-based salary levels, optimizing the salary structure, and establishing a dynamic adjustment mechanism. These ideas are expected to help optimize the salary incentive mechanism for general practitioners in China.

Objective:To investigate the protective effect of external diaphragm pacing on the prevention of ventilator-induced diaphragm dysfunction (VIDD) in rabbits and its mechanism.Methods:Eighty-five New Zealand white rabbits were randomly (random number) divided into the blank control group (BC, n=5), spontaneous breathing group (SB, n=20), volume control ventilation group (VC, n=20), external diaphragm pacing group (EDP, n=20), external diaphragm pacing and volume control ventilation group (EDP+ VC, n=20). After successful modeling, the rabbits in each group were treated accordingly except for the BC group. Rabbitss in the BC group were not mechanically ventilated, and the diaphragm was removed immediately after anesthetizing. Whole diaphragms of 5 rabbits per time point per other group were also collected after anesthesia at post treatment hour (PTH) 6 and on post treatment day (PTD) 1, 3, and 7. Diaphragm weight/body weight and diaphragm isometric contractile force of each group were measured. The pathological changes of diaphragmatic tissues were observed by HE staining. The protein expressions of Cyt c, RyR1, caspase-3, and p-mTORC1 were measured by Western blot. Repeated measures analysis of variance was used for the comparison between multiple groups of variables at different time points, and LSD- t test was used for the further comparison between two groups at the same time point, a P<0.05 was considered statistically significant. Results:Compared with the BC group, the VC group showed diaphragmatic pathological changes conformed to VIDD: DW/BW was decreased obviously; HE staining revealed obvious changes in diaphragmatic tissue; Diaphragmatic contractility was also significantly decreased; The expression of Cyt c and caspase-3 were increased while the expression of RyR1 and p-mTORC1 were decreased gradually with the extension of treatment time ( P<0.05). Compared the EDP+VC group with the VC group, with the extension of treatment time, DW, DW/BW, pathological damages and diaphragmatic contractility were improved [PTD 1: (0.80±0.05)kg vs (0.56±0.04) kg, PTD 3: (1.06±0.05) kg vs (0.47±0.03) kg, PTD 7: (1.24±0.10) kg vs (0.39±0.07) kg, all P<0.05; PTD 1: (2.05±0.54) vs (1.86±0.72), PTD 3: (2.19±0.61) vs (1.74±0.40), PTD 7: (2.46±0.62) vs (1.53±0.85), all P<0.05; PTD 1: (2.39±0.42) N/cm 2vs (1.91±0.25) N/cm 2, PTD 3: (2.57±0.62) N/cm 2vs (1.72±0.50) N/cm 2, PTD 7: (2.77±0.55) N/cm 2vs (1.54±0.33) N/cm 2, all P<0.05]. The expression of Cyt c and caspase-3 were decreased while the expression of RyR1 and p-mTORC1 were increased gradually in the EDP+VC group ( P<0.05). Conclusions:External diaphragm pacer plays a protective role in ventilator-induced diaphragm dysfunction, which can inhibit mitochondrial damage, reduce oxidative damage, and mitigate diaphragmatic atrophy and injury.