Objective To describe a technique of closed reduction and percutaneous internal fixation for the treatment of displaced patellar fractures and evaluate the clinical results. Methods Fifteen cases (nine males and six females with mean age of 35.5 years, ranging from 24 to 65 years) with displaced patellar fractures were treated with closed reduction (or an arthroscopic-assisted reduction) and percutaneous cannulated screw fixation (or Kirschner wire tension band wiring technique) under guidance of fluoroscopy or C-arm X-ray tomography. Controlled passive range of motion exercises started on the first postoperative day. The mean follow-up was 28 months (24-35 months). Results All cases healed successfully with healing time of (1.2?2.2) months and mean Lysholm II score of 86.8 (79-96), except for one patient regained full knee range of motion. Compared with the contralateral side, a mean quadriceps atrophy of 0.8 cm was seen in unilateral cases based on Tandogan measurement. There was no implant failure or postoperative infection. Conclusions The technique of closed reduction and percutaneous internal fixation is appropriate for displaced, transverse, longitudinal or oblique patellar fractures and can facilitate early postoperative range of motion exercises and accelerate rehabilitation of the affected knee with few complications and minor incision without disturbing blood supply of the patella. But, this method is not suitable for severely comminuted fractures.

Abscess ; microbiology ; therapy ; Cellulitis ; Humans ; Nasal Septum ; microbiology

Objective To investigate the possibility,surgical methods,outcome and surgical indications of minimal invasion dynamic hip plate (MIDHP) through percutaneous limited open reduction in treatment of subtrochanteric femur fractures.Methods All cases underwent percutaneous limited open reduction with MIDHP.Duration of operation,intraoperative bleeding volume,length of incision,incidence of intra-or post-operative complications of all case were recorded.X-ray films were reviewed periodically after operation to analyze aspects of fracture displacement,loosening of intemal fixation,screw cutting femoral neck,screw penetrating out of or withdrawing from femoral head,bending or breaking of internal fixation,and fracture healing.Hip joint function was evaluated according to Huang' s criteria.Results Operation lasted for 45-55 minutes (average 50 minutes),showing the incision length of 4.0-5.0 cm (average 4.5 cm) and blood loss of 50-200 ml (average 150 ml).A total of 21 cases were enrolled in the study and were followed up for 6-28 months (average 18 months).In the follow-up,loosening or bending of internal fixation,fracture displacement,screw cut-out,and screw penetrating or withdrawing from femoral head did not occur.In the meantime,incision,bone,and joint were not infected.All cases had bony fusion within 3 months with the fracture healing rate of 100％.According to Huang' s criteria,hip function was excellent in 19 cases and good in two.Conclusions MIDHP with percutaneous limited open reduction is characterized by less trauma,small incision,less blood loss,less postoperative complications,firm fixation,early functional exercise,free load,and good hip functional recovery and hence is suitable for cases of different subtrochanteric femur fractures,especially for cases combined with osteoporosis.

Objective To perform a mechanical test of fresh cadaver specimens and compare the biomechanical properties of the novel minimal invasion dynamic hip plate (MIDHP) and the dynamic condylar screw (DCS) in treatment of subtrochanteric fractures of the femur.Methods All specimens were firstly used to simulate models of Seinsheimer type ⅡA subtrochanteric fractures of the femur,which were later divided into DCS group and MIDHP group.Based on experimental requirements,the femoral head and distal femur were embedded using seff-freezing type dental base acrylic resin powder.Torsion strength test was given in the first place,succeeded by compression strength test.Finally,destructive test was made to record the limit load.All experimental data were analyzed statistically.Results Torsion strength test showed that specimens of both groups were basically stable as the reverse was within 3°.Torque for specimens in DCS and MIDHP groups was (3.16 ± 0.13) N · m and (3.31 ± 0.27) N · m respectively as the reverse was 1.5°.Both torque and torsion stiffness had no statistical significance between the two groups,and the anti-rotation features of the two internal fixations were similar.Compression strength test showed that compression stiffness of specimens in DCS group was (532.27 ±61.02) N/mm and (581.98 ±77.56) N/mm in MIDHP group at a load of 800 N,with evidently higher compression displacement and stiffness in MIDHP group (P ＜ 0.05).Destructive test showed the maximum load of specimens in DCS and MIDHP groups was (2 994.38 ±244.81) N and (3 322.13 ± 141.21) N respectively,far higher in MIDHP group (P ＜ 0.01).Conclusions MIDHP is characterized by reasonable design,strong anti-rotation property and anti-compression property over DCS.In comparison with DCS,MIDHP has biomechanical advantage in treatment of femoral subtrochanteric fractures,for it can be performed minimally invasive and is worthy of further application.

Objective To study the feasibility and clinical effect of percutaneous C2 pedicle lag screw in treatment of Hangman's fracture and define the indications of the technique. Methods There were 9 patients including 5 males and 4 females at average age of 36 years (26-68 years). According to a Levine and Edwards System, there were 5 patients with type Ⅰ hangman' s fracture, 3 with type Ⅱ hangman' s fracture and 1 with type Ⅱ A hangman' s fracture. According to American spinal injury association (ASIA) system, the spinal cord function was ranked at Type D in 2 patients and Type E in 7. All patients achieved anatomic reduction by skull traction. Under general anesthesia, 9 patients were fixed with percutaneons C2 pedicle lag screw. The whole procedure was done under monitoring of "C"-arm fluoroscopy for safety and accuracy. Results All patients obtained bony fusion within 2-3 months, with no infection, neurological deficits, vertebra artery injury or other complications. CondusionsThe percutaneous C2 pedicle lag screw fixation is minimally invasive and effective for treatment of Hangman's fracture. During the course of treatment, the function of upper cervical spine remains unaffected.

Objective To investigate radiological characteristics of the posterior tibial plateau fracture and operative treatments for the fracture.Methods Thirty-one cases of posterior tibial plateau fracture treated between February 2009 and February 2014 were enrolled.There were 19 men and 12 women aged 24-72 years (mean,42.5 years).Injury arose from traffic accidents (13 cases),falls from a height (9 cases),fall on the ground (5 cases),and crash (4 cases).Type Ⅴ in 15 cases and type Ⅵ in 15 cases were classified by the Schatzker classification.Meanwhile,all fractures were identified as three-column pattern.According to the X-ray and CT manifestations of fracture displacement,the cases with minor displacement were grouped as Group A (22 cases) and the cases with major displacement group as Group B (9 cases).Depending on the radiographic characteristics of fracture size and angle off fracture line,anterior approach for reduction and fixation was performed in Group A and combined anterolateral and posteromedial approaches in Group B.Radiographic and functional outcomes were evaluated using the Rasmussen score.Results All cases underwent one-stage surgery uneventfully.Operation time was 80-120 minutes (mean,98 minutes) in group A and was 110-165 minutes (mean,110 minutes) in Group B.Mean total operation time was 105 minutes.Period of follow-up was 6-48 months (mean,21.5 months).Rasmussen radiographic results showed total excellent to good rate of 84％ with 86％ in Group A and 78％ in Group B respectively.Rasmussen functional results showed total excellent to good rate of 87％ with 91％ in Group A and 78％ in Group B respectively.Conclusions Anterior approach or anterolateral approach combined with posteromedial approach for reduction and internal fixation is developed according the radiographic findings and degree of fracture displacement.Clinical outcome is good and associated intraarticular soft tissue injury can be managed concurrently.

Objective Preoperative autologous blood donation ( PABD) may reduce the need for allogeneic blood , but it may also cause a short massive blood loss in pregnant women , and its fetal and maternal safety has to be adequately assessed .This study was to evaluate the feasibility and safety of PABD for pregnant women and their fetuses . Methods A prospective observational study was conducted among the women who met the inclusion criteria and gave birth in Nanjing Drum Tower Hospital between January and December 2013 .According to the clinical validation of risk stratification criteria for peripartum hemorrhage of California 2013 , the ca-ses were classified into a low-, a medium-, and a high-risk group.Data on blood donation procedures , obstetric outcomes, and blood transfusions were collected after delivery for analysis . Results Totally, 92 pregnant women accomplished 115 blood donations .The median volumes of the donated blood were 300, 300, and 400 mL in the low-, medium-, and high-risk groups, respectively ( P>0.001).There were no significant changes in HR , SBP and SpO2 during the blood donation procedures (P>0.05) except for the fall of diastolic blood pressure by an average of 3.4 mmHg (P<0.05) at 5 minutes after blood collection, which was restored to normal later.Non-reassuring fetal heart rate patterns were not found in any of the cases .The levels of HB and HCT were remarkably lower af-ter donation than before it (P<0.05) but restored to normal before delivery in the PABD cases who donated once only (P>0.05), which were similar to those in the cases who donated twice , with no significant differences before and after the donation (P>0.05). Homologous blood transfusion was performed for 5 cases (17.9%) in the high-risk group, with the volume of blood loss >2000 mL in all the cases.All the newborns survived without asphyxia and there was no perinatal death . Conclusion PABD can provide timely autologous whole blood donation for pregnant women .Under strict management , PABD is feasible and safe for pregnant patients who are at a high risk for massive blood loss during delivery or have a rare type of blood no readily available .

BACKGROUND: Nanosphere, an ideal nonviral gene delivery vector, is not excellence of immunogenicity and oncogenicity. Nanotechnology and gene interference are used to block hypoxia-inducible factor 1 alpha (HIF-1α) expression in esophageal squamous carcinoma tissue and decrease tolerance of malignant cells to chemotherapeutics. Theoretically, they become effective methods to inhibit malignant cell growth of esophageal squamous carcinoma. OBJECTIVE: To study the inhibitory effect of small interference RNA targeting HIF-1α (siRNA-HIF-1α) nanospheres on human esophageal squamous cancer TE-1 cell growth. DESIGN, TIME AND SETTING: Based on in vitro cultured esophageal squamous cancer TE-1 cells, a completely randomized controlled study was performed at the Central Laboratory, the Third Hospital Affiliated to Sun Yat-sen University from January 2007 to December 2008. MATERIALS: siRNA-HIF-1α was synthesized by Shanghai Bioengineering Company; siRNA-HIF-1α nanospheres were prepared using solvent evaporation technique; human esophageal squamous cancer TE cell strain was provided by Shanghai Cell Bank of the Chinese Academy of Sciences. METHODS: TE-1 cells cultured in vitro were assigned into four groups: saline, gene-free nanospheres, siRNA-HIF-1α, and siRNA-HIF-1α nanospheres groups. MAIN OUTCOME MEASURES: HIF-1α mRNA expression was detected by RT-PCR; HIF-1α protein expression was detected by Western blot; apoptosis of TE-1 cells was determined by flow cytometry; TE-1 cell growth was examined by MTT. RESULTS: At 72 hours after treatment, both HIF-1α mRNA expression and HIF-1α protein expression in the siRNA-HIF-1α nanospheres group were significantly less than other three groups (P < 0.01), but apoptotic rate was significantly greater than other three groups (P < 0.01). TE-1 cell growth was remarkably inhibited in the siRNA-HIF-1α nanospheres group, which was significantly different compared with other three groups (P < 0.01).CONCLUSION: siRNA-HIF-1α nanospheres can specifically reduce both HIF-1α mRNA and HIF-1α protein expressions in esophageal squamous carcinoma TE-1 cells, significantly increase tumor cell apoptosis, and remarkably inhibit TE-1 cell growth.

Objective:To analyze the fetal heart rate tracing patterns in active phase and last hour before delivery,and to ex-plore the indicative role of fetal heart rate tracing patterns in different labor stages in neonatal prognosis.Methods:A total of 181 full-term vaginal delivery primiparas from February 2014 to may 2014 in Nanjing Drum Tower Hospital Affiliated to Nan-jing University Medical School.The fetal heart rate tracing patterns in the active phase and those in the last hour before deliver-y were recorded and compared with each other.Indicative significance of uncertain fetal heart rate tracing patterns duration in the last hour before delivery and long second stage of labor on neonatal prognosis was analyzed with ROC curve.Results:1.No category III fetal heart rate pattern was found in the 181 cases.The proportion of Category I fetal heart rate patterns was lower in the last hour before delivery than that in the active stage while the proportion of category II fetal heart patterns was on the contrary(P <0.05).The proportion of atypical decelerations in the last hour before delivery was significantly higher than that in the active stage(P <0.05).2.In active stage,no significant difference in any category offetal heart patten was found between the favorable prognosis group and the poor prognosis group(P >0.05).3.In the last hour before delivery,duration of category II in the poor prognosis group was longer than that in the favorable prognosis while the duration of category I was on the con-trary(P <0.05).The proportions of slow returns and non-moderate variability were higher in the poor prognosis group(P <0.05).4.The area under the ROC of the relationship between category II duration in the last hour before delivery and neonatal prognosis was 0.646 (95%CI 0.544-0.748).Conclusions:All types of atypical decelerations in fetal heart rate tracing patterns were prone to appear during the last hour before delivery.Different standards may be required to interpret fetal heart rate trac-ing patterns in the active stage and in the last hour before delivery.Category II duration in the last hour before delivery had cer-tain significance in predicting neonatal prognosis,especially the appearance of slow returns and non-moderate variability,while the duration of the second stage of labor had no relationship with neonatal prognosis.

Objective To search and integrate relevant evidence of Traditional Chinese Medicine rehabilitation care during recovery of stroke patients with limb dysfunction,and to provide the evidence for clinical practice.Methods We systematically search domestic and foreign guideline websites,professional association websites,and databases such as Cochrane Library,PubMed,Embase,CNKI,CBM for evidence on Chinese medicine rehabilitation care for limb dysfunction following stroke.The search included guidelines,clinical decisions,evidence summaries,systematic reviews,expert consensuses,and randomized controlled trials,with the search timeframe spanning from the inception of the respective databases to May 2023.The literature was evaluated and rated for quality by 2 researchers independently.Results A total of 17 articles,including 7 guidelines,4 systematic reviews,1 evidence summary and 5 randomized controlled trials were included to summarize 28 pieces of evidence on Traditional Chinese Medicine rehabilitation care for stroke patients with limb dysfunction.The evidence can be categorized into 4 areas,including evaluation,Traditional Chinese Medicine nursing technology,health education and precautions.Conclusion Traditional Chinese Medicine nursing technology for stroke patients with limb dysfunction have various forms and rich contents.Appropriate Traditional Chinese Medicine nursing techniques should be selected according to the actual situation and the willingness of patients to promote the rehabilitation of their limb functions.