BACKGROUND:The most effective method for the treatment of acetabular fracture is open reduction and internal fixation, however, this treatment for some special types of acetabular fracture cannot get satisfactory prognosis, and is prone to complications, such as traumatic coxarthrosis and avascular necrosis of femoral head. OBJECTIVE:To evaluate the curative effect of open reduction and internal fixation and total hip arthroplasty in the treatment of special acetabular fracture. METHODS:Twelve cases of acetabular fracture were included, including seven cases of traffic accident wound, three cases of crush injury, and two cases of fal ing injury. The type of bone fracture:two cases of posterior wal fracture, two cases of posterior column and posterior wal fracture, one case of T shaped fracture, five cases of transverse and posterior wal fracture, and two cases of acetabular roof sexual fracture. Complications:one case was femoral head centric dislocation, five cases were latter dislocation, and three cases were caput femoris fractures. Before injury, three cases had coxarthrosis, and two cases were avascular necrosis of femoral head. Al the cases were treated with open reduction internal fixation and total hip arthroplasty, of which nine cases were treated with biological prosthesis, and three cases were treated with bone cement prosthesis. The time from hospitalization to surgery was 3-15 days, and average was 6 days. The patients were fol owed-up once every 2 months in 1 year after replacement, and the Harris score was used to evaluate the hip function recovery. RESULTS AND CONCLUSION:No surgical site and deep wound infection, joint dislocation, lower limb deep vein thrombosis, and death were found in these 12 cases. Among them, 11 cases were fol owed-up for a longtime;the fol ow-up was lasted for 6-82 months. The acetabular fracture was healed at 6-16 months after reduction without prosthesis loosening and sinking. The hip function was evaluated during final fol ow-up according to the Harris score:excellent in eight cases, good in two cases, poor in one case, and the excellent and good rate was 91%. Open reduction internal fixation and one-stage total hip arthroplasty can avoid long-term bed, get out of bed as soon as possible, and reduce complications, thus reconstruct the hip joint painlessly and good functional y.

Objective To investigate the effect of prosthetic replacement for senior patients with unstable intertrochanteric fractures of the femur.Methods Fifty-three senior patients with comminuted intertrochanteric fracture of the femur were subjected to total hip arthroplasty (n =23) and bipolar artificial femoral head replacement (n =30).Uncemented long-stem prostheses were used in 50 patients and cemented long-stem prostheses in 3.Time interval between admission and surgery was 3-13 days (mean 6 days).Results The total hip arthroplasty had the operation time for mean 90 minutes (range,80-110 minutes) and blood loss for mean 350 ml (range,260-410 ml).While the hemiarthroplasty had operation time for mean 65 minutes (range,50-90 minutes) and blood loss for mean 230 ml (range,180-290 ml).Fifty-one patients were available to mean 49.6-month follow-up (range,13-65 months).Four patients presented with frequent hip pain at a tolerable level after hemiarthroplasty and the symptom was relieved after oral non-steroidal anti-inflammatory drug therapy.One patient with postoperative infection was cured by timely debridement.Seven patients were died of heart and brain disorders in 5 years,with no relation to surgical complications.The period for fracture healing was mean 10 months,with excellence rate of 96％ for hip function but with no acetabulum abrasion,implant loosening or submersion.Conclusion Early prosthetic replacement is an effective treatment for unstable intertrochanteric femoral fractures in the elderly.

Objective To investigate clinical effect of surgical repair and reconstruction of traumatic floating shoulder injuries (FSI). Methods Sixteen patients with FSI were treated with open re-duction and reconstructive internal plate fixation. Of all, one patient was with transverse clavicle fracture, six with oblique clavicle fracture and nine with comminuted clavicle fracture. There was one patient with type Ⅰ scapula fracture, three with type Ⅱ, four with type Ⅲ, six with type Ⅳ and two with type Ⅴ. The combined injuries included rib fracture plus hemopneumothorax in six patients, traumatic moist lung in two, craniocerebral injuries in two, hepatic and splenic rupture in two and brachial plexus damage in one. The average time from primary injury to operation was seven days (3-21 days). Results Fifteen out of 16 patients were followed up for 6-28 months (average 11 months). All patients obtained bone u-nion, without infection, loosening or breakage of internal fixation. According to Herscvici evaluation standard of function, the shoulder joint outcome was rated as excellent in 11 patients, good in three and fair in one, with excellence rate of 93%. Conclusion The surgical repair and reconstruction of FSI can, to a greatest extent, recover the anatomical structure and stability around the shoulder joint and shorten the immobilization period of joint, which is beneficial to functional restoration of the joint and de-crease of occurrence of complications.

Objective:To present the surgical technique and to evaluate the results of the modified ar-throscopic Latarjet procedure.Methods: Arthroscopic Latarjet procedure has proven to be a reliable method of treatment for difficult anteroinferior instability of the shoulder joint.However, there is no ante-rior capsule reattachment and too much subscapularis damage for the classic procedure.From February 2013 , we modified the classic procedure with reattachment of anterior joint capsule and muscle-tendon junction splitting of subscapularis.Coracoid graft position was evaluated using CT scanning.Results:From March 2012 to August 2014, 51 modified Latarjet procedures were successfully performed arthro-scopically for patients with anterior shoulder instability.According to the CT scanning at the final follow up, the graft was flush with the glenoid in 94.1%, and medially placed in 5.9%.Vertical positioning was perfect in 96.0%(2 to 5 o’clock), too high in 2.0%, and too low in 2.0%.There were no cases of recurrent dislocation or subluxation.Conclusion: The modified arthroscopic Latarjet procedure has shown satisfactory results with good graft positioning.It is a minimal invasive and accurate approach, which combines the advantages of the open procedure.

To study the infection rate of leaf spot disease, the drying rate of root and volatile oil content of Asarum heterotropoides var. mandshuricum at the unwrapping stage, blooming stage, the initial fruit stage, fructescence and wither stage during the growth period under the different sunlight intensity of 100% (I), 50% (II), 28% (III), 12% (IV). The volatile oil content was measured according to the method of Chinese Pharmacopoeia and the oil composition was determined by GC-MS. The unwrapping stage, blooming stage and the early fruit stage postponed about 2 days with decrease of the sunlight intensity. The infection rate of leaf was 88.46%, 70.00%, 0.23%, 0.07% under light intensity of I, II, III and IV, respectively, the drying rate was 25.14%, 28.27%, 30.23%, 31.57% under light intensity of I, II, III and IV, respectively, and the volatile oil content was 18.1, 17.6, 16.3, 15.3 mL x kg(-1) under light intensity of I, II, III and IV, respectively. The composition of the oil determined by GC-MS was different between the groups, but the content did not changed significantly with the decrease of the light intensity.
Asarum ; growth & development ; radiation effects ; Light ; Regression Analysis

OBJECTIVE:To investigate improvement effect of external administration of water extract from Eriocarpous Glochidion on chronic dermatitis-eczema model mice, and to provide reference for developing new dermatological drug. METHODS:A total of 60 mice were randomly divided into blank group (distilled water), model group (distilled water), compound triamcinolone acetonide acetate group (positive control group, original liquid) , high-concentration, medium-concentration and low-concentration groups of water extract from Eriocarpous Glochidion(2.0,1.0,0.5 g/mL,calculated by crude drug),10 mice in each group. Except for blank group,other groups were given 2,4-dinitrochlorobenzene to induce chronic dermatitis-eczema model. Since the third day of the experiment,two sides of right ears of the mice were given relevant medicine twice at 7:00 and 15:00,15 μL each time,for consecutive 12 d. In the tenth,thirteenth,sixteenth day of the experiment,the difference of thickness of right ears of the mice was calculated(the difference value before experiment),the times of scratching in ear of mice were recorded within 30 min. In sixteenth day of the experiment,ear swelling degree of mice was determined,and thymus index and spleen index in mice were calculated. Optical microscope was used to observe the pathological changes of ear tissues of mice. RESULTS:Compared with blank group,the difference of thickness of right ears,ear swelling degree,spleen index and scratching times were increased significantly in model group(P<0.05 or P<0.01). The epidermis of the ear tissue was thickened,the cell proliferation was obvious,and cavernous edema was found in the epidermis. Compared with model group,other indexes in were decreased significantly,except that the difference value of thickness of right ears in sixteenth day of the experiment,scratching times in ninth and fifteenth day of the experiment were decreased slightly in low-concentration group of water extract from Eriocarpous Glochidion and the thymus index and spleen index in medium-concentration, low-concentration groups of water extract from Eriocarpous Glochidion (P<0.05 or P<0.01). The pathological changes of ear tissue were improved in administration groups to certain extent. CONCLUSIONS:External administration of water extract of Eriocarpous Glochidion has good improvement effect against chronic dermatitis-eczema in mice, which is worthy of further development and investigation.

Objective To investigate the development and application of blood purification in PICU. Methods The demographic data,diagnosis,length of stay,prognosis,patterns and frequency of blood purifi-cation and complications of PICU patients treated with blood purification in our hospital from 2010 to 2017 were retrospectively analyzed. Results The patients with blood purification accounted for 3. 1％ of hospital-ized children in the same period. From 2010 to 2017,the patients and times with blood purification increased by 370. 6％ and 398. 3％ respectively. The times of continuous veno-venous hemodiafiltration(CVVHDF), plasma exchange and hemoperfusion increased by 135. 2％,6300％ and 1600％ respectively. The frequency of CVVHDF,plasma exchange and hemoperfusion accounted for 42. 8％(492/1151),33. 5％(386/1151), and 23. 7％ (273/1151) respectively. Drug and toxic poision accounted for the highest proportion of 28. 6％(81/284),neurological diseases accounted for 20. 8％(59/284),sepsis with multiple organ dysfunction syn-drome accounted for 18. 0％( 51/284 ) , digestive system diseases, autoimmune diseases, renal diseases and metabolic diseases accounted for 14. 4％( 41/284 ) ,4. 9％( 14/284 ) ,4. 9％ ( 14/284 ) and 4. 2％( 12/284 ) respectively. The cure rate was 63. 8％. Complication included thrombus. Conclusion Blood purification has become the preferred modality for the management of critically ill children. Pediatric blood purification tech-niques have developed rapidly in our PICU and domestic pediatric. Further specification is required,so that it may represent the adequate choice for critical ill children.

Objective:To compare the 1-year effects of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy with Roux-en-Y duodenal bypass (SG+RYDJB) on weight loss, remission of diabetes, and postoperative complications in patients with obesity and type 2 diabetes.Methods:A single-center retrospective cohort study was conducted at the First Affiliated Hospital of Nanjing Medical University from January 2020 to December 2020. Sixty-four patients with type 2 diabetes and body mass index (BMI) of 27.5-40.0 kg/m 2 were included in this study and divided into the RYGB group ( n=34) and the SG+RYDJB group ( n=30). In both procedures, the biliopancreatic branch was measured 100 cm distal to the Treitz ligament, and the food branch was measured 100 cm distal to the gastric or duodenojejunal anastomosis. Patients were followed up by telephone or WeChat, a free messaging and calling app at 1, 3, 6, and 12 months postoperatively to determine their weight loss and remission of diabetes. The primary outcomes were the weight loss and reduction in blood glucose concentrations at 1 year after surgery and postoperative complications. Other postoperative changes, including body weight, BMI, percentage of total weight loss (%TWL), percentage of excess weight loss (%EWL), glycated hemoglobin A1c (HbA1c), and fasting blood glucose at 1 year after surgery were also assessed. Results:There were no significant differences in baseline data between the two groups (all P>0.05). No conversion to open surgery or death occurred in either group. Operation time was longer in the SG+RYDJB than the RYGB group (137.8±22.1 minutes vs. 80.0±24.9 minutes, t=9.779, P<0.001) and the incidence of perioperative complications was higher in the SG+RYDJB than the RYGB group (20% [6/30] vs. 2.9% [1/34], χ 2=4.761, P=0.029). However, the postoperative hospital stay was similar between the two groups [3.0 (3.0, 4.3) days vs. 3.0 (4.0, 6.0) days, U=641.500, P=0.071]. Perioperative complications comprised small gastric pouch anastomotic leakage in one patient in the RYGB group and leakage (three patients) and bleeding (two patients with gastrointestinal bleeding and one with trocar site bleeding) in the SG+RYDJB group. Long-term complications were as follows. The incidence of anemia was significantly higher in the RYGB than the SG+RYDJB group (26.5% [9/34] vs. 3.3% [1/30], χ 2=6.472, P=0.011). However, there were no significant differences in incidences of postoperative reflux, dumping syndrome, alopecia, diarrhea, constipation or foul-smelling flatus between the two groups (all P>0.05). Compared with 1 year before surgery, the body weights and fasting plasma glucose concentrations of patients in the SG+RYDJB and RYGB group (72.4±10.6 kg vs. 98.5±14.2 kg, respectively; 68.2±10.0 kg vs. 91.9±14.8 kg, respectively), BMI (25.2±2.9 kg/m 2 vs. 34.3±4.2 kg/m 2, respectively; 24.3±2.4 kg/m 2 vs. 32.7±3.7 kg/m 2, respectively) (5.5±1.6 vs. 10.6±3.3, respectively; 5.8±2.1 vs. 9.0±3.4, respectively); HbA1c (5.7±0.8 vs. 9.7±1.2, respectively; 9.1±1.9 vs. 5.9±0.9, respectively) were significantly lower at 1 year after surgery (all P<0.05). However, the % TWL (26.5%±6.0% vs. 25.6%±4.4%, t=0.663, P=0.510) and % EWL (109.1%±38.2% vs. 109.4%±40.3%, t=-0.026, P=0.026), rate of complete remission of diabetes at 1 year (80.0% [24/30] vs. 82.4% [28/34], χ 2=0.058, P=0.810] did not differ significantly between the two groups (all P>0.05). Conclusions:Although SG+RYDJB surgery compared with RYGB is more difficult to perform, it can achieve similar weight loss and remission of diabetes and is associated with a lower incidence of anemia because of the preservation of the pylorus.

Objective:To compare the 1-year effects of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy with Roux-en-Y duodenal bypass (SG+RYDJB) on weight loss, remission of diabetes, and postoperative complications in patients with obesity and type 2 diabetes.Methods:A single-center retrospective cohort study was conducted at the First Affiliated Hospital of Nanjing Medical University from January 2020 to December 2020. Sixty-four patients with type 2 diabetes and body mass index (BMI) of 27.5-40.0 kg/m 2 were included in this study and divided into the RYGB group ( n=34) and the SG+RYDJB group ( n=30). In both procedures, the biliopancreatic branch was measured 100 cm distal to the Treitz ligament, and the food branch was measured 100 cm distal to the gastric or duodenojejunal anastomosis. Patients were followed up by telephone or WeChat, a free messaging and calling app at 1, 3, 6, and 12 months postoperatively to determine their weight loss and remission of diabetes. The primary outcomes were the weight loss and reduction in blood glucose concentrations at 1 year after surgery and postoperative complications. Other postoperative changes, including body weight, BMI, percentage of total weight loss (%TWL), percentage of excess weight loss (%EWL), glycated hemoglobin A1c (HbA1c), and fasting blood glucose at 1 year after surgery were also assessed. Results:There were no significant differences in baseline data between the two groups (all P>0.05). No conversion to open surgery or death occurred in either group. Operation time was longer in the SG+RYDJB than the RYGB group (137.8±22.1 minutes vs. 80.0±24.9 minutes, t=9.779, P<0.001) and the incidence of perioperative complications was higher in the SG+RYDJB than the RYGB group (20% [6/30] vs. 2.9% [1/34], χ 2=4.761, P=0.029). However, the postoperative hospital stay was similar between the two groups [3.0 (3.0, 4.3) days vs. 3.0 (4.0, 6.0) days, U=641.500, P=0.071]. Perioperative complications comprised small gastric pouch anastomotic leakage in one patient in the RYGB group and leakage (three patients) and bleeding (two patients with gastrointestinal bleeding and one with trocar site bleeding) in the SG+RYDJB group. Long-term complications were as follows. The incidence of anemia was significantly higher in the RYGB than the SG+RYDJB group (26.5% [9/34] vs. 3.3% [1/30], χ 2=6.472, P=0.011). However, there were no significant differences in incidences of postoperative reflux, dumping syndrome, alopecia, diarrhea, constipation or foul-smelling flatus between the two groups (all P>0.05). Compared with 1 year before surgery, the body weights and fasting plasma glucose concentrations of patients in the SG+RYDJB and RYGB group (72.4±10.6 kg vs. 98.5±14.2 kg, respectively; 68.2±10.0 kg vs. 91.9±14.8 kg, respectively), BMI (25.2±2.9 kg/m 2 vs. 34.3±4.2 kg/m 2, respectively; 24.3±2.4 kg/m 2 vs. 32.7±3.7 kg/m 2, respectively) (5.5±1.6 vs. 10.6±3.3, respectively; 5.8±2.1 vs. 9.0±3.4, respectively); HbA1c (5.7±0.8 vs. 9.7±1.2, respectively; 9.1±1.9 vs. 5.9±0.9, respectively) were significantly lower at 1 year after surgery (all P<0.05). However, the % TWL (26.5%±6.0% vs. 25.6%±4.4%, t=0.663, P=0.510) and % EWL (109.1%±38.2% vs. 109.4%±40.3%, t=-0.026, P=0.026), rate of complete remission of diabetes at 1 year (80.0% [24/30] vs. 82.4% [28/34], χ 2=0.058, P=0.810] did not differ significantly between the two groups (all P>0.05). Conclusions:Although SG+RYDJB surgery compared with RYGB is more difficult to perform, it can achieve similar weight loss and remission of diabetes and is associated with a lower incidence of anemia because of the preservation of the pylorus.

Objective:To investigate the influencing factors of reflux esophagitis after sleeve gastrectomy and its plus procedures.Methods:The retrospective case-control study was conducted. The clinical data of 130 patients who underwent sleeve gastrectomy and its plus procedures (jejunal bypass, duodenal-jejunal bypass) for the treatment of metabolic diseases in the First Affiliated Hospital of Nanjing Medical University from May 2010 to August 2021 were collected. There were 34 males and 96 females, aged (32±8)years, with the body mass index (BMI) as (38±7)kg/m 2. Observation indicators: (1) incidence of reflux esophagitis before and after surgery; (2) clinical manifestations of reflux esophagitis and treatment; (3) influencing factors of reflux esopha-gitis after surgery; (4) follow-up. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test or Fisher exact probability. In univariate analysis, the median value of clinical variable was used for grouping and the chi-square test was used for subsequent analysis. Multivariate analysis was conducted using Logistic stepwise regression model. Results:(1) Incidence of reflux esophagitis before and after surgery. Of 130 patients, there were 5 cases with Los Angeles classification grade A reflux esopha-gitis before the surgery, and there were 35 cases with reflux esophagitis after surgery, including 26 cases as Los Angeles classification grade A esophagitis, 8 cases as Los Angeles classification grade B esophagitis and 1 case as Los Angeles classification grade C esophagitis. There was a significant difference in the incidence of reflux esophagitis for patients before and after surgery ( P<0.05). (2) Clinical manifestations of reflux esophagitis and treatment. The 5 patients with preoperative reflux esophagitis described with no obvious heartburn and acid regurgitation and did not receive treat-ment. For the 35 patients with postoperative reflux esophagitis, 22 cases described with heartburn and acid regurgitation, and 13 cases described without any symptoms. Of the 35 patients, 10 were treated with continuous oral proton pump inhibitors, 2 were treated with intermittent oral proton pump inhibitors, 10 were relieved by dietary adjustment, and 13 were not treated. For the 95 patients without postoperative reflux esophagitis, 5 cases described with heartburn and acid regurgitation, requiring continuous oral proton pump inhibitor treatment. The remaining 90 cases described no heartburn and acid regurgitation and did not receive treatment. (3) Influencing factors of reflux esophagitis after surgery. Results of multivariate analysis showed that the preoperative reflux diagnostic questionnaire scoring >0 and the occurrence of postoperative heartburn and acid regurgi-tation were independent risk factors of postoperative reflux esophagitis ( odds ratio=7.84, 47.16, 95% confidence interval as 2.04?30.20, 11.58?192.11, P<0.05). (4) Follow-up. All 130 patients were followed up for 17(range, 12?60)month after surgery. The BMI, percentage of total weight loss, diabetes remission rate, fasting blood glucose and glycosylated hemoglobin of the 130 patients at postoperative 12 month were (25±4)kg/m 2, 31%±8%, 84.6%(22/26), (5.6±1.2)mmol/L and 5.9%±1.3%. Conclusions:The sleeve gastrectomy and its plus procedures increase the risk of postoperative reflux esophagitis. Preoperative reflux diagnostic questionnaire scoring>0 and the occurrence of postoperative heartburn and acid regurgitation are independent risk factors of postoperative reflux esophagitis. Dietary adjustment and proton pump inhibitor therapy can alleviate symptoms of reflux esophagitis, but cannot cure reflux esophagitis.