OBJECTIVETo systematically review the effectiveness of bone substitute augmentation combined with internal fixation versus internal fixation alone in treating proximal femoral fractures in the elderly.

METHODSSubject term and keywords were searched from Pubmed, Cochrane databases and CNKI from database foundation to August 2015. Randomized controlled studies and qusi-randomized controlled studies on bone substitutes augmentation combined with internal fixation versus internal fixation alone for the treatment of proximal femoral fractures in the elderly were chosen. Postoperative re-displacement, re-operation rate, complications (infection and bone ununion), functional outcome, quality of life scores and muscle strength were seen as outcome indicators. Enumeration data were statistical analyzed by risk difference and 95% confidence interval. Measurement data were analyzed by standardized mean difference and 95% confidence interval. If the same measurement data were evaluated by different standards in different studies, standardized mean differences and 95% confidence interval were used. The methods of statistical analysis were used by Cochrane databases.

RESULTSEleven RCTs (677 patients) were included. Meta-analysis results indicated that bone substitutes augmentation combined with internal fixation occurred fewer re-displacement [SMD = -0.75, 95% CI (-1.03, -0.47)] and obtained better function [SMD = 0.40, 95% CI (0.20, 0.59)]. While there were no significant differences in reoperation rate [RD = 0.02, 95% CI (-0.05, -0.09)], pain at 1 week after operation [MD = -1.79, 95% CI (-13.55, -9.96)], pain ranged from 6 to 8 weeks [MD = -7.24, 95% CI (-20.07, -5.59)], postoperative pain at 12 weeks [MD = -0.32, 95% CI (-4.9, -3.55)], muscle strength [MD = 1.25, 95% CI (-6.98, -9.48)], bone ununion [RD = 0.02, 95% CI (-0.01, -0.05)] and postoperative complications [MD = 0.01, 95% CI (-0.03, -0.04)].

CONCLUSIONCompared with single internal fixation, bone substitutes augmentation combined with internal fixation for the treatment of proximal femoral fractures in the elderly less occur re-displacement and could obtain better functional recovery.

Aged ; Aged, 80 and over ; Bone Substitutes ; administration & dosage ; Female ; Femoral Fractures ; surgery ; therapy ; Fracture Fixation, Internal ; Humans ; Male ; Middle Aged ; Randomized Controlled Trials as Topic ; Treatment Outcome

It is an important teaching task how to make respiratory disease specialists to accept the standardization training of pulmonary function. However, the theory of pulmonary function is comparatively abstract and the training time is short, but the task is heavy. In order to explore a set of feasible training mode, the pulmonary function laboratory of Zhongshan Hospital affiliated to Fudan University carries out various forms of training, such as compiling textbooks, establishing case database, using multimedia teach-ing, arranging one-to-one guided teaching, and training the ability of doctor-patient communication.

Objective To investigate the role of Wnt signaling pathway hypofunction mediated by dephosphorylation ofβ-catenin in the impaired wound healing of type 1 diabetic rats. Methods The back skin defect wounds were produced in rats with type 1 diabetes. These rats were divided into control, diabetes, lithium chloride treatment, and epidermal growth factor ( EGF) treatment groups. The situation of back wound healing, the ratio ofβ-catenin positive cells,β-catenin, phosphorylatedβ-catenin, and vascular endothelial growth factor ( VEGF) levels were detected. Results Compared to diabetes group, the wound granulation tissue was more mature, wound healing time was shorter, and healing rate, as well as the ratio ofβ-catenin positive cells, dephosphorylatedβ-catenin, and VEGF levels, were higher in normal group, lithium chloride treatment group, and EGF treatment group ( P<0. 05 or P<0. 01). Conclusion The hypofunction of Wnt signaling pathway is involved in the process of wound healing in type 1 diabetic rats, of which the dephosphorylation ofβ-catenin is the key point. EGF may play a beneficial role in the wound healing of type 1 diabetic rat models via Wnt pathway.

Objective To discuss the diagnosis and management and prevention of spontaneous renal allograft rupture. Methods A retrospective analysis of 12 spontaneous renal allograft rupture was conducted. Clinical presentations were similar in all patients: sudden pain and swelling over the graft and declining blood pressure accompanied by anufia. Color-ultrasound combined with clinical manifestation had higher sensitive in detecting a case. Eleven cases were performed emergency operation, 3 of them lost their kidneys, 8 of them were performed transplant-preserving operation,2 cases lost their allograft because of rerupture of the kidney. Conservative therapy was carried on 1 case. Results Five cases of transplant nephrectomy were given hemodialysis to maintain, 6 eases who had accepted surgery to retain kidney transplantation and 1 case of using conservative treatment were cured and discharged. Conclusions Acute rejection and acute tubular necrosis are the main causes of spontaneous renal allograft rupture. Color-ultrasound combined with clinical manifestation have higher sensitive in detecting a case. As soon as possibly adopting internal medicine, surgery for a joint deal with the breakdown of renal aUograft rupture is important.Prevention should begin with the removal of the kidney, operation of the renal graft, rational use of immunodepressants, and early management of transplant rejection.

Objective To further investigate direct effects of dipeptidyl peptidase-4(DPP4) on calcification and to identify responsible signaling pathways in human vascular smooth muscle cells (HVSMC). Methods The effect of DPP-4 on calcification of HVSMC was observed by alizarin red, and Western blot was used to detect whether DPP4 induced calcification-related protein expressions through extracellular signal-regulated kinases 1/2 (ERK1/2) pathway. Results The Alizarin red staining results showed that calcified nodules in DPP4 group were significantly increased as compared with control group, similar to calcification group.The protein expressions of osteoprotegerin (OPG), osteopontin (OPN), Runt-related transcription factor 2 (RUNX2), and bone morphogenetic protein 2 (BMP2) were stimulated by DPP4 in a concentration- and time-dependent manner. The phosphorylation level of ERK1/2 was significantly increased after DPP4 incubation for 15 min (P<0.05). PD98059, an ERK1/2 inhibitor, significantly lowered DPP4-stimulated expressions of calcification-related proteins (P<0.05). Conclusion DPP4 may promote the calcification of HVSMC through ERK1/2 signaling pathways.

Objective To investigate the effect of ERK1/2 phosphorylation on the proliferation of human aorta vascular smooth muscle cells (HAVSMCs) stimulated by advanced glycation end products (AGEs) Methods CCK8 was used to test the effect of AGEs with different concentration on the proliferation of HAVSMCs, and the effect of PD98059, a specific inhibitor of ERK1/2, on HAVSMCs proliferation stimulated by AGEs was also detected. Flow Cytometer (FCM) was used to detect the cell cycle transformation induced by AGEs. Western Blot was used to detect the expression of relative proteins. Results 10 mg/L AGEs observably facilitated the proliferation and the DNA synthesis of HAVSMCs and PD98059 (40 umol/L) markedly inhibited the proliferation and cell cycle evolution of HAVSMCs induced by AGEs. Furthermore, ERK1/2 phosphorylation, and PCNA were regulated by AGEs and thus it showed time and dose dependent. Conclusion AGEs participates in the proliferation of HAVSMCs by activating ERK1/2 signal path.

Objective To evaluate the curative effect of endovascular treatment for Leriche syndrome.Methods The clinical data of 57 patients with Leriche syndrome,who were admitted to authors' hospital during the period from September 2010 to October 2014,were retrospectively analyzed.The curative effect of percutaneous transluminal angioplasty (PTA) was analyzed.Results Among the 57 patients (65 diseased limbs in total),simple PTA was employed in 2,catheter directed thrombolysis (CDT) with subsequent PTA and stenting in 5,and PTA plus stenting in 50.A total of 97 stents were implanted,the technical success rate was 100％.After the treatment,the ankle brachial index (ABI) increased from preoperative (0.42±0.22) to postoperative (0.83±0.15),the difference between the two data was statistically significant (P＜0.01).Thepatients were followed up for (9.8±2.8) months.The 6-month and 12-month primary patency rates were 95.4％ and 90.7％ respectively,the postoperative secondary patency rate was 96.4％.After the treatment,the symptoms of lower limb ischemia were improved in all patients.During perioperative period,iliac artery rupture due to balloon dilatation occurred in 2 patients,pseudoaneurysm at brachial aaery puncture point in one patient,hematoma at puncture point in 3 patients,cerebral infarction in 2 patients and myocardial infarction in one patient.One patient developed contrast-induced nephropathy and finally died of multiple organ dysfunction syndrome.The perioperative mortality was 1.75％.One patient developed in-stent obstruction in 3 months after two stage treatment,and artificial vascular bypass grafting had to be carried out.Conclusion For the treatment of Leriche syndrome,PTA is safe and reliable,it carries less complications and lower perioperative mortality with satisfactory short-term patency rate.(J Intervent Radiol,2017,26:221-224)

16 and the distribution of severe trauma more than 2 anatomic parts.They were randomly divided into two groups:intensive insulin treatment group(n=31)and control group(n=31).Intensive insulin treatment group received insulin with insulin pump in order to maintain blood glucose levels at 4.0-6.1 mol/L,while the control group received routine insulin treatment in order to mmaintain blood glucose levels at 10.0- 11.0 mol/L.Plasma levels of TNF-?,IL-1,IL-6, CRP,APACHEⅡscores and cure rate were analyzed before and after the treatment.Data was expressed as mean?standard deviation.Two- tailed T test and ANOVA were used for comparison in SPSS 10.0,and changes were considered as statistically significant if P value was less than 0.05.Results After the intensive insulin treatment, patient's hemodynamic parameter apparently improved,APACHEⅡscores descended,and the levels of TNF-?, Ib-1,IL-6,CRP all declined,in comparison with control group,there were significant differences. Intensive insulin treatment might improve patient's general condition and decrease complications and mortality of severe multiple trauma.

Adolescent ; Child ; Hemangioma, Capillary ; diagnostic imaging ; Humans ; Male ; Testicular Neoplasms ; diagnostic imaging ; Ultrasonography

Objective To investigate the clinical method of closing defect and regain the sensory on forefoot injury.Methods Lateral tarsal artery,flap was designed as a reverse flow flap to close forefoot de- fect in dorsal lateral foot while perforating branche of lateral tarsal artery as turning point.Lateral cutaneous nerve was inosculated to lateral plantar fascia.Donor site was covered by skin-grafting.Results seventeen cases survived satisfactorily with good shape and regaining sensory.Conclusion Lateral tarsal artery flap can be used in coveraged of forefoot defect.Lateral tarsal artery flap was thin flap with good shape and to regain the sensory of forefoot.