[Summary] Osteoporosis in elderly women are commonly accompanied by elevated levels of ferritin. Abnormal iron metabolism plays a key role in the progress of osteoporosis. Research on bone metabolic disorders caused by iron accumulation remains at the exploratory stage, including NF-κB pathway in differentiation of osteoclasts. A review on the relationship between NF-κB pathway and osteoporosis induced by iron accumulation is herewith presented, with a view to provide further ideas for transforming the clinical outcomes.

[Objective]To investigate the treatment effects of the anatomical plate on proximal humeral fractures and analyze the structural characteristics of the plate clinically.[Method]From June 2003 to June 2005,comminuted fractures of the proximal humerus of 32 patients(18 males and 14 females,with average age of 39 years)were treated with anatomical plates.Fractured proximal humerus was exposed by a standard deltopectoral approach after a dissection from the deltoid and pectoral muscle.Anatomical plates were placed on lateral sides of the humerus after reduction.The arm was immobilized in a sling,passive movement was begun on the first day after surgery,and active movement of the shoulder was started after three week.Active movement with resistance was allowed when there was radiological evidence of bone healing which usually occurred after six weeks.The patients were reviewed clinically and radiologically.[Result]All 32 patients were available at follow up with mean duration of 20 months (7~28 months).No complications such as nonunion of fractures,infection,the loosening and breakage of the plate were ever occurred.The clinical results were graded as excellent in 21 patients,good in 7,fair in 2,and poor in 2 according to the Neer's classification.The excellent and good rate was 87.5%.[Conclusion]Anatomical plate for the proximal humerus holds a 3-dimensional structure,which facilitates the fracture exposure,bone fragments reduction and fixation.It is concluded that rigid fixation of displaced fractures of the proximal humerus with an anatomical plate provides sufficient primary stability to allow early functional treatment.And is advocated that primary open reduction and rigid internal fixation using anatomical plates for the proximal humerus fracture.

[Objective]To explore the operating methods and key points of bysteel-wire guiding fixative steel-wire repearing tibial intercondylar eminence avulsion fractures under arthroscope.[Method]From February 2006 to August 2006,14 patients with tibial intercondylar eminence avulsion fractures were treated in bysteel-wire guiding fixative steel-wire method.Among them,there are 9 males and 5 females with an average age of 32.6 years,aged from 5 to 40 years.Injury cause:7 of road accident,5 of falling down while moving and 2 of falling from height.The results of preoperative x-Ray and Artoscan of all patients suggested the avulsion fracture of anterior cruciate ligament from the tibial spine.In the operation,firstly,fixative steel-wire cross the avulsion fracture tendon-bone joint zone.Then,make each side of avulsion fracture a bone tunnel on the tibial plateau.Finally,guide fixative steel-wire out of these two bone tunnels and then fix this steel-wire with the help of guiding steel-wires.After operation,fix the knee joint with plaster slab bended at 20? in three or four weeks.Remove the plaster slab and do functional exercise after 4 weeks.And move with walking stick 8 weeks later.[Result]All 14 patients were available at follow up with mean duration of 10.5 months.The X-Ray suggested bone healed at about 5.5 months after operation.We got the excellent in 8 cases,good in 4 and fair in 2 according to the advanced Lyshdm's classification at the last follow up.The excellent and good rate was 85.1%.[Conclusion]The technique needn't traditional cut,and has many advantages,such as micro injury,rapid recovery and few complications.And it is good to master the main points of this technique for applying it.

Researchers subjective emphasis on application for the project,contempt to complete the project.To safeguard the research projects carried out smoothly and successfully completed,improve hospital credibility,the hospital in many ways to strengthen the scientific research project management,such as creating a strong scientific and academic atmosphere,the establishment of preresearch funds,hospital research,enhance service awareness,the establishment of the project evaluation system to strengthen the management of project mid-term and node title,funds management,effectively promoted the development of the hospital research.

To carry out the teaching of hospital management in-depth and improve teaching quality, the group of teaching hospital management in 2010, through questionnaires, discussion and other forms, found out and analyzed the teaching situation, including the nature of this course, start time and hours, teacher team, teaching content, teaching methods, evaluation form, and so on. The result was that most students thought it not necessary to open so many courses. Then the article put forward some suggestions and countermeasures to further improve the management course.

Objective To explore clinical characteristic of metal-on-metal hip joint prosthesis with large heads(ASRTMXL).Methods Total hip arthroplasty(THA)with ASRTMXL was performed in 14 patients including two with ankylosing spondylitis combined with hip amalgamation,three with avascular necrosis,two with secondary osteoarthritis and seven with femoral neck fractures.Based on shortterm follow-up results,we analyzed its design characteristic and clinical properties.Results All patients walked with crotches one week after operation and began weight bearing without support six weeks later.An improvement was seen on the average range of motion of the hip including anteflexion,retroextension,internal rotation,external rotation,adduction and abduction.The mean Harris score was increased from precperative 30 points(13-50 points)to postoperative 90 points(75-100 points),with statistical difference.Postoperative X-ray showed right positions of the prostheses,normal abduction angle and anteversion angle,without complications cccurred.Condusion Short-term follow-up results show that metal-on-metal hip joint prosthesis with large heads has advantages of lower wearing,large range of motion,few dislocation and small deformation of acetabular cup.

Objective To explore the changes of type H vessel during the low bone mineral density caused by iron accumulation and discuss its clinical meaning.Methods Ten 8-week old male C57BL/6J mice were used for experiments,and randomly divided into two groups:control group and iron group,and 5 mice in each group.In the iron group,0.1 g/kg of iron dextran was injected intraperitoneally once a week for 8 weeks.The control group was injected with the same amount of saline.The femoral and tibial specimens were examined by microscopic CT scan and bone tissue type H vessel immunohistochemical staining.Liver tissue from the two groups were collected for the content of iron by atomic absorption spectroscopy.All experimental data were analyzed with t-test.Results The content of hepatic iron in mice was significantly higher than that in the control group,which indicating that the model was successfully established.The tibia specimens were collected for immunostaining.The vascular area of type H at metaphyseal regions is 11.24％± 1.76％ in iron group and 30.69％±2.78％ in control group,respectively.There is significant difference between the two groups (P＜0.005).The femur specimens were collected for Micro-CT scan,the value of bone mineral density (BMD),bone volume/tissue volume (BV/TV),trabecular thickness (Tb.Th),trabecular number (Tb.N) and trabecular separation (Tb.Sp) was (0.19±0.013) g/cm3,11.92％±1.199％,(35.66±2.684) μm,(2.36±0.429)/mm and (284.41±23.197) μm in iron group and (0.37±0.023) g/cm3,35.76％± 1.336％,(62.05±2.238) μm,(5.68± 1.039)/mm and (163.23± 13.203) μm in control group,respectively.The differences between the two groups were statistically significant (P＜0.05).Conclusion Iron accumulation can lead to low BMD and suppress type H vessel formation in bone,which might provide a new experimental value for mechanism research on osteoporosis caused by iron accumulation.

Objective:To investigate the predictive efficacy of global inhomogeneity (GI) index based on pulmonary electrical impedance tomography (EIT) in postoperative pulmonary infection of patients with craniocerebral trauma.Methods:A total of 90 patients with emergency craniocerebral trauma underwent surgery under general anesthesia in Suzhou Science & Technology Town Hospital. According to the complication of pulmonary infection at the 3rd day after operation, they were divided into the pulmonary infection group (P3 group) and non-pulmonary infection group (NP3 group), and according to the complication of pulmonary infection at the 7th day after operation, they were divided into the P7 group and NP7 group. The average GI index within 5 min before anesthesia induction (T 0) and 5 min after endotracheal intubation (T 1) and other clinical data in the perioperative period were collected. The prevalence of pulmonary infection at the 3rd and 7th days after operation was recorded. Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of preoperative GI index for pulmonary infection at the 3rd and 7th days after operation. Results:A total of 88 patients were included. Among them, 26 patients developed pulmonary infection within 3 days after operation, and the prevalence rate was 29.5%. Pulmonary infection occurred in 38 patients within 7 days after operation, and the prevalence rate was 43.2%. Within 3 days after operation, the preoperative Glasgow Coma Scale score in the P3 group was significantly lower than that in the NP3 group ( P < 0.05). Within 3 days after operation, GI index in the P3 group increased significantly at T 1 when compared with the NP3 group ( P< 0.001). Within 7 days after operation, GI index in the P7 group increased significantly at T 1 when compared with the NP7 group ( P < 0.05). GI index at T1 accurately predicted pulmonary infection within 3 days after operation (AUC = 0.857, P < 0.001), and the best intercept value was ≥0.4225 (sensitivity: 0.846, specificity: 0.823). GI index at T 1 predicted pulmonary infection within 7 days after operation (AUC = 0.667, P < 0.005), and the best intercept value was ≥0.4225 (sensitivity: 0.579, specificity: 0.780), but the prediction efficiency was poor. Conclusions:The average GI index within 5 min after endotracheal intubation can be used as an effective predictor of pulmonary infection within 3 days after operation.

With the aging of society, the incidence of osteoporosis is increasing. Osteoporotic fractures are directly related to osteoporosis. In the context of the gradual increase in osteoporosis, the number of osteoporotic fractures is increasing, and the incidence of refractures is also increasing annually. Refracture after an osteoporotic fracture refers to the occurrence of a new fracture after the initial fracture due to the lack of improvement in bone density and quality and the effect of low-energy external force on the bone. The occurrence of refracture has more harm to the patient's treatment plan, fracture healing, rehabilitation training, self-care ability, psychological expectation, compliance and other clinical indicators. Therefore, the prevention and management of refracture after osteoporotic fracture has gradually become a hot topic at home and abroad. At present, in this field of prevention and treatment, both clinicians and community doctors have problems with insufficient awareness and short-sighted clinical management, such as unclear management standards for refracture prevention, unclear division of labor between doctors at all levels and various types of doctors, and inadequate measures to improve patient's compliance. Focusing on the characteristics of osteoporotic fractures, refractures, and refracture prevention and management, the core points of refracture prevention and management are proposed and elaborated, and the corresponding contents, fixed teams, proprietary databases or proprietary books of refracture prevention and management should be clarified, so as to provide reference for further improving the clinical management of refracture prevention and treatment after osteoporotic fractures.

Objective:To screen the risk factors for post-traumatic stress disorder (PTSD) after emergency trauma surgery in the patients.Methods:The medical records of emergency surgical trauma patients (traffic accident, fall, engineering accident, etc.) were retrospectively collected.The general condition and perioperative clinical indicators of the patients were recorded.The patients were divided into PTSD group and non-PTSD group according to whether PTSD occurred within 1 month after surgery.Multivariate logistic regression analysis was used to screen the risk factors for PTSD.Results:A total of 312 patients were enrolled, and the incidence of PTSD at 1 month after surgery was 19.9%.There were significant differences in preoperative VAS score, ratio of gender, intraoperative use of propofol, intraoperative use of dexmedetomidine, and postoperative ICU transfer rate between PTSD group and non-PTSD group ( P<0.05). The results of logistic regression analysis showed that intraoperative use of propofol, preoperative high VAS score and postoperative admission to ICU were independent risk factors for PTSD, and intraoperative use of dexmedetomidine was a protective factor for the prevention of PTSD ( P<0.05). Conclusions:Intraoperative use of propofol, preoperative high VAS score and postoperative transfer to ICU are independent risk factors for postoperative PTSD in the patients with emergency trauma, and intraoperative use of dexmedetomidine is a protective factor for the prevention of PTSD.