Objective To study the clinical effect and necessity of removing internal fixation after treatment of acromioclavicular dislocation (Tossy Ⅲ ) with AO clavicular hook plate. Methods From October 2001 to October 2004, 31 patients with acromioclavicular dislocation (Tossy Ⅲ ) were treated with AO clavicular hook plate and were followed up. All of their broken acromioclavicular joints were sutured and the clavicular insertions of deltoid and trapezius muscles were repaired. The coracoclavicular ligaments were sutured for only 9 patients. Their shoulder functions before and after taking out of the internal fixation were assessed by Constant and Murley evaluation and compared. Results 24 patients were followed up from 4 to 40 months after operations (averaging 22 months). There were no loosening or breakage of internal fixations. The plates were removed 12 to 27 months postoperatively (averaging 18 months) in only 9 patients. No redislocation occurred after taking out of the plates. The scores of shoulder joint function were 76.5? 8.6 and 99.5? 1.0 (P

Objective To evaluate the preliminary outcome of surgical treatment of unstable distal radius fractures caused by osteoporosis in the elderly patients with open reduction and internal fixation with T-shaped locking compression plates(T-LCP).Methods From June 2003 to may 2005,13 elderly cases of comminu ted unstable distal radius fractures caused by osteoporosis were treated with op en reduction and T-LCP internal fixation.They were four males and nine females,with an average age of 74 years old(ranging from 67 to 81).According to AO classification,two cases belonged to types B2,three to type B3,two to type C1,five to type C2 and one to type C3.All of them were closed fractures.They were fixated with T-LCP through the volar approach and their dorsal soft tissues were not dissected during the operation.Osteoset,the artificial bone substitute,was implanted in one case of large bone defect.The postoperative functional recovery ranged from 6 to 30 weeks with an average of 12.3 weeks.Passive wrist motion,active finger motion and forearm rotation were encouraged immediately after surgery.Active wrist motion was suggested seven days postoperatively.Result s The 13 cases were followed up for 4 to 22 months,with an average time of 13.2 months.The X-ray pictures showed that one-stage union was achieved in all the patients,with a mean healing time of seven weeks.No such complications were found as infection,non-union,loosing of nails,carpal tunnel syndrome or medium neuritis.Their clinical outcomes were evaluated according to the modified Mcbride grading system.Nine were rated as excellent,three as good and one as fair,with their good-excellent rate being 92.3%.Conclusions T-LCP can ensure a good fixation in the treatment of unstable distal radius fractures caused by osteoporosis in elderly patients,allow the patients to do early exercise,and achieve satisfactory clinical outcome.

Objective: To study the propagation and phenotypes changes of killer cell (CD3AK cell activated by CD3 mAb in vitro. Methods: Lymph nodes taken from lung cancer patient is dissociated into single cell suspension by mechanical method and cultured in culture medium added CD3 mAb and a little dose IL-2. We analyze cell immunophenotype by flow cytometry and proliferation by trypan blue exclusion test per 2 days. Results: Immunophenotypic analysis showed that CD3AK expressing CD3, CD8, CD56, CD25 increased, and reached a peak value which is 2.33 times than before culturing in the 8 th day. Conclusion: CD3 mAb added to the culture medium can obviously activate CD3AK cell and stimulate proliferation and keep its killer activity.

Objective To detect the expression of a disintegrin and metalloproteinase with thrombospondin motifs 4 (ADAMTS4),Versican,and Aggrecan in hearts of myocardial infarction rats.Methods Male Wistar rats were chosen to make myocardial infarction model.Fifteen rats were randomly assigned into the myocardial infarction group and five rats into the sham-operation group.Rats were killed 3 d after surgery and the left ventricles were taken to produce frozen section.ADAMTS4,Versican,and Aggrecan protein expressions were detected by imnunohistochemistry method.Results ADAMTS4 expressed in myocardial cells at marginal zone of the infarcted area.ADAMTS4 expressed weakly while Versican expressed strongly in capillary endothelial cells of marginal zone of the infarcted area.Aggrecan showed no expression in the cardiac tissue and vascular endothelium of both myocardial infarction group and sham-operation group.Conclusions ADAMTS4 is involved in the inflammation after myocardial infarction.Degradation of ADAMTS4 to Versican exists in the vessels after myocardial infarction.Aggrecan is not involved in the pathophysiological process of myocardial infarction.

As the importance of clinical risks management grows hospital management,reducing hospital medical errors for patients safety has become a key quality management process.Failure Mode and effect analysis( FMEA) is a proactive technique for error detection and reduction.In this paper,based on a brief review of it's history of development,described in detail the implementation method and steps of FMEA,mainly introducing the research progress for using FMEA in reducing hospital medical errors.

Objective To investigate the effectiveness of femoral troehanter reconstruction and artificial femoral head replacement in treatment of unstable intertrochanterie fractures in the elderly pa- tients. Methods Femoral trochanter reconstruction and artificial femoral head replacement was done on 106 patients with unstable intertrochanterie fractures. There were 45 males and 61 females, at age range of 80-105 years (average 88 years). Most of patients slipt in the room and got fractured. According to the Evans classification, there were 31 patients with type ⅢA fractures, 45 with type ⅢB and 30 with type IV. We used 4 kinds of methods to reconstruct the fracturad imertrochanters : (1) shape of" ∞ " ten- sion band fixation after intertrochanterie fracture reduction;(2) wire loop fixation of the lesser troehanter around proximal femur;(3)defect within the femoral ealear was filled with bone cement and remodeled; (4) for patients with relative intact base of femoral neck, the intertrochanterie fracture was transformed in- to femoral neck fracture and the femoral ealear was fixed with femoral prosthesis stem. Results All the operations continued successfully, with duration of the operation for 45-70 minutes (average 55 minutes). No artificial femoral head dislocation occurred during hospitalization. Of all, 79 patients were followed up for 6-48 months (average 16 months). No Late loosening, dislocation or infections occurred, with total excellence rate of 87.3%. Conclusions For elderly patient with unstable intertrochanterie fractures, reconstruction of femoral intertrochant and artificial femoral head replacement can restore the proximal femoral anatomy, maintain stability of the hip joint and help early functional exeereise, as can reduce ease fatality rate and improve the quality of life.

Objective: To investigate the relationship between total homocysteine (tHcy) levels and sarcopenia among the elderly, so as to provide insights into the prevention and treatment of sarcopenia. Methods: The elderly aged 65 years and older who participated in the physical examination of Shibantan Township Health Center in Xindu District, Chengdu City from April to June 2021 was selected as the study subjects. The elderly with sarcopenia (diagnosed according to the diagnostic criteria of the Asian Sarcopenia Working Group in 2019) and non-sarcopenia were matched 1︰1 by gender and age (±2 years). Demographic information, skeletal muscle mass, skeletal muscle strength and tHcy were collected through questionnaire surveys, physical examination and laboratory testing. Multivariable conditional logistic regression model was used to explore the relationship between tHcy and sarcopenia. Results: A total of 320 individuals, including 160 sarcopenia patients and 160 non-sarcopenia individuals, were investigated. There were 138 males (43.13%) and 182 females (56.87%), with a median age of 71.00 (interquartile range, 6.00) years. There were 57 drinkers (17.81%), 78 smokers (24.37%), 173 cases of hypertension (54.06%) and 124 cases of hyperhomocysteinemia (38.80%). Multivariable conditional logistic regression analysis showed that elevated tHcy was associated with an increased risk of sarcopenia (OR=1.107, 95%CI: 1.024-1.197), after adjusting for smoking, alcohol consumption, hypertension, waist circumference, neck circumference, body mass index, platelet count and high density lipoprotein cholesterol. Conclusion Elevated tHcy is associated with sarcopenia, and intervention should be carried out for the elderly with higher tHcy.

Objective To explore the mechanism of percutaneous laser disc decompression (PLDD) for treating prolapse of intervertebral disc. Methods 15 rabbits were divided into 3 groups randomly: sham group, model group with PLDD treatment, model group without PLDD treatment. The nerve conduction velocity (NCV) of L6 nerve root and the activity of phospholipase A2 (PLA2) in the intervertebral disc of L5-6 were determined 2 weeks after the initial surgery. Results NCV in the group with PLDD was significantly faster than that in the group without PLDD (P<0.001); NCV in the group without PLDD was significantly lower than that in the sham group (P<0.001). The activity of PLA2 in the group with PLDD was significantly lower than that in the group without PLDD (P<0.001); The activity of PLA2 in the group without PLDD was significantly higher than that in the sham group (P<0.001). Conclusion The activity of PLA2 in the herniated discs is higher than that in normal discs, which result in NCV falls remarkably. The PLDD can reduces chemical factors such as PLA2.

ObjectiveTo discuss the clinical application of the temporary balloon occlusion of the common iliac artery in the control of hemorrhage in the operations of the old pelvic fractures.Methods From January 2006 to June 2009,twelve patients (10 males,2 females; mean age 33.9 years) with old pelvic fractures of Tile C type were treated operatively.Three cases were treated with external fixator.Operative treatments were delayed for the treatment of the life-threatening visceral injuries in six nonunions and three malunions.A balloon catheter was placed through intravascular intervention in the common iliac artery of the affected side.The balloon catheter was infolded when the osteotomy was performed and the operations were undertaken under temporary and total occlusion of the common iliac artery.Osteotomies and internal fixations were performed in 12 cases.Decompressions of lumbosacral trunk were undertaken in 4 cases complicated with injuries of sciatic nerve.ResultsThe mean time of operations was 290 min(range,210-367min).The mean time of occlusions was 65 min (range,45-90 min).The loss of blood ranged from 700 ml to 2800 ml,with an average of 1833 ml.All cases were followed up for 12-48 months,with an average of 35 months.The mean time of bone healing was 20.6 weeks (range,16-24 weeks).No thrombosis of the common iliac artery and deep venous thrombosis of the lower extremity or ischemic necrosis happened.In the four cases complicated with injuries of sciatic nerve,three recovered partly and could walk with a crutch and one recovered completely and could walk normally.Two cases limped and other six cases could walk normally.ConclusionThe effect of temporary balloon catheter occlusion of common iliac artery is reliable.It drastically reduces hemorrhage during the operation and avoid the complications of selective arterial embolism and ligation and makes the operations of the old pelvic fractures more safer.

Objective To investigate the characteristics of pathogenic bacteria in cancer patients with severe infection after radiotherapy and chemotherapy and the application value of metagenomic next-generation sequencing(NGS)in the detection of pathogenic bacteria.Methods A total of 112 patients with severe infection after malignant tumor radiation and chemotherapy admitted to Department of Critical Care Medicine of Wuwei Tumor Hospital from October 2019 to August 2023 were selected as the research objects.A total of 150 specimens from suspected infection sites were collected and tested by traditional etiology and NGS.The characteristics of pathogenic bacteria in severe infection of cancer patients after chemoradiotherapy and the application value of NGS in pathogen detection were analyzed.Results Among 150 samples of 112 patients with severe infection after radiotherapy and chemotherapy,the highest proportion of respiratory system infection was 51.79%(58 cases),followed by 25.89%(29 cases)of bloodstream infection,the lowest central nervous system infection rate was 1.79%(2 cases).Gram-negative bacteria were the most common pathogenic bacteria[NGS 35.33%(53 cases),traditional pathogen detection 23.33%(35 cases)],followed by Gram-positive bacteria[NGS 20.67%(31 cases),traditional pathogen detection 12.00%(18 cases)],and multi-drug resistant bacteria infection rate was more than 80.00%,multi-drug resistant fungal infection rate also reached 28.57%.In the patients with severe infection after radiotherapy and chemotherapy,the positive rate of pathogenic bacteria of NGS was significantly higher than that of traditional pathogen detection[87.33%(131/150)vs.42.67%(64/150),P＜0.01],and the positive detection rate of Gram-negative bacteria,Gram-positive bacteria,fungi and other pathogens was significantly higher than that of traditional pathogen detection[Gram-negative bacteria:35.33%(53/150)vs.23.33%(35/150),Gram-positive bacteria:20.67%(31/150)vs.12.00%(18/150),fungi:22.67%(34/150)vs.6.67%(10/150),others:8.67%(13/150)vs.0.67%(1/150),both P＜0.05].Conclusions The detection rate of pathogenic bacteria of NGS in patients with severe infection after radiotherapy and chemotherapy was significantly higher than that of traditional pathogen detection.The distribution and drug resistance of pathogenic bacteria in severe infection after radiotherapy and chemotherapy are unique,and strengthening the detection of pathogenic bacteria is helpful to improve the curative effect.