Fracture Fixation ; methods ; trends ; Fractures, Bone ; surgery ; Humans ; Pelvic Bones ; injuries ; surgery

Objective To investigate the clinical effects of posterior reduction and interbody fusion in the treatment of thoracolumbar fractures and dislocations ,and its impact on the neural function .Methods 12 cases with thoracolumbar fractures and dislocations were treated with posterior reduction and interbody fusion .After treatment , flange height ,Cobb angle ,nerve function ,complications of internal fixation were observed ,and the clinical efficacy was evaluated.Results The anterior height of fractured vertebrae was significantly increased from (56.7 ±7.9)% to (90.4 ±9.8)% in 12 patients(t=9.3,P<0.05);Cobb angle was significantly reduced from (28.4 ±3.8)°to (7.9 ±2.9)°(t=14.9,P<0.05);The grade of neural function was obviously improved (from 2 cases A,5 cases B, 4 cases C and 1 case D to 1 case A,1 case B,2 cases C,6 cases D and 2 cases E),and there were no serious compli-cations.Conclusion The clinical effect of posterior reduction and interbody fusion in the treatment of thoracolumbar fractures and dislocations was good ,which is worthy of clinical application .

Objective To explore the efficacy of different modes of fluid resuscitation (early or delayed use of norepinephrine) on lung injury of septic shock rat induced by LPS.Methods A total of 60 male Wistar rats were randomly (random number) divided into 4 groups:the normal control group (group A,n =15),septic shock control group (group B,n =15),conventional fluid resuscitation group (group C,n =15),fluid resuscitation with early using of norepinephrine group (group D,n =15).All rats were mechanically ventilated with the same parameters.In the group C,norepinephrine was used 30 min after fluid resuscitation.In the group D,norepinephrine was used at the beginning of fluid resuscitation.Vital signs,volume of fluid infused and dosage of norepinephrine were recorded.Rats were sacrificed 2 h later and blood samples were collected for blood gas analysis.The lung tissues and BALF were collected.Pathological changes of the lung tissues were observed under light microscope.The levels of MPO,SOD and MDA were detected.The levels of IL-6,IL-8 and TNF-α in BALF and in serum were detected by using ELISA.Results Compared with group C,the mean volume of fluid infusion to achieve target blood pressure was decreased,oxygenation index was improved and the level of blood lactic acid were decreased in group D (P ＜ 0.05).HE staining indicated that inflammatory cells were decreased,pulmonary edema and alveolar walls hyperemia were alleviated in group D in comparison with group C.Inflammatory cytokines (IL-6,IL-8 and TNF-α) in BALF and in serum were significantly decreased in group D compared with group C (P ＜0.05).Levels of MPO were decreased in group D compared with group B and group C.However,early using of norepinephrine had limited effect on the levels of SOD and MDA.Conclusions The current study demonstrated that fluid resuscitation with early use of norepinephrine exhibited a protective effect on lung injuries induced by LPS.

To introduction the biological function of vascular endothelial growth factor and to explore the role of vascular endothelial growth factor(VEGF)and in the pathogenesis of endotoxin,ischemia-reperfusion,hyperoxia,ventilator-induced lung injury(ALI)/acute respiratory distress(ARDS).

Compared with hip replacement, internal fixation in the treatment of the elderly femoral neck fracture, especially the application of cannulated screws, is minimally invasive, easy to operate and economical. In recent years, it becomes the research focus in the field of orthopedic clinical research. However, configuration of cannulated screws is still controversial. Most clinicians believe that three cannulated screws being placed in parallel in an inverted triangle configuration is better than that in a triangular configuration in biomechanics and clinical effect. Nonparallel strong oblique nailing technique allows the screws to share more weight to reduce postoperative complications, so that it is more suitable for elderly patients with osteoporosis. However, the related complications of internal fixation such as nonunion, femoral neck shortening and other problems are still the focus of domestic and foreign scholars. Issues about how to control the indication of internal fixation surgery, understand related factors of the complications, and prevent complications are required to be further explored.
Aged ; Bone Nails ; Femoral Neck Fractures ; surgery ; Fracture Fixation, Internal ; adverse effects ; methods ; Humans ; Internal Fixators

Hip arthroplasty is one of the most effective surgical operations to treat femoral neck fracture in the elderly.After surgery,patients can do exercises out of bed earlier,avoiding such complications as bedsore and deep vein thrombosis due to long-term lying in bed.However,there is still a great controversy concerning the clinical efficacy and complication rates of cemented and uncemented prostheses in the arthroplasty.It is a clinical problem at present how to choose the most appropriate prosthesis for different patients.This article addresses this problem in the elderly population by reviewing the literature in the aspects of design characteristics,clinical outcomes and complications between cemented and uncemented prostheses.

Plasma exchange as an important technique for blood purification,its treatment involves a wide range of atypical hemolytic uremic syndrome,nervous system disease,kidney disease,poisoning disease,metabolic disease etc.Clinical in pediatric patients for blood purification treatment must be considered in children with primary disease and clinical symptoms,in order to reduce the incidence of various types of complications,ensure the clinical efficacy.

Objective To explore early prognostic value of quantitative detection of paraquat (PQ) plasma concentration and urine sodium dithionite assay for prognosis in patients with acute PQ poisoning. Methods A prospective study was conducted. The patients with acute PQ poisoning admitted to Department of Emergency of First Hospital of China Medical University from August 2013 to December 2015 were enrolled. At admission, blood samples and urine samples were collected. The PQ plasma concentration was determined by high-performance liquid chromatography (HPLC), and the PQ urine concentration was determined by sodium dithionite, meanwhile the biochemical parameters were determined to carry out sequential organ failure assessment (SOFA) score. According to the prognosis of 90-day follow-up, the patients were divided into survival group and death group. Logistic regression analysis was used to analyze the relationship between the prognosis and the indexes, and the receiver operating characteristic curve (ROC) was drawn to evaluate the prognosis. Results There were 148 patients with acute PQ poisoning, with 43 alive and 105 dead, and the 90-day mortality rate was 70.9%. The ingestion volume (mL: 22.69±18.57 vs. 9.91±4.61), plasma concentration of PQ (mg/L: 2.28±1.52 vs. 0.91±0.38) and positive rate of urine sodium dithionite (87.6% vs. 14.0%) in death group were significantly higher than those of survived group (all P < 0.01), but no significant differences in gender, age, poisoning time, gastric lavage time between the two groups were found. Significant differences in white blood cell count [WBC (×109/L): 13.45±6.12 vs. 23.03±7.67] and blood lactate [Lac (mmol/L): 1.50±0.45 vs. 8.10±4.51] between survival group and death group were found (both P < 0.01), while no significant difference in SOFA score was found (0.98±0.72 vs. 1.34±1.29, P > 0.05). It was shown by logistic regression analysis that the key factors affecting the prognosis of patients with PQ poisoning were urine sodium dithionite assay [odds ratio (OR) = 8.731, 95% confidence interval (95%CI) = 2.828-26.954, P = 0.000], PQ plasma concentration (OR = 2.082, 95%CI = 1.204-3.603, P = 0.009) and ingestion volume (OR = 1.175, 95%CI = 1.048-1.318, P = 0.006) respectively. It was shown by ROC curve that the area under ROC curve (AUC) of plasma PQ concentration, urine sodium dithionite assay, poisoning dose and SOFA score for predicting the prognosis in patients with acute PQ poisoning was 0.866, 0.857, 0.826, and 0.631 respectively (all P < 0.05). The sensitivity of urine sodium dithionite assay for predicting the prognosis was 87.6%, and the specificity was 83.7%. Conclusions Early plasma PQ concentrations can objectively reflect the body absorbed toxicant doses and actual situation after poisoning, and help to judge the early evaluation of prognosis. The accuracy of urine sodium dithionite assay in judging the prognosis of PQ poisoning is high. Because of its simplicity and availability, it was easier to be performed in the primary hospital.

Objective To investigate the clinical value of combining early urine paraquat early clearance rate (UPCR) with severity index of paraquat poisoning (SIPP) in predicting the prognosis for paraquat poisoning patients.Methods In this retrospective research,a total of 425 cases diagnosed with acute paraquat poisoning from March 2014 to March 2016 in Emergency Intensive Care Unit,First Affiliated Hospital of China Medical University were enrolled.The general data of patients,the results of rapid qualitative test of paraquat in blood and urine,the concentration of paraquat in blood / urine,the poisoning time,the concentration of blood lactic acid and the APACHE Ⅱ score were collected.The early UPCR and SIPP were measured at different time intervals,and the ratio of 6-SIPP and 12 h-UPCR were calculated.These patients were divided into death groups and survival groups according to the 28-day mortality.The relationship between these factors and the mortality were analyzed.Results Of all the 425 patients,268 cases (63.1％) died,157 cases (36.9％) survived;the blood concentration of paraquat,the lactate concentration,SIPP values and the APACHE Ⅱ scores were significant difference between the two groups (P ＜ 0.05).The mortality of 2-6 hour paraquat rapid qualitative test result positive patients was higher (96.4％) than that of the negative patients (3.6％) (P ＜ 0.05);the mortality of 12-24 hour paraquat rapid qualitative test result negative patients was lower (11.5％) than that of the positive patients (88.5％) (P＜0.05).The 2-6 hour SIPP value was 19.8 ±6.7 in death group,which was higher than that in survival group (4.9±3.1) (P＜0.05);the 2-6 hour UPCR value was (41.7±9.3) indeath group,which was lower than that in survival group (86.3 ± 15.8) (P ＜ 0.05).There was no significant difference in the 2-6 hour UPCR value and 12-24 hour UPCR value between two groups (P ＞0.05).The 6 h-SIPP/12 h-UPCR value was (41.94 ±5.9) in death group,which was higher than that in survival group (5.27 ± 3.6) (P ＜ 0.05).Conclusion The combined use of early UPCR and SIPP values is an effective indicator of the prognosis of patients with acute paraquat poisoning and is helpful for the early stratification.We should pay more attention to the patients whose rapid qualitative blood test is positive because of their high mortality risk;for the patients whose 12 h urinequalitative test was negative,the hemoperfusion therapy might be stopped because the toxin was completely excluded,and the medical resources can be saved reasonably.The UPCR might indicate the excretion of toxins,and SIPP might indicate the severity of poising.

Objective　To establish the normal growth velocity of fetal liver length and compare them with those of intrauterine growth retardation, pregnant diabetes and maternal-fetal blood types imcopatible. Method　Three hundred and five normal pregnant women and 24, 10, 16 pathological pregnant women of intrauterine growth retardation (IUGR), gestational diabetes and maternal-fetal blood types incompatible respectively had ultrasonographic measurement of fetal liver length at 18 to 42 weeks′ gestation. Results　Normal fetal liver length has a linear relation to gestational age, and showed a significantly rapid increase after 28th week with a growth rate of 1.76 mm per week, and 1.00 mm per week before 28th week (P<0.05). The growth rate of IUGR group before and after therapy were 1.19 mm and 1.23 mm per week, significantly lower than those of normal group (P<0.05). The growth rate of pregnant diabetes group before and after therapy were 1.63 mm and 1.63 mm per week, no statistical significance with normal group (P>0.05). The growth rate of maternal-fetal blood types incompatible group before therapy was 1.98 mm, showed no difference with normal group (P>0.05), but after therapy, the growth rate of fetal liver was 1.38 mm per week, significantly lower than normal group (P<0.05). Conclusion　Dynamic measurement of fetal liver length can help us to understand whether the fetus grow well in uterus and whether the treatments are effective.