OBJECTIVE: To summarize the current situation and progress of treating transverse acetabular fractures using different types of internal fixations. DATA SOURCES: The databases including PubMed were retrieved using key words of "acetabular/acetabulum, fracture, plate/plates, screw/screws, cable" both in English and Chinese. DATA SELECTION: The basic research, clinical research, review articles, as well as case reports concerning operation opportunity, and internal fixation methods were included. And repeated papers or articles with incomplete data were excluded. MAIN OUTCOME MEASURES: Totally 35 papers were selected, including 3 review articles, 8 basic research and 24 clinical research. RESULTS: Open reduction and internal fixation has been a preferred treatment for transverse acetabular fractures. The goals of treatment are anatomical reconstruction of articular surfaces and rigid internal fixation of the fragments of the fracture, so that to get early active motion. Reconstruction plate was characterized by great strength, good toughness, stable fixation, as well as excellent histocompatibility, which has accepted as standard internal fixation materials. However, the application of newly developed system, such as locking plate, absorbable screws, shape memory alloy staple, and acetabular memory internal fixation system, has received a better clinical results. CONCLUSIONS: There are plenty of internal fixations can be used in treating transverse acetabular fractures, and the reconstruction plate is the most accepted one. Actually, the internal fixations should be combined together to obtain a good result if necessary.

From January 2006 to December 2007,44 cases of humeral shaft fractures were admitted to Department of Orthopaedics,Sixth People's Hospital of Shanghai Jiao Tong University,including 29 males and 15 females,with an average age of 40.7 years old(ranging 19-89 years).Of them,13 cases of fracture involved upper segment,24 involved middle segment and 7 lower segment.All fractures were close fractures.According to AO/ASIF classification,there were 5 cases of type A1,11 of A2,6 of A3,6 of B1,12 of B2,and 4 of B3.All patients were treated by expendable intramedullary nailing system.Time of operation,hospitalization and healing,blood loss,intra-or postoperative complications and range of shoulder and elbow motion were recorded and analyzed statistically.X-ray was shot to observe the union of fractures.The expendable intramedullary nailing was successfully performed in all patients for 86 minutes(ranging 30-150 minutes).The blood loss ranged from 30 to 200 mL with a mean of 70 mL.Except primary injury-caused radial paralysis,no iatrogenic radial paralysis occurred.All 44 patients were follow-up with an average of 18 months.Of them,41 patients had fracture union,and 3 nonunion.The average healing time was 15.8 weeks.There were 15 patients complained of pain in the shoulder joint,which did not affect daily life.According to UCLA shoulder scoring system,an excellent result was found in 18 patients,good in 23 patients,and fair in 3 patients with an excellent/good rate of 93.2%.All the patients had the excellent results according to Mayo elbow performance score system.No infection,iatrogenic fracture,limb shortening,nail breakage,fat embolism syndrome or peripheral nerve injury was found.The expandable nail offers the advantages of little blood loss,reduced operation time and exposure to radiation.However,nail antegrade insertion may lead to shoulder pain,and it should be paid more attention for cases of rotational instability in inferior segment of the humerus.

To explore a method of identifying myocardial capillaries and to use it to observe the effects of ischemic preconditioning on the myocardial capillaries. Anesthetized open chest dogs in ischemic preconditioning (IP) group ( n =6) were subjected to 5min ischemia and 5min reperfusion for 4 cycles before 1 hour of left descending coronary artery (LDA) occlusion followed by 2 hours of reperfusion, while in the ischemia reperfusion (IR) group ( n =6) they were only subjected to 1 hour occlusion followed by 2 hour reperfusion. Myocardial samples in ischemic area were obtained to display capillaries by silver hexamethylenetetramine staining, and their quantitative analysis was conducted by imaging analyzing system. Two growps were then compared. The results showed that myocardial capillaries were clearly shown by silver hexamethylenetetramine, and it revealed that the numerical points density, numerical perimeter density and numerical profile density of myocardial capillaries in ischemic region were obviously increased in IP group compared with IR group. The results suggested the method to identify myocardial capillaries by silver hexamethylenetetramine was reliable and practical, and IP could protect the myocardial capillaries from the damage of ischemia reperfusion.

Objective To investigate the association between the systolic/diastolic orthostatic hypotension (OH-S/OH-D) and myoeardial infarction (MI) in the elderly.Methods Health screening physical examination were carried in 1081 subjects without MI aged over 65 years in Guangzhou Military region.The orthostatic blood pressure and heart rate were measured in supine position after resting for more than 5 minutes and at 0 and 2 minutes after standing.All the cases were divided into systolic or diastolic group on the basis of definition of orthostatic hypotension and followed up by telephone or inpatient medical records with mean period of 315.8 days.The primary endpoint was MI occurrence.Results The prevalence of OH in this cohort was 24.5％ ( OH-S/OH-D:19.3％/17.2％ ).Significant differences in the occurrence of OH and OH-S were found in the elderly and the very elderly subjects( ≥80 years) (26.1％ vs 20.1％,P=0.045; 21.0％ vs 14.6％,P =0.018),while no difference was found in OH-D.The prevalence of MI in the OH positive subjects was significantly higher than that in the OH negative subjects,as well as in OH-S or OH-D group.After adjustment of age,supine blood pressure,creatinine and cerebrovascular history by logistic regression,the association was observed between MI and OH ( HR 15.635,95 ％ CI 3.299-74.091,P=0.001),OH-S(HR 8.760,95％CI2.487-30.851,P=0.001)and OH-D(HR 3.889,95％ CI 1.097-13.790,P =0.035 ).Conclusion OH-S and OH-D hypotension are robust predictors for MI in the elderly.

Objective To investigate the effect of Shenmai injection in treating elderly with orthostatic hypotension. Methods The total of 97 cases of patients with orthostatic hypotension were randomly divided into 2 groups, which was injected intravenously with 100 mL Shenmai injection once daily as the treatment group, with 100 mL glucose as the control.The treatment lasted 14 days. The clinical symptom score, the difference of blood pressure, the P￣selectin, and the platelet maximum aggregation were measured. Results Compared with the control, Shenmai injection significantly reduced the clinical symptom scores of patients (P<0.05), lowered the difference of blood pressure for upright and supine significantly (P<0.05), decreased the platelet maximum aggregation and P￣selectin remarkably (P<0.05). Conclusion Shenmai injection significantly reduces the difference of blood pressure for upright and supine of the elderly with orthostatic hypotension, and inhibits the activities of platelets, thus improves the clinical symptoms.

Objective To investigate the relationship between orthostatic hypotension (OH) and antihypertensive therapy in the elderly hypertensive population.Methods A total of 1174 elderly retired people (849 cases with hypertension and 325 cases without hypertension) in Guangzhou Military Region underwent health physical examination.All people were surveyed by questionnaires.The orthostatic blood pressure and heart rate were measured in supine position after resting for more than 5 minutes and then at 0 and 2 minutes after standing.Comparative analysis was made on the prevalence of OH and the relationship between OH and antihypertensive therapy.Results A significant difference in the prevalence of OH was observed between hypertensive patients and nonhypertensive patients [29.4％ (250/849) vs.15.7％ (51/325),x2 =23.32,P＜0.01].There was no significant difference in the prevalence of orthostatic hypotension in patients with versus without antihypertensive therapy [30.5％ (220/721) vs.23.4％ (30/128),x2 =2.62,P＞0.05].Conclusions Orthostatic hypotension is common observed in elderly hypertensive patients.Antihypertensive therapy may not increase the prevalence of OH.

ObjectiveTo investigate the morning blood pressure surge(MBPS) and its relationship with 24-hour blood pressure variability and anti-hypertensive drugs in middle-aged and elderly hypertensive patients.Methods A total of 521 middle-age and elderly men were surveyed with ambulatory blood pressure monitoring and ambulatory electrocardiograms recordings as well as questionnaire investigation from January 2009 to December 2010.Subjects were divided into MBPS positive group and MBPS negative group according to the level of MBPS[ ＞35 mm Hg (1 mm Hg=0.133 kPa) or ≤35 mm Hg].ResultsIn all the cases,the prevalence of MBPS was 19.4％,of which the elderly and very elderly had higher prevalences ( 18.9％ and 21.8％,respectively) than the middle-aged (5.6％,both P ＜0.01 ).Significant differences could be found in age [ ( 81.6 ± 6.4 ) years vs ( 78.7 ± 9.7 ) years ],day mean systolic blood pressure [ ( 132.8 ± 13.3) mm Hg vs ( 128.8 ±13.3) mm Hg],fasting blood glucose [ (5.96 ± 1.59) mmol/L vs (5.68 ± 1.22) mmol/L] and 24-hour blood pressure variability between the two groups ( all P ＜ 0.05 ).Significant difference could be observed in the prevalence of MBPS between the diuretics-taking group and non-taking group (27.4％ vs 17.6％,P ＜0.05 ).ConclusionsThe elderly hypertensive patients are prone to appear MBPS phenomenon.Fasting blood glucose level,24-hour blood pressure variability may be associated with MBPS.Diuretic antihypertensive treatment may not be conductive for MBPS control.

Objective To evaluate T cell and CD4+ CD28-T in the development and progression of abdominal aortic aneurysms (AAAs).Methods Fifty Wistar rats were randomly divided into 5 groups (n =10 each).An AAA animal model is established by enhancing perfusing elastase to the infrarenal abdominal aorta of the rats.The levels of T cell,B cell and macrophage cell of abdominal aorta of the rats on days 3,7,14 and 28,were detected by enzyme linked immunosorbent assay(ELISA).CD4+ CD28-T cell of the peripheral blood were measured by flow cytometry.Result There was significant T-lymphocyte infiltration both in middle and outer membrane of the artery of the rats on day 7 after surgery.T-lymphocyte,B-lymphocyte and macrophage cell infiltration were on the peak in middle and outer membrane of the artery on day 14 after surgery.The ratio of CD4+ CD28-T cell in rat peripheral blood reached peak on day 7(P ＜0.05).Conclusions T cell and CD4+ CD28-T cell expression increased in peripheral blood and abdominal aorta in AAA rat model,suggesting a potential role of T cell and CD4+ CD28-T cells in the pathogenesis of AAAs,especially during the early development of AAAs.

AIM:To explore the protective effect of ischemic preconditioning on myocardial capillary bed. METHODS: Anesthetized open-chest dogs in ischemic preconditioning (IP) group ( n =6) were subjected to 5 min ischemia and 5 min reperfusion for 4 times in left descending coronary artery (LDA) while the dogs in sham-operated (SO) group ( n =6) were observed for 40 min without any stimulating. Myocardial contrast echocardiography (MCE) was performed before the surgery, at the end of the first and the fourth ischemia and reperfusion period, respectively. Myocardial samples in ischemic area were obtained for capillaries ultrastructure examination and their quantitative analysis was conducted by corresponding imagine analyzing system, then compared within group and between control group. RESULTS: (1) Comparing fourth 5 min ischemia with first one, the percents of area defect in minimum (AD min%) by MCE decreased from 32.6%?5.7% to 21.8%?5.2%( P

OBJECTIVETo analyze the prevalence and orthostatic blood pressure changes in subjects with symptomatic orthostatic hypotension (OH), and to observe the relation between symptoms and orthostatic blood pressure change in this population.

METHODSA total of 193 subjects who consulted physicians due to OH related symptoms were selected, and divided into three groups: young (n = 37), middle-aged (n = 66) and elder (n = 90). Height, body weight, waist circumference, hip circumference and resting heart rate were measured. Symptom scores of every subject were obtained. CAVI and ABI were measured. Blood pressure including recumbent position, orthostatic systolic and diastolic blood pressure was measured at the morning and at the afternoon on two separate examination days with at least one week interval. After that, orthostatic changes in systolic blood pressure (OCs) and orthostatic changes in diastolic blood pressure (OCd) were calculated.

RESULTSOH prevalence was 32.6% in this cohort. The prevalence of three groups was similar [young: 32.4%, middle-aged: 25.8%, and elderly: 37.8%, respectively (P > 0.05)]. Only 9 cases (14.29% of confirmed OH cases) reached the OH diagnostic criteria with equal or more than 2 times orthostatic blood pressure measurements. OH was diagnosed in 63 patients during the 4 times orthostatic blood pressure check, of which 19.5% to 57.14% cases were diagnosed with single orthostatic blood pressure check. Age, weight, body mass index, waist-to-hip ratio, smoking, drinking habit, sex, coronary heart disease, hypertension, Parkinson's disease, stroke history, antihypertensive drug use were similar between OH group and non-OH group. Height, waist circumference, hip circumference, and resting heart rate were significantly lower in OH group than in non-OH group (P < 0.05). The values of the factors in OH group were lower. CAVI was 8.45 ± 0.19 in non-OH group and 8.37 ± 0.27 in OH group (P > 0.05), ABI was significantly lower in OH group than in non-OH group (1.004 ± 0.013 vs. 1.051 ± 0.009, P < 0.01).

CONCLUSIONThe prevalence of OH in people with related symptoms is high. Repeated orthostatic blood pressure measurements can improve OH detection rate.

Adolescent ; Adult ; Blood Pressure ; Female ; Humans ; Hypotension, Orthostatic ; epidemiology ; physiopathology ; Male ; Middle Aged ; Prevalence ; Young Adult