BACKGROUND: Huperzine A is a reversible cholinesterase inhibitor extracted initially by China from huperzia serrata,a Chinese herb. Its mechanism in improving choline function and ameliorating cognitive state of patients with dementia is to increase acetylcholine (Ach) concentration in neural synapse through impeding the hydrolysis of acetylcholinesterase.OBJECTIVE: To investigate the effects of huperzine A on the improvement of cognitive function of patients with Alzheimer disease (AD).DESIGN: A randomized controlled study based on patients.SETTING: Second internal department of neurology in a general hospital of military area command of Chinese PLA.PARTICIPANTS: Totally 69 AD patients hospitalized in the Second Department of Neurology,General Hospital of Jinan Military Area Command of Chinese PLA between March 2000 and December 2003 were allocated into huperzine A group( n = 38,male,aged between 68 and84 years old,average age of 76 years old) and control group( n = 31,male,aged between 68 and 80years old,average age of 74 years old) according to the wills of the patients.MAIN OUTCOME MEASURES: Positive expression percentage of Fas,Apo2.7 and Bcl-2 on platelet membrane and the integral of mini-mental state examination(MMSE),Hasegawa' s dementia scale(HDS) and activities of daily living (ADL) of two groups after therapy.RESULTS: The positive expression of Fas,Apo2.7 or Bcl-2 on peripheral platelet membrane after therapy in huperzine A group were (2.23 ± 0.49)%,(2.37 ±0. 36)%,or(2.01 ±0. 32)% respectively,which was significantly lower than(3.12 ± 0. 74)%,(2. 83 ± 0.67)% or (2. 59 ± 0. 54)% of control group ( P ＜ 0.01). The prognostic integral of MMSE,HDS or ADL of huperzine A group was 20.45 ±4. 14,21.39 ±4.89,or 36. 15 ±5.11,which was significantly higher or lower than that of the control group(15.76 ± 3.23,17.32 ±2.09,4.26 ±7.21)(P ＜ 0.05).CONCLUSION: HuperzineA actually can effectively improve the memory and cognitive function of AD,and effectively improve ADL as well.

Female ; Humans ; Immunohistochemistry ; In Situ Hybridization ; Infant, Newborn ; Lung ; metabolism ; pathology ; Macrophage Migration-Inhibitory Factors ; analysis ; genetics ; Male ; Respiratory Distress Syndrome, Adult ; blood ; genetics ; pathology

With the development of social economy, high-intensity energy is the direct cause of fracture, such as traffic accident, fall injury and tumble. Fracture healing is affected by many factors, such as malunion, delayed union, nonunion and wound infection. Tibial fractures are usually caused by high-energy mechanisms and can also be caused by low-energy mechanisms of ankle rotation. With the gradual deepening of orthopedic surgeons′ understanding of bone nonunion, the treatment of tibial nonunion is mainly divided into surgical treatment and non-operative treatment. Surgical treatment is generally the first choice for the treatment of bone nonunion, in which plate internal fixation plays an unique advantage in the treatment of tibial nonunion. By reviewing the recently published literature, this paper reviews the latest progress in the treatment of tibial nonunion with plate internal fixation.

Abstract: In the United States, it is estimated that 1% to 4% of pregnant women are infected with hepatitis C virus （HCV）, which carries approximately a 5% risk of transmission from mother to infant. Hepatitis C virus can be transmitted to the infant in utero or during the peripartum period, and infection during pregnancy is associated with an increased risk of adverse fetal outcomes, including fetal growth restriction and low birthweight. The purpose of an excerpt of Society for Maternal-Fetal Medicine Consult Series #56: Hepatitis C in pregnancy—updated guidelines: Replaces Consult Number 43, November 2017 is to discuss the current evidence, provide updated recommendations regarding screening, review treatment, and address management of hepatitis C virus during pregnancy.

Objective To explore the clinical outcomes of locking plate fixation of intertrochanteric fractures in patients with deformed proximal femur.Methods A retrospective review was made of the 25 patients with intertrochanteric fracture and deformed proximal femur who had been treated from January 2009 to July 2015.They were 17 men and 8 women,from 22 to 76 years of age (mean,45.2 years).The proximal femoral deformities were postpoliomyelitis syndrome in 6 cases,fibrous dysplasia in 4,malunion in 13,and hip varus caused by implant breakage following intramedullary nailing in 2.By AO classification,there were 4 cases of type 31-A2.1,3 ones of type 31-A2.2,16 ones of type 31-A3.1,and 2 ones of type 31-A3.2.All the patients were treated by open reduction plus locking plate fixation.At the final follow-up,function of the affected hip was evaluated by the Hip Disability and Osteoarthritis Outcome Score (HOOS),and quality of life of the patients was evaluated using the SF-36 health survey questionnaire.Results The 25 patients were effectively followed up for 12 to 24 months (mean,17.4 months).No infection,pneumonia,fat embolism,or deep venous thrombosis of lower limb was observed.The fractures healed without nonunion or refracture after a mean time of 5.9 months (range,from 3 to 6 months) in the 25 patients.By the HOOS evaluation at the final follow-ups,the 25 patients scored,on average,83.7± 15.6 in pain,55.6± 14.1 in symptoms,53.6 ± 9.5 in daily living function,52.7 ± 8.9 in sports and recreational activities and 62.4 ± 12.3 in quality of life;by SF-36 evaluation,they had a mean total score of 71.2 ± 13.8.Both the HOOS and SF-36 scores were not significantly different from the pre-injury values (P ＞ 0.05).Conclusion Locking plate fixation is a simple and effective way for the intertrochanteric fractures complicated with deformed proximal femur because intramedullary nailing is difficult or infeasible.

OBJECTIVETo study the nutrition status of premature infants in the neonatal intensive care unit (NICU) and risk factors of extrauterine growth retardation (EUGR).

METHODSThe clinical data of 110 premature infants who were admitted to the NICU from August 2007 to September 2008 were retrospectively reviewed. The possible factors influencing the nutrition status were analyzed.

RESULTSThe incidence of EUGR was 53.6% (59/110), 31.8% (35/110) and 10.0% (11/110) by weight, length and head circumference respectively among the premature infants. The risk factors of EUGR included: small-for-gestational-age (SGA), low birth weight, low speed of weight gain during hospitalization, large extent of physiological weight loss, long time to reach oral calorie goal, and maternal complications.

CONCLUSIONSThe nutrition status and physical development are not desirable in premature infants hospitalized in the NICU. Therefore, reasonable nutritional support and proactive control of risk factors are important strategies to improve the perinatal nutrition and long-term prognosis.

Birth Weight ; Female ; Growth Disorders ; etiology ; Humans ; Infant Nutritional Physiological Phenomena ; Infant, Newborn ; Infant, Premature, Diseases ; physiopathology ; Intensive Care Units, Neonatal ; Logistic Models ; Male ; Nutritional Status ; Risk Factors

Objective To evaluate the clinical application of our self-designed ultradistal locking tool in the intramedullary nailing for tibial fractures.Methods From January 2014 to May 2016,175 patients with tibial fracture were treated at our department.They were 119 men and 56 women,from 19 to 73 years of age (average,46.3 years).They were divided into 2 groups according to the different targeting devices used in the intramedullary nailing.Conventional locking tools were used in the 83 patients from January 2014 to January 2015 and our self-designed new ultradistal locking tools in the 92 patients from February 2015 to May 2016.The 2 groups were compared in terms of operation time,frequency of intraoperative fluoroscopy,and successful rate of one-time locking.Results There were no significant differences between the 2 groups in general clinical data(P ＞ 0.05),showing similarities of the 2 groups.The operation time(59.8 ±4.3 min),frequency of intraoperative fluoroscopy(11.0 ± 2.1 times),and rate of one-time successful locking[94.4％ (238/252)] in the ultradistal locking group were significantly better than those in the conventional locking group [73.6 ± 5.3 min,23.0 ± 3.8 times and 85.7％ (180/210),respectively] (P ＜ 0.05).Conclusions Our new ultradistal locking tools are superior to the conventional ones in that they lead to shorter operation time,less intraoperative fluoroscopy and higher successful rate of one-time locking.Additionally,the new locking tools are easy to handle and incur no extra costs.

Objective:To investigate the effect of double steel plate internal fixation combined with autogenous iliac bone grafting on aseptic nonunion after femoral shaft fractures.Methods:Retrospective analysis of clinical data of 73 patients with aseptic nonunion after femoral shaft fracture treatment was performed in department of orthopedies, Honghui Hospital, Xi′an Jiaotong University from January 2017 to December 2018, there were 42 males and 31 females, aged 30 to 58 years, with an average age of 40.63 years. They were divided into control group ( n=33) and observation group ( n=40) according to different surgical methods, the control group was treated with intramedullary nail replacement, and the observation group was treated with double steel plate internal fixation combined with autogenous iliac bone grafting. The general indicators of perioperative period (intraoperative blood loss, duration of operation, postoperative drainage), bone nonunion healing, and surgical efficacy were compared between the two groups. The follow-up time in outpatient clinic was (15.24 ± 4.72) months, and the follow-up deadline was December 2019. At 6 months after surgery, joint function, joint mobility, visual analogue scale (VAS) and Oswestry disability index(ODI) were evaluated. Measurement data were expressed as mean ± standard deviation ( Mean ± SD), and comparison between groups was analyzed using independent sample t test. Count data were expressed as percentage (%), and comparison between groups was analyzed using χ2 test. Comparison of ordinal data was analyzed by Mann-whitney U non-parametric test. Results:The patients in both groups were followed up. The amount of intraoperative blood loss, duration of operation, and postoperative drainage [(201.6±38.4) mL, (138.7±22.7) min, (25.8±6.9) mL] in the observation group were significantly less than those in the control group [(278.5±40.6) mL, (171.4±20.1) min, (43.2±8.5) mL], the differences were statistically significant between the two groups ( P<0.05). Comparison of postoperative bone nonunion healing, the healing time of the observation group (5.15±0.42) months was significantly shorter than that of the control group (6.31±0.58) months, and the healing rate of the observation group (100%) was significantly higher than that of the control group (90.1%), the differences were statistically significant between the two groups ( P<0.05). After 6 months of follow-up, the excellent and good rate of joint function were compared between the two groups. The knee joint excellent and good rate (97.50%) and hip joint excellent and good rate (97.50%) in the observation group were significantly better than those of the control group (78.79%, 81.81%), the differences were statistically significant between the two groups ( P<0.05). Comparison of joint mobility between the two groups of patients, knee joint mobility [extension angle (0.64±0.14) °, flexion angle (138.72±6.37) °]and hip joint activity [adduction angle (35.13±9.44) °, the abduction angle (74.38±5.22) °] were significantly better than the knee joint mobility [extension angle (0.48±0.21) °, flexion angle (113.57±5.43) °] and hip joint motion [adduction angle (21.57±8.63) °, abduction angle (69.57±6.37) °], the differences were statistically significant between the two groups ( P<0.05). The VAS and ODI efficacy scores [(3.24±0.43), (23.45±4.77) scores]in the observation group were significantly better than those of the control group [(4.64±0.71), (27.25±4.38) scores] at 2 and 4 weeks after operation, the differences were statistically significant between the two groups ( P<0.05). Conclusions:The double steel plate internal fixation combined with autologous iliac bone grafting is ideal and significant in the treatment of aseptic nonunion after femoral shaft fracture. Meanwhile, it has the advantages of less trauma throughout the operation, quicker postoperative recovery, and significantly improved joint function. It is worthy of clinical application.

Nonunion of femur is a common complication after intramedullary nail operation of femoral fracture, with an incidence of 1% to 12.5%. At present, the treatment of femoral nonunion is mainly divided into surgical treatment and non-operative treatment, and surgical treatment is the first choice. The gold standard for surgical treatment of femoral nonunion is replacement of intramedullary nail, but for non-isthmus femoral nonunion, larger diameter intramedullary nail could not solve the problem of rotation and angular displacement of the broken end of nonunion. For malnourished nonunion, atrophic nonunion and bone nonunion with large bone defect, the replacement of intramedullary nail and autogenous bone graft are not enough to eliminate the gap between the broken ends and increase the contact area between the broken ends. It cannot provide a good biological environment for the broken ends. Because the replacement of intramedullary nail does not expose the broken ends of bone nonunion, and the corresponding tissue cannot be taken for bacteriological culture, so it is difficult to judge whether the broken end sare complicated with infection. The double plate technique is to find the site of bone nonunion under direct vision, and two plates are placed with different angles. This paper reviews the literature related to the treatment of femoral nonunion with double plate technique published at home and abroad in the past 10 years, and concludes that double plate fixation combined with autogenous iliac bone graft provides a three-dimensional fixation model for the healing of nonunion. It has the characteristics of strong stability and plays an active role in improving the biological behavior and mechanical stability of the fracture ends. The operation is beneficial to the flexion and extension of the knee joint, with the characteristics of high healing rate, low complication rate, effective pain relief and so on.

Objective To explore the application of 3D-printing rapid prototyping in classification of acetabular fractures and education of young surgeons.Methods The data of 20 patients with acetabular fracture were reviewed in this study who had been treated between January and June 2016.Three junior orthopedic surgeons and 3 senior ones were chosen as observers.The conventional radiographs (X-ray films of the pelvis and acetabulum,CT scans and 3D reconstruction images of the pelvis) and 3D-printing rapid prototyping models of the 20 patients(1∶ 1) were randomly numbered.All the observers were asked to make Letournel-Judet classification of each radiograph and 3D-printing model independently in the first assessment.Four weeks later in the second assessment,all the observers were asked to make the same classifications after all the conventional radiographs and 3D-printing models were randomly numbered again.The kappa statistics was used to evaluate inter-and intra-observer agreements among the recorded results.Results At the first assessment,the inter-observer agreement was 0.887 and 0.962 respectively for conventional radiographs and 3D-printing models in senior surgeons while 0.659 and 0.849 in junior surgeons.The second assessment showed the intra-observer agreement was 0.906 for radiographs and 0.925 for 3D-printing models in senior surgeons while 0.696 and 0.849 in the junior ones.Conclusions Compared with conventional radiographs,since 3D-printing models can effectively enhance the reliability of acetabular fracture classification,they may be more helpful for young surgeons in understanding acetabular fractures.