BACKGROUND:The mechanical characteristics of intramedul ary and intramedul ary fixations for treating intertrochanteric fracture were hot research of finite element, but there was few comparative research on tension side and pressure side of proximal femur. In our study, we found that the distribution of the stress zone was important indication to researches on intertrochanteric fracture and internal fixation design. OBJECTIVE:To explore the effects of intramedul ary and extramedul ary fixations for treating intertrochanteric fracture on pressure side and tensile side of proximal femur. METHODS:CT scan and Mimics modeling of volunteer’s femur were conducted, and the model Evans type I intertrochanteric fracture was constructed and treated with proximal femoral nail antirotation and dynamic hip screw respectively. The stress condition of proximal femur in weight status was simulated. The Abaqus 6.13 was used for finite element analysis, and the tension side and pressure side of proximal femur in both fixations were also analyzed. RESULTS AND CONCLUSION:(1) The stresses of compressive side and tensile side in proximal femoral nail antirotation group were both less than that in dynamic hip screw group. The stress of proximal femur in proximal femoral nail antirotation group was more similar to that in physiological status. (2) These findings verified that for treating intertrochanteric fracture, intramedul ary fixation exerted better mechanical behavior than extramedul ary fixation. The protection of compressive side and tensile side of proximal femur had achieved by intramedul ary fixation.

Objective To investigate the effect of total flavones of Rhizoma Drynariae on femur distraction osteogenesis in the rabbits. Methods Thirty-two healthy rabbits were randomly divided into treatment group and control group, 16 rabbits in each group. The femoral fracture was treated with unilateral femoral distraction and was fixed with a self-made distraction instrument. After 7-day intermittent period, the fractured femur was distracted at a rate of 1 mm/d, twice a day for 10 continuous days. The treatment group was fed with total flavones of Rhizoma Drynariae from the first post-operative day to the end of the experiment. And then all of the animals were sacrificed after fixation for 28 days. The bone specimens were used for histological observation and immunohistochemical detection. Results The area of mature bone in the newborn bone tissue of the treatment group was increased, and osteoblasts number and the percentage of trabecular bone area were significantly higher than those of the control group . The bone morphogenetic protein-2 (BMP-2) and transforming growth factor-β1 (TGF-β1) were stained brown deeply, the staining degree being stronger than that of the control group. Conclusion Rhizoma Drynariae total flavones can effectively accelerate the formation and maturation of newborn bone tissue during bone distraction.

Objective To compare the efficacy of small splint fixation and plaster fixation in treating distal radius fracture. Methods One hundred and four cases of type A2 distal radius fracture admitted from January of 2012 to May of 2013 were randomly divided into small splint fixation group and plaster fixation group. After reduction, patients in the two groups were fixed with small splint and plaster separately. Wrist function scores, 36-item Short Form ( SF-36) scores and roentgenographic scores were evaluated for the two groups at different time points. Results ( 1) Within 3 months of follow up, the improvement of wrist function in small splint fixation group was significantly superior to that in plaster fixation group (P<0.05), and the differences of wrist function scores were insignificant between the two groups with the prolongation of follow-up (P>0.05). (2) SF-36 scores of the two groups were gradually increased along with the follow up. After follow-up for one week, 2 weeks, one month and 3 months, the SF-36 scores in small splint fixation group were significantly higher than that in plaster fixation group ( P<0.05) , but there was no significant difference after 6 months ( P>0.05). ( 3) After follow up for one year, the excellent rate for roentgenographic scores was higher than 80% in both groups, and there was no significant difference between the two groups (P>0.05). Conclusion Both small splint fixation and plaster fixation have satisfacory efficacy in treating type A2 distal radius fracture. But during the therapeutic process, wrist function scores and life quality scores in the small splint fixation group were higher than those in the plaster fixation group.

BACKGROUND: Splint fixation was a common treatment for limb fracture, but there were some limitations, such as lack of individual difference, easy to lose and being unable to self-adjusting.OBJECTIVE: To explore the design method of digital splint and related finite element analysis.METHODS: Forearms were scanned with CT; periphery parameters were extracted, followed by reverse modeling and modifying. The digital splint models were constructed. Material attribute and mechanical loading were conducted. Thelimb length, maximum stress and displacement of the bone, soft tissue and splint were calculated by finite elementanalysis. RESULTS AND CONCLUSION: The digital splint has favorable tight attaching and balanced stress to skin, and whichkeeps well stability for the micro-motion fracture ends. Our study indicated that better tight attaching splint could bedesigned by digital modeling technology. Favorable fracture fixation and mechanical property could be also achieved.

Objective To establish a distraction osteogenesis SD rat model for exploring the effect of total flavonoids from Rhizoma Drynariae on the quality of rat bone formation in the process of distraction osteogenesis from the perspective of tomography.Methods Twenty-four rats were randomly divided into experimental group and control group after successful modeling,and were respectively given intragastric administration with total flavonoids from Rhizoma Drynariae(in dose of 77.125 mg/kg) and saline for 8 weeks.Seven days after operation,the tibias of all the rats were given distraction at the speed of 0.2 mm for 20 days.Eight weeks after the operation,X-ray examination for all the rats was performed,and then the rats were killed for obtaining the tibia samples for Micro-CT scanning.The differences of X-ray Lane-Sandhu scores,the bone mineral density and bone mineral content were compared between the two groups.Results The X-ray Lane-Sandhu scores,the bone mineral density and bone mineral contents showed by Micro-CT scanning in the experimental group were higher than those in the control group,and the differences were statistically significant (P ＜ 0.05).Conclusion The total flavonoids from Rhizoma Drynariae can improve the quality of bone formation in the process of distraction osteogenesis in rats.

Objective:To evaluate the feasibility and safety of uniportal video-assisted thorascopic pneumonectomy for non-small cell lung cancer patients, as well as the surgical techniques.Methods:From January 2017 to June 2018, 23 non-small cell lung cancer patients who underwent uniportal VATS pneumonectomy in our hospotal were retrospectively evaluated. There were 20 males and 3 females with a mean age of(60.3±6.0) years. The clinical data, complications and operative mortality were analyzed.Results:All 23 patients with lung cancer were operated safely. There was no conversion to thoracotomy. The mean operating time was(160.8±65.0) min. The mean blood loss was(131.3±121.3) ml. The mean hospital stays were(14.0±6.3) days. The mean postoperative hospital stays were(8.0±4.5) days. Postoperative morbidity occurred in 4 patients(17.4%). There was no perioperative mortality. Pathology examination of all patients were lung cancer(5 cases of adenocarcinoma, 15 cases of squamous carcinoma, 2 cases of large cell carcinom, 1 case of adenocarcinoma combined with large cell carcinoma).Conclusion:Uniportal video-assisted thorascopic pneumonectomy is a feasible operation that could be performed safely in a selected group of patients by experienced surgeons.

Objective To analyze the mechanism of Huangwu Ganfu Ointment in relieving pain of knee osteoarthritis(KOA)based on network pharmacology;To verify it in animal experiments.Methods The active components of Huangwu Ganfu Ointment were obtained by TCMSP database,PubChem database and SwissADME platform,the effective components were screened,and the targets were obtained from SEA database.KOA disease-related targets were obtained from GeneCards,OMIM and other databases,and the intersection targets were obtained.A effective component-target-disease network was constructed using Cytoscape 3.9.0 Software.Protein-protein interaction(PPI)network was constructed by STRING database and core targets were screened.GO and KEGG enrichment analysis of intersection targets were analyzed using DAVID platform.The KOA rat model with cold and damp syndrome was established,and the intervention of Huangwu Ganfu Ointment was carried out.The efficacy was observed and the core target expressions were detected.Results Totally 104 effective components were screened from Huangwu Ganfu Ointment,and 59 potential targets were obtained for treating KOA.PPI network interaction analysis obtained the important targets of IL6,IL1B and PTGS2.KEGG enrichment results showed that Huangwu Ganfu Ointment may involve 84 signaling pathways such as IL-17,TNF,TRP and NF-κB in the treatment of KOA,most of which were related to inflammation.The results of animal experiments showed that Lecuesne MG scores increased in the model rats(P<0.05),and paw withdrawal threshold(PWT)significantly decreased(P<0.05).Compared with model group,PWT in Huangwu Ganfu Ointment medium-and high-dosage groups were significantly recovered,and synovitis Krenn score decreased(P<0.05).The Mankin score of cartilage tissue of Huangwu Ganfu Ointment high-dosage group decreased(P<0.05).The contents of IL-6 and IL-1β in all Huangwu Ganfu Ointment groups decreased(P<0.01).Huangwu Ganfu Ointment medium-and high-dosage groups could down-regulate the expression of TRPV1 protein(P<0.05,P<0.01).Conclusion The mechanism of Huangwu Ganfu Ointment in alleviating the pain of KOA may be related to reducing inflammatory response,reducing the release of inflammatory factors of IL-1β and IL-6,alleviating inflammatory pain sensitivity of KOA,and down-regulating the expression level of TRPV1.

Objective To clarify the necessity of therapeutic drug monitoring (TDM ) of voriconazole ,and give relevant clinical tips ,by comparing the plasma concentration of different clinical specialties before and after adjustment of dose .Methods This is a retrospective study of voriconazole TDM data .It involves 435 cases voriconazole plasma trough concentration meas-urement results of 154 inpatients to make a preliminary assessment .Results 4 .3% plasma concentration were higher than 5 .5 μg/ml ,26 .5% plasma concentration were less than 1 .0 μg/ml in renal transplantation department ;while 52 .3% plasma concentration were higher than 5 .5 μg/ml ,no less than 1 .0 μg/ml in infectious disease department .Conclusions Therapeutic drug monitoring is necessary for rational use of voriconazole .The majority of plasma concentrations in renal transplantation pa-tients were <1 .0 μg/ml ,lower than recommended treatment concentration range ;while most infectious disease patients have> 5 .5 μg/ml ,higher than recommended treatment concentration range .Clinical pharmacists can be more closely involved in the clinical use of voriconazole based on the results of the therapeutic drug monitoring .

Objective To investigate the safety and efficacy of total thoracoscopic pneumonectomy for malignant lesion from a single-center pneumonectomy database.Methods A retrospectively analysis of 43 cases of malignant lesions in patients underwent total thoracoscopic pneumonectomy from surgical database of Shanghai Pulmonary Hospital from December 2013 to August 2017 was conducted,and then the mortality,complications,and disease recurrence were summarized.Results All lesions in 43 patients were pathologically comfirmed malignant,including 39 non-small cell lung cancers and 3 small cell lung cancers and 1 pulmonary metastasis.Complete thoracoscopic pneumonectomy was pedormed in 43 patients.The average operation time was (181.1 ± 68.0) min,blood loss was (146.5 t 113.6) ml,mean tube length was (8.4 ± 3.4) days.Perioperative mortality was 2.3％ (1/43).The complication rate of grade 3 or above was 16.3％.Median follow-up was 18 months,with 9 cases occuning local recurrence or distant metastasis;6 cases suffered from cancer-related death while non-cancer related death happened in 1 patient.Conclusion For selected locally advanced pulmonary malignant lesion,total thoracoscopic pneumonectomy is an alternative to open thoracic surgery with a better perioperative safety and satisfied mid-term oncologic survival.