BACKGROUND:With more and more research available,there are different classification systems for intertrochanteric fracture,from Evans and Boyd-Griffin classification to Evans-Jensen and AO/OTA classification,all providing guidance for choosing an appropriate treatment scheme.OBJECTIVE:To review the advance in the treatment of senile unstable intertrochanteric fractures.METHODS:PubMed,Web of Science,WanFang and CNKI databases were searched with the keywords of intertrochanteric fracture,intramedullary nail,hip arthroplasty in English and Chinese,respectively.1 535 literatures were retrieved firstly,and finally 47 articles were included in accordance with the inclusion and exclusion criteria.RESULTS AND CONCLUSION:The therapy conception of intertrochanteric fractures has been changed from conservative traction to early surgical treatment.With the development of technology,the internal fixators have been improved continuously.Screw-plate system has been developed from Jewett plate,AO/ASIF plate to dynamic hip screw.Intramedullary nails such as Gamma,proximal femoral and proximal femoral antirotation nails have been successfully applied in clinic.Senile patients with unstable intertrochanteric fractures also obtain favorable prognosis through active internal fixation,but the high incidence of complications appears because of osteoporosis,osteogenesis deficiency and accompanied by degenerative hip diseases.Thereafter,hip arthroplasty is recommended to treat senile unstable intertrochanteric fractures so as to achieve rapid functional recovery,desired efficacy and low incidence of complications.However,it still remains controversial to choose internal fixation or hip arthroplasty.

Objective To explore the accuracy and feasibility of infrared computer navigation for femur,tibia tunnel positioning in arthroscopic anterior cruciate ligament (ACL) reconstruction.Methods Data of patients who had undergone ACL reconstruction using infrared computer navigation from January 2012 to June 2013 were retrospectively analyzed.There were 26 males and 9 females,with an average age of 26.8 years old.35 patients were with concomitant meniscal injury 21 cases,and 3 cases with medial collateral ligament injury.All patients were treated with gracilis and semitendinosus knit stitch as grafts,and bone ends were made with hydroxyapatite extrusion screws,door-shaped nails and porous plate.Results The mean follow-up time was 16 months.The rate of postoperative femoral tunnel site measurements was 63.8％±6.6％,and tibial tunnel site measurements was 45.7％±4.2％.1 patient appeared heterotopic ossification in tibia tracker pinhole 3 months after surgery,and the joint activities was normal.Lachman test:there were 1 case with Ⅱ degree,30 with Ⅲ degree,and 4 with Ⅳ degree before operation,and 33 with Ⅰ degree,1 with Ⅱ degree,1 with Ⅲ degree after operation.The KT-1000 test was from 6.47±0.75 mm preoperatively to 1.01±1.14 mm postoperatively.Preoperative knee laxity differences was more than 5 mm in 32 cases,3-5 mm in 3,and after operation they were 0-3 mm in 31,3-5 mm in 2,and less that 0 mm in 2 cases.Lysholm score and Tegner scores were from preoperative 52.74± 10.91 points and 4.64± 1.34 points to postoperative 93.97±4.13 and 6.56±0.81 points.ROM was from 85.6°± 11.2° to 118.3°±5.7°;33 cases were without flexion and extension limited; two cases had knee flexion,extension limitation less than 10°.After straight leg raising training and proprioception functional training for 6 months,the knee ROM returned to normal.Conclusion Infrared computer assisted navigation system for arthroscopic ACL reconstruction is to navigate through the use of anatomical landmarks and kinematic data,kinematic data by detecting and recording the knee,selected a secure tunnel site,viable surgical method,you can make femur,tibia tunnel position more accurately,good curative effect evaluation.

Data of 55 patients with duodenal mass lesions treated by endoscopic submucosal dissection (ESD) were retrospectively analyzed. Risk factors of delayed bleeding after ESD were explored by univariate analysis and multivariate unconditional logistic regression analysis. Duodenal delayed bleeding occurred in 5 patients (9.09%). No closure treatment under endoscopy( P=0.035) was significantly different between the delayed bleeding group and the non-delayed bleeding group. Multivariate non-conditional logistic regression showed no closure treatment under endoscopy was an independent risk factor for delayed bleeding after ESD in duodenal mass lesions ( P=0.029, OR=0.079, 95% CI: 0.008-0.776). Patients older than 60 years and who did not take endoscopic closure treatment have higher incidences of delayed bleeding after ESD. No closure treatment under endoscopy is directly related to postoperative delayed bleeding.

AIM:To compare the difference between diopter of refration measured after cycloplegic mydriasis with retinoscopy and hand-held autorefractor so as to explore the feasibility of using hand - held autorefractor for refraction screening in cadet candidates.
METHODS:Respectively using hand-held autorefractor and streak retinoscope to do optometry examination in 317 cadet candidates students ( 634 eyes ) after mydriasis. Main index of refraction values ( spherical, cylindrical mirror degree and axial) were analyzed by difference test and correlation analysis. And the elimination rate was comparatively analyzed.
RESULTS: Diopters of sphere and cyclic refraction measured by hand-held autorefration were significantly higher than those by retinoscopy ( P< 0. 05 ), but the correction analysis showed that there was high correlation (r=0. 733, 0. 694), axial of refration measured by these two methods were non - significant ( P > 0. 05 ). The disqualifying rate using autorefraction was much higher than that using retinoscopy. It was easy to be wrongly eliminated.
CONCLUSION:Because of the high correlation between diopters of autorefraction measured by retinascopy and autorefractor, autorefraction has application value in refraction screening in cadet candidates with normal vision.

Adult ; Crown Lengthening ; Dental Restoration, Permanent ; Esthetics, Dental ; Female ; Humans ; Incisor ; Malocclusion ; therapy

Objective To study the natural history of mild cognitive impairment (MCI) progress to dementia and to evaluate the efficacy of acetylcholinesterase inhibitor (AChEI) donepezil on MCI.Methods Ninty-eight patients with MCI including amnestic MCI and non-amnestic MCI were retrospectively analyzed. The patients with donepezil or not were separately divided to two groups while they were matched by sex, age,degree of MCI and possession of the ApoE?4 allele.The rate of conversion from MCI to dementia, measured with the Mini-Mental State Examination (MMSE),Alzheimer's Disease Assessment Scale- Cognitive section(ADAS-Cog) and Wechsler Memory Scale-Revised (WMS-R),was compared between the two groups.Results In aMCI group,the rate of conversion dropped by 15.1% and 8.3% (P0.05).Conclusion Donepezil could postpone the conversion of MCI to dementia.

Objective To analyze the curative effects of total knee arthroplasty(TKA)for severe genu varus combined with flexion deformity.Methods The clinical data of 25 patients(36 knees),who had undergone TKA for severe genu varus combined with flexion deformity from January 2005 to October 2010,were retrospectively analyzed.There were 7 males and 18 females,aged from 55 to 80 years(average 70.5 years).The primary diseases were osteoarthritis in 22 cases and rheumatoid arthritis in 3 cases.HSS knee score was used before and after the operation to assess the efficacy of the TKA.Results All of the patients were followed up for 4 to 9 years(average 6 years).The degree of flexion deformity was reduced from (21 ±63)°to(1.1 ±2.3)°;the degree of the varus decreased from(210 ±4.8)°to(175.6 ±2.1)°;range of motion of the knee joint increased from(70.5 ±20.5)°to(115.1 ±5.3)°;knee score augmen-ted from(33.2 ±10.5)to(90.7 ±8.5);function score added from(35.5 ±14.2)to(85.6 ±10.5);there were 21 cases(8 knees)rated as excellent,2(3 knees)as good and 2(3 knees)as fair,and the excel-lent and good rate was 86%.Most of the patients had normal force line of the knee joint,but 2 patients re-mained varus deformity of 5°~10°.Conclusion Satisfying outcome can be achieved by TKA in treating severe genu varus combined with flexion deformity of the knee.

Objective Patients with knee osteoarthritis undergoing total knee arthroplasty may have a different degree of pain during the perioperative period. This will not only bring a lot of adverse effects to the patients,and directly affect the early postoperative functional exercise and rehabilitation of the knee joint. At present,the commonly methods used to relieve the pain after TKA are:patient con-trolled Intravenous analgesia(PCIA)、patient controlled epidural analgesia( PCEA)、continuous femoral nerve block analgesia(CFNB)、joint peripheral injection analgesia and some methods without using medi-cine. In this paper,the analgesia methods used during the perioperative period of TKA and the latest de-velopment are reviewed.

Objective To seek an effective method for the treatment of grade ⅢB tibial fractures.Method From Oct. 1985 to Oct.1999, 26 cases of grade ⅢB tibial fractures were treated by early soft tissue coverage(including 12 cases of free muscle flaps and 14 cases of local muscle flaps), early fracture fixation(including 21 cases of external fixation and 5 cases of non-reamed intramedullary nail) and early bone grafting(15 cases).Results The follow up duration were from 10 to 32 months with an average of 15.5 months. The success rates of free and local muscle flaps were respectively 91.7 %(11/12) and 92.9 %(13/14)?Infection occurred in 5 cases (3 cases of local superficial infection and 2 cases of osteomyelitis). The time for bone union were from 17 to 66 weeks with an average of 42 weeks. Conclusion "San-Zao"therapy,especially early soft tissue coverage and early fracture fixation is on effective management for grade ⅢB tibial fractures with the advantages of promoting wound healing and bone union and decreasing the possibility of infection.

Objective To explore the therapeutic effects of early short time venous-venous hemofiltration(SVVH) on severe acute pancreatitis(SAP) with acute lung injury(ALI).Methods Twenty-there patients with SAP and ALI were treated by routine project,and among them twelve patients accepted SVVH therapy.During the therapy,life sign、PaO2/FiO2 and APACHEII score were registered.Results Compared with control group,the clinical representation and organ function of SVVH group meliorated. PaO2/FiO2 were raised, APACHEII score and death risk were declined.Conclusions The early short time venous-venous hemofiltration(SVVH) on severe acute pancreatitis(SAP) with acute lung injury(ALI) could improve clinical symptom ,protect the organ dysfunction and decline the death risk.