Objective To analyse the safety and feasibility of laparoscopic techniques in the treatment of elderly patients with acute intestinal obstruction.Methods A prospective two-center single-arm clinical study was conducted.A total of 441 patients with acute intestinal obstruction treated at the department of general surgery of Longyou County People's Hospital and Hospital Affiliated to Qinghai University from October 2017 to October 2021 and met the inclusion criteria were selected as study subjects.Among them,10 patients had chronic obstructive pulmonary disease(COPD)and were given mechanical ventilation,noninvasive ventilation,continuous low-flow oxygen inhalation,nebulization inhalation,and bronchodilator treatment after surgery.Twelve patients had chronic kidney disease(CKD)and were given hemodialysis treatment after surgery.All 441 patients underwent laparoscopic exploration,small intestine decompression,and definitive surgery.After surgery,they received intravenous nutrition,antibiotics,and subcutaneous injection of low-molecular-weight heparin(10 U/kg).The blood gas analysis(for patients with COPD),renal function(for patients with CKD),weight,body mass index(BMI),complications,and prognosis were observed before surgery,after surgery,and at discharge.Results There were 441 elderly patients with intestinal obstruction in the study,including 240 males and 201 females.The mean duration of the disease was(74.2±6.4)hours,and the BMI was(25.4±6.7)kg/m2.A total of 280 patients with adhesions underwent adhesion lysis surgery,while 87 patients with small bowel necrosis and 19 patients with small bowel lipoangiomatosis underwent small bowel resection and anastomosis.Additionally,21 patients with obturator hernia underwent hernia repair surgery,and 34 patients with small bowel persimmon stones underwent small bowel incision and stone removal surgery.For the 10 patients with COPD,there was a significant increase in arterial partial pressure of oxygen[PaO2 mmHg(1 mmHg≈0.133 kPa):80.3±3.3 vs.72.6±2.7,P<0.01],and a significant decrease in arterial partial pressure of carbon dioxide(PaCO2)compared to preoperative levels(mmHg:35.7±3.6 vs.47.6±1.3,P<0.01).Four patients died of type Ⅱ respiratory failure,and 6 patients had a significant decrease in PaO2[(77.4±6.7)mmHg]and a significant increase in PaCO2[(42.1±5.2)mmHg]at discharge compared to postoperative levels(both P<0.01).Among the 12 patients with CKD,both blood urea nitrogen(BUN)and serum creatinine(SCr)increased significantly after surgery compared to preoperative levels[BUN(μmol/L):79.5±8.5 vs.18.8±4.7,SCr(μmol/L):312.7±12.1 vs.138.4±9.7,both P<0.01].Two patients died of renal failure,and 8 patients had a significant decrease in BUN[(9.2±0.7)μmol/L]and SCr[(112.5±3.8)μmol/L]at discharge compared to postoperative levels(both P<0.01).There were no significant differences in BMI and weight between preoperative,postoperative,and discharge times[BMI(kg/m2):25.4±6.7,24.9±3.9 vs.23.9±3.5;weight(kg):74.2±6.8,73.7±3.3 vs.72.8±4.6;all P>0.05].A total of 435 patients recovered from acute intestinal obstruction with no complications such as lower extremity venous thrombosis,intestinal fistula,wound dehiscence,or wound infection.Conclusion The strategy of treating elderly patients with acute intestinal obstruction by laparoscopic exploration,intestinal decompression,definitive surgery,treatment of underlying diseases,and subcutaneous injection of low-molecular-weight heparin is safe and feasible.

Objective: To evaluate the clinical efficacy of percutaneous kyphoplasty (PKP) in the treatment of stage Ⅲ Kümmell＇s disease with no neurological symptom. Methods: From January 2009 to June 2018, 45 patients underwent PKP for stage Ⅲ Kümmell＇s disease with no neurological symptom at Department of Orthopaedics, The First Hospital Affiliated to Soochow University. They were 12 males and 33 females, aged from 61 to 85 years (average, 70.9 years). Their visual analog scale (VAS) scores for back pain, Oswestry disability indexes (ODI), heights of fractured vertebrae and kyphosis cob angles were recorded and compared between preoperation, one day, 3 months and final follow-up after operation. Results: All the 45 patients were followed up for 12 to 48 months (average, 28.0 months). Their VAS scores (2.4±0.7, 2.2±0.7 and 2.3±0.6), ODI sores (34.7±6.8, 34.2±6.5 and 34.1±6.6) and cobb angles (15.7°±2.2°, 15.8°±2.2° and 15.9°±2.4°) at one day, 3 months and final follow-up after operation were significantly lower than those (8.2±1.1, 75.3±9.0 and 25.2°±3.9°) before operation (P<0.001). Their anterior height ratios of the fractured vertebra (54.0%±4.3%, 53.7%±4.2% and 53.6%±4.0%) and median height ratios of the fractured vertebra (56.8%±4.0%, 56.5%±3.9% and 56.6%±3.9%) at one day, 3 months and final follow-up after operation were significantly higher than those (25.8%±3.9% and 27.2%±3.1%) before operation (P<0.001). The rate of cement leakage was 13.3%(6/45). No patients had neurological symptoms after operation. Conclusion PKP is a minimally invasive, safe and effective treatment for stage Ⅲ Kümmell's disease with no neurological symptom, because it can relieve the symptoms of the patients, restore the height of the fractured vertebral body and reduce the local kyphosis cobb angle.

Objective To investigate the expression and prognostic significance of DEAH-box helicase (DHX16) by pan-cancer analysis. Methods The expression and prognostic significance of DHX16 were analyzed using the UALCAN web-portal. Gene ontology and kyoto encyclopedia of genes and genomes analyses of proteins interacting with DHX16 were performed using DAVID 6.8 functional annotation software. Results DHX16 was highly expressed in bladder urothelial carcinoma, head and neck squamous cell carcinoma, esophageal carcinoma, liver hepatocellular carcinoma, and cholangiocarcinoma (all P ＜ 0.001). Proteins interacting with DHX16 were located mainly in catalytic step 2 spliceosome, nucleoplasm, and cell membrane, and participated in mRNA splicing and processing, binding to poly (A) RNA and nucleic acids, and RNA helicase activity. Spliceosome, mRNA surveillance, RNA degradation, and transport pathways were implicated. Conclusion The high expression of DHX16 is helpful for the prognosis of bladder urothelial carcinoma prognosis, and unfavorable for prognoses of adrenocortical carcinoma, sarcoma, brain lower grade glioma, liver hepatocellular carcinoma, and acute myeloid leukemia. Thus, DHX16 may have value as a prognostic marker.

Objective To evaluate the clinical effects of minimally invasive percutaneous new C2transpedicular lag-screw fixation for management of Hangman's fractures.Methods From October 2015 to June 2017,25 patients who had Hang-man's fracture were operated with minimally invasive percutaneous new C2transpedicular lag-screw fixation assisted by infrared navigation,among them there were 18 male and 7 female,aged from 28 to 70 years[average(46.1±13.3)years].According to the Levine-Edwards classification:16 patients were TypeⅠ,6 patients were TypeⅡand 3 patients were TypeⅡA.The cause of the in-jury was road traffic accident in 20 patients and fall from height in 5 patients.19 patients were simple Hangman's fracture and oth-er associated lesions included odontoid fracture of TypeⅡ(2 patients),atlas fracture of TypeⅠ(2 patients),rupture of spleen(1 pa-tient),and rib fractures(1 patient).According to American Association for spinal cord injury,graded as spinal cord injury D in 3 cases and E in 22 cases.The clinical outcomes were evaluated by visual analog scale(VAS)scores and related indicators,such as operation time,the range of motion(ROM)of cervical spine and ratio of bony union were recorded.The pre-and post-operative VAS scores of neck pain were compared with repeated measures analysis of variance. Results The mean follow-up time was (12.5±6.0)months,ranging from 3 to 24 months.Satisfactory reduction was obtained in all cases(minimal translation≤2 mm with-out obvious C2,3angulation).The average operation time was(65.9±12.1)min.At first day,one month,three months and the last fol-low-up, VAS scores of neck pain decreased comparing with preoperational measurements. There was significant difference be-tween the pre-and post-operative VAS scores of neck pain(t=24.7,25.8,23.1,24.1,P<0.001).According to American Associa-tion for spinal cord injury,three cases restored from D to E.There was no spinal cord or vertebral artery injury during operation and there was no screw loosing or breakage and cervical malformation happened during follow-up period. Bony fusion was achieved in all of these cases and the range of neck rotation was stored normal at the last follow-up.The average time of Bony fu-sion was(3.4±0.8)months.Conclusion The primary clinical efficacies of minimally invasive percutaneous new C2transpedicu-lar lag-screw fixation for treatment of Hangman's fracture were satisfactory,which carries precision and safety,immediate stability and more reliable.So it could be considered as a new choice for management of Hangman's fractures.

Objective To investigate the impacts of water supply on water quality in the pipeline of the dental comprehensive treatment platform to contribute to pollution control.Methods Totally 8 platforms from the stomatological department underwent 2-a detection and tracing.The water sources included tap water,distilled water and filtered water,and the discharge water went through sampling and bacteriological analysis before and after disinfection.Results The mean numbers of colonies by tap water,distilled water and filtered water were (472±385),(380±372) and (446±382) cfu/ml respectively,and the qualification rates by tap water,distilled water and filtered water were 33.3％,45.8％ and 37.5％ respectively.All the colonies numbers were limited within 0 and 60 cfu/ml with the qualification rate being 100％ after disinfection.Conclusion Water source cannot relieve bacterial infection effectively,and disinfection eliminates bacteria and improves water quality in the pipeline of the dental comprehensive treatment platform.

Objective To compare the radiographic and clinical outcomes of uniaxial and polyaxial locking plates used in the treatment of complex intraarticular calcaneal fractures.Methods A retrospective comparative study was performed on the 50 patients with intraarticular calcaneal fracture (Sanders types Ⅲ and Ⅳ) who had been treated by uniaxial locking plates (n =26) or polyaxial locking plates (n =24) between January 2013 and June 2015.Operation time,intraoperative bleeding,union time,radiological and functional outcomes and functions by the Maryland foot score were compared between the 2 groups.Results All the patients were followed up for 12 to 44 months(average,20.8 months).There were no significant differences between the 2 groups in average operation time (105.2 ± 18.2 min versus 95.5 ± 17.7 min),average intraoperative bleeding (125.2 ±23.4 mL versus 120.3 ±21.5 mL),or union time (12.1 ± 3.7 weeks versus 11.8 ± 3.7 weeks) (P ＞ 0.05).All patients obtained bony union.The polyaxial locking plates group displayed significantly better B(o)hler and Gissane angles at 3 and 12 months after operation than the uniaxial locking plates group (P ＜ 0.05).Evaluated by the Maryland foot score,the excellent and good rate for the polyaxial locking plates group [91.7％ (22/24)] was insignificantly higher than that for the uniaxial locking plates group [84.6％ (22/26)] (P =0.267).Conclusions Both uniaxial locking and polyaxial locking plates can lead to satisfactory therapeutic outcomes for complex intraarticular calcaneal fractures,but polyaxial locking plates may be superior in stability and functional recovery.

BACKGROUND:Whether lumbar spondylolisthesis needs to be treated with reduction remains controversial.OBJECTIVE:To investigate the clinical effectiveness of pedicle screw fixation combined with posterior lumbar interbody fusion for degenerative lumbar spondylolisthesis in the patients aged more than 70 years old.METHODS:The clinical data of 30 patients with degenerative spondylolisthesis aged over 70 years old undergoing pedicle screw fixation combined with posterior lumbar interbody fusion were analyzed retrospectively.The Visual Analogue Scale,Oswestry Dysfunction Index and the Japan Orthopedics Association scores were compared and analyzed before and after surgery.RESULTS AND CONCLUSION:(1) Among 30 patients,12 were male and 18 female,the average age was (75.1±6.7) years old,and all were followed up for more than 12 months.(2) The postoperative Visual Analogue Scale,Oswestry Dysfunction Index and the Japan Orthopedics Association scores were significantly improved compared with baseline (P ＜ 0.05).According to the Japan Orthopedics Association scores,3 cases were cured,24 were significantly effective,and 3 effective.(3) Graft fusion was achieved at all patients,the average fusion time was (5.13±0.65) months.(4) The average operation time was (225.6±23.4) minutes,the average intraoperative blood loss was (470±45.5) mL,and the average follow-up time was (25.8±3.5) months.(5) Six patients presented complications (20％),including one case of dural tear,two cases of paralytic intestinal obstruction,and three transient lower extremity nerve symptoms.(6) These results indicate that if the associated disorders are strictly controlled,pedicle screw fixation combined with posterior lumbar interbody fusion can achieve good surgical results in the treatment of degenerative spondylolisthesis in the elderly.

Objective To explore the reproduction needs of men with spinal cord injury. Methods Data was collected with questionnaire. Results 57 men with spinal cord injury had urgent needs of reproduction meanwhile professional services were deficient seriously. Conclusion The professional services for reproduction can't meet the needs of persons with spinal cord injury

Total hip replacement is a very effective method to cure many kinds of hip joint illnesses. About a century ago, it was first used in clinic. Since then, total hip replacement has been well developed. Hip joints sustain the most load of body, so people pay great attention to the hip prothesis' mechanics property. Especially after the finite element analysis was widely used in biomechanics investigation, the stress distribution of different designs can be easily compared with each other, and the relatively better parameters of the design could be decided. The stress distribution of different materials with the same design also can be valued. However, studies have indicated that total hip joint replacement still has some disadvantages. Loosening of the hip prothesis is still the most likely cause of the failure of surgery, and generally this is believed to stem from either mechanical failure of the fixation in response to over high density stresses, or osteolysis of the surrounding bone stock responsing to particular wear debris. Many researchers on computational studies have considered the potential for the former one, but only a few have attempted to tackle the latter. The process of osteolysis of the bone is not yet completely known. Nowadays, in order to solve the problems of loosening, investigators are trying to find different methods. Some of them are working on improving the geometry parameters and the shape of the hip prothesises, some are trying to find new suitable biomaterials, and, at the same time, the fixation methods are under deliberation.
Arthroplasty, Replacement, Hip ; adverse effects ; Computer-Aided Design ; Finite Element Analysis ; Humans ; Prosthesis Design ; Prosthesis Failure ; Stress, Mechanical ; Weight-Bearing

OBJECTIVE:To compare the therapeutic effect of surgical approach that should be used for posterior interbody fusion,posterolateral fusion with or without lumbar interbody fusion for adult spondylolisthesis.METHODS:From January 2004 to May 2008,75 patients with adult spondylolisthesis were retrospectively analyzed,comprising 22 males and 33 females,aged 53.3 years (ranging 49-70 years).There were 47 cases in L4,28 in L5;5 cases of degree Ⅰ,24 of degree Ⅱ,37 cases of degree Ⅲ,and 9 of degree Ⅳ.A total of 21 patients were treated with pedicle screw fixation and posterolateral lumbar fusion (group A),26 with pedicle screw fixation and posterior lumbar interbody fusion using cage (group B),and 28 with pedicle screw fixation and posterolateral lumbar fusion with posterior lumbar interbody fusion using cage.The satisfaction rate and fusion rate were compared among the three groups.RESULTS:All 75 patients were followed up for 6 months 3 years.The fusion rate of group A was 57%,and the satisfaction rate was 62%;the fusion rate of group B was 85%,and the satisfaction rate was 89%;the fusion rate of group C was 89%,and the satisfaction rate was 93%.There were no significant differences in the satisfaction rate and fusion rate between groups B and C (P>0.05),but the satisfaction rate and fusion rate of groups B and C were superior over group A (P<0.05).CONCLUSION:Posterior interbody fusion and posterolateral fusion with lumbar interbody fusion display similar treatment effects,which are better than posterolateral fusion.