Objective:To assess the effectiveness and postoperative stability of proximal femoral varus derotational osteotomy combined with modified triple innominate osteotomy in treating hip dislocation in cerebral palsy.Methods:A total of 28 hips (11 left, 17 right) from 23 patients with cerebral palsy-induced hip dislocation who underwent the said surgical procedures were retrospectively examined between November 2018 and September 2022. The median age at the time of surgery was 7.7 years. Preoperatively, 29% of hips exhibited pain. Intraoperatively, a three-dimensional subtrochanteric osteotomy was performed with internal fixation using a Pediatric Hip Plate, alongside a modified triple innominate osteotomy via the Smith-Petersen and perineal approaches. Clinical assessments included pre- and postoperative evaluations of hip pain and joint mobility, as well as imaging evaluations, including migration percentage, acetabular index, acetabular offset, neck shaft angle, and femoral neck anteversion.Results:With a median follow-up of 15 months (range: 12 months to 20 months), all patients were successfully monitored. The median surgery duration was 6.1 hours, with blood loss averaging 400±153 ml (range 200-800 ml). The difference between the median postoperative (1 week after operative) MP 0% (0%, 0%) and the median preoperative MP 50.5% (38.2%, 75.8%) was statistically significant ( Z=4.624, P<0.001). The difference between the median postoperative AI 1.0° (-3.3°, 11.8°) and the median preoperative AI 29.4° (26.3°, 38.0°) was statistically significant ( Z=4.623, P<0.001). The difference between the median postoperative AO 69.8 (66.0, 76.0) mm and the median preoperative AO 72.3 (69.1, 81.1) mm was statistically significant ( Z=4.099, P<0.001). The difference between the median postoperative NSA 124.3° (118.7°, 129.9°) and the median preoperative NSA 145.6° (139.6°, 153.5°) was statistically significant ( Z=4.541, P<0.001). The difference between the median postoperative FNA 13.0° (5.4°, 24.1°) and the median preoperative FNA 33.6° (27.8°, 39.8°) was statistically significant ( Z=4.407, P<0.001). The pain was relieved postoperatively in 7 hips (88%) and residual hip pain in 1 hip. The postoperative range of motion was preserved. No case of avascular necrosis of the femoral head was observed. There were 2 hips (7%) with nonunion in the iliac arcuate line. No case of redislocation was observed at the last follow-up, and no revision was performed recently. There was no significant difference between the median MP at the last follow-up of 0% (0%, 10.0%) and the median postoperative MP ( Z=0.561, P=0.575). Conclusion:The modified triple innominate osteotomy proved to be an effective intervention for correcting acetabular deformity in cerebral palsy-induced hip dislocation. The combination of proximal femoral varus derotational osteotomy with the modified triple approach not only significantly corrected hip dislocation but also alleviated pain and maintained joint mobility in pediatric patients with cerebral palsy.

Objective:To analyze the impact of Beijing Medical Reform on inpatient costs of medical and surgical patients in a hospital, and to provide reference for the hospital to explore the path of patient cost control.Methods:Based on the data of medical and surgical inpatients′ expenses from June 2016 to December 2019 in a hospital in Beijing, breakpoint regression method was used to analyze the impact of the two reforms(namely the comprehensive reform of separation of medicine and pharmacy and the comprehensive reform of medical consumption linkage)on the level of medical and surgical inpatients′ expenses and the cost structure of drugs and consumables.Results:The two reforms controlled the rapid rise of hospitalization expenses and reduced the proportion of drugs and medical consumption. The effect of the reforms on the total cost control of internal medical patients was better than that of surgical patients.For internal medical patients, the reform of separation of medicine and pharmacy played a greater role in the proportion of medicine; For surgical patients, the two reforms had effectively reduced the proportion of consumables, and the proportion of drugs had gradually decreased.Conclusions:The two reforms have effectively controlled the growth trend of hospitalization expenses, and changed the cost structure of drugs and consumables.

Objective To observe the effect of clindamycin for preventive infection in arthroplasty prophylac-tic.Methods 108 knee replacement patients were injected by 600mg intravenous clindamycin preoperation and con-tinue to use 1 -2 days after operation.The average postoperative hospitalization,postoperative outcome,body tempera-ture and blood after WBC changes of CRP and ESR in the fall of superficial infection trend,the average postoperative day,take out stitches after operation and the number of cases,postoperative deep infection early after infection (2 weeks)and delayed infection cases (within one year)were observed in order to evaluate the efficacy of preopera-tive antibiotics.Results 2 cases had superficial infection due to wound dehiscence (two times after suture recover-y),there was no complications of surgical wound in the other cases.In all cases,after operation,body temperature and blood WBC became to the normal level in seventh days,postoperative patients'CRP,ESR monitoring were significantly higher than those before operation (CRP:F =105.32,P =0.045;ESR:F =118.47,P =0.039),but on the 5 day after operation they were started to decline,CRP in the 21 postoperative day gradually returned to normal,and ESR gradually returned to normal after 6 months of operation.Preoperative HSS score was significantly lower than the post-operative score[(46.8 ±9.7)points vs.(91.7 ±3.4)points,t =6.38,P <0.05].Conclusion Clindamycin plays a definite role in prevention of infection,especially in the beta lactam antibiotic allergy cases,it can be preoperative antibiotic prophylaxis instead of cephalosporins.

ObjectiveTo observe the clinical efficacy of acupuncture at cranial sutures (cranial acupuncture) plus rehabilitation training in treating cerebral infarction.MethodSixty patients with cerebral infarction were randomized into an acupuncture-rehabilitation group (cranial acupuncture plus rehabilitation training) and a rehabilitation group (dryrehabilitation training), 30 cases in each group, to respectively receive cranial acupuncture plus rehabilitation training and dry rehabilitation training. The Fugl-Meyer Assessment (FMA) and Barthel Index (BI) were adopted to respectively evaluate the motor function of limbs and activities of daily living (ADL); the content of hypersensitive C-reactive protein (hs-CRP) was also observed before and after treatment for the evaluation of therapeutic efficacy.ResultThe acupuncture-rehabilitation group wassuperior to the rehabilitation group in improving the motor function and ADL, and down-regulating the hs-CRP content (P<0.05).ConclusionCranial acupuncture plus rehabilitation training is the optimal protocol in treating cerebral infarction, and it canproduce a more significant efficacy than dry rehabilitation training.

Objective To explore the effect of dihydromyricetin (DMY) on the cholesterol efflux in macrophage derived foam cells and analyze the possible mechanisms. Methods RAW 264.7 macrophages were incubated by oxidized low densi?ty lipoprotein (ox-LDL, 50 mg/L) for 48 h to induce foam cells. Subsequently, the foam cells were subdivided into control group (RPMI1640 media) and DMY 1-4 groups (10, 20, 40 and 80μmol/L) and cultured for 24 h. Cholesterol efflux from foam cells was examined by [3H] labed cholesterol. The high performance liquid chromatography assay was used to test the cellular contents of free cholesterol (FC), cholesteryl ester (CE) and total cholesterol (TC). The expression of ATP-binding cassette transporter A1 (ABCA1) was measured by Western blot assay. Results Compared with control group, cholesterol efflux was significantly increased, the content of FC, TC CE and CE/TC ratio were significantly decreased and expression of ABCA1 was significantly up-regulated in dose dependent manner in DMY (20, 40 and 80μmol/L) groups (P<0.05). There were no significant differences in cholesterol efflux, the content of FC, TC and CE, and expression of ABCA 1 between control group and DMY (10μmol/L) group of foam cells (P>0.05). Conclusion DMY promotes the cholesterol efflux in the macro?phage derived foam cells, which may be related with the increase of ABCA1 induced by DMY.

Objective: To investigate the effect of clopidogrel on antiplatelet therapy in patients with coronary artery disease (CAD) combining chronic kidney disease (CKD) in order to provide a medication reference in clinical practice. Methods: We retrospectively investigated 423 CAD patients with coronary angiography (CAG) conifrmed diagnosis in our hospital from 2014-01 to 2014-09. According to the value of eGFR, the patients were classiifed into 2 groups:CAD+ CKD- group,n=257 patients with eGFR ≥ 90 ml/(min?1.73 m2), including 182 male and 75 female at the mean age of (60.39 ± 11.09) years, and CAD+CKD+ group,n=166 patients with eGFR < 90 ml/(min?1.73 m2), including 107 male and 59 female at the mean age of (65.80 ± 10.84) years. The patients were treated either by aspirin 0.1 g/d with clopidogrel 75 mg/d for at least 7 days, or by PCI operation with the load of aspirin 0.3g and clopidogrel 300 mg. The thrombelastography was conducted to examine and compare the inhibitory rates of ADP receptor and arachidonic acid (AA) pathway in platelet between 2 groups. Results: The inhibitory rate of platelet ADP receptor in CAD+CKD- group (64.9 ± 27.2) % was higher than that in CAD+CKD+ group (56.6 ± 27.4) %,P=0.039. Based on clinical standard of platelet’s ADP and AA inhibitory rates, in CAD+CKD- group, there were 24/257 (9.4%) of patients only insensitive to clopidogrel, in comparison with 25 (9.7%) of patients only insensitive to aspirin,P=0.99. While in CAD+CKD+ group, there were 21/166 (12.7%) of patients only insensitive to clopidogrel, in comparison with 11 (6.6%) of patients only insensitive to aspirin,P= 0.045. Conclusion: Clopidogrel has decreased effect on anti-platelet therapy in CAD patients combining with CKD, such patients have reduced sensitivity to relevant medication.

Objective To observe the protective effect of Apelin-13 on the cerebral ischemia-reperfusion injury (CIRI), and to explore the possible mechanism in rat model. Methods Fifty male SD rats were randomly divided into five groups:sham group, CIRI model group and Apelin-13 (0.1, 1.0 and 10.0 μg/kg) treatment groups. The model of CIRI was established by filament. After 2 h ischemia, the focal middle cerebral artery was followed by 72 h reperfusion. Apelin-13 was administrated by intracerebroventricular injection 30 minutes before reperfusion. The score of neural function was estimated in different time points. The 2,3,5-triphenyl tetrazolium chloride (TTC) dye was used to calculate the volume and percentage of cerebral infarction. The endoplasmic reticulum stress (ERS) protein markers including glucose-regulated protein 78 (GRP78) and CCAAT/enhancer binding protein homologous protein (CHOP) in cerebral cortex were measured by Western blot assay. Results Compared with the sham group, the score of neural function was significantly increased, the infarct rate was reached(47.63 ± 5.81)%and the protein expressions of GRP78 and CHOP were significantly up-regulated in CIRI model group (P＜0.05). There were no significant differences in these data between the CIRI model group and 0.1 μg/kg Apelin-13 treatment group (P＞0.05). Compared with the CIRI group, the neural function defect was significantly improved, the muscle strength was significantly enhanced and the infarct rate was significantly decreased, and the protein expressions of GRP78 and CHOP were significantly down-regulated in the 1.0 and 10.0 μg/kg Apelin-13 treatment groups (P＜0.05). Conclusion Apelin-13 protects the cerebral ischemia-reperfusion injury in rat model, which may be related with the inhibition of endoplasmic reticulum stress.

Objective To investigate the effect of hydrogen sulfide (H2S) on the cholesterol efflux and ATP-binding cassette transporter A1 (ABCA1) expression in foam cells .Methods RAW 264 .7 macrophages were incubated with oxidized low density lipoprotein to induce foam cells .Foam cells were incubated with H2S donor sodium hydrosulfide .Cholesterol efflux from macropha-ges was tested by labed cholesterol .The cellular levels of free cholesterol (FC) ,cholesterol ester (CE) and total cholesterol (TC) were measured by high performance liquid chromatography assays .The mRNA and protein expressions of ABCA1 were detected by Real-time PCR and Western blot .Results Compared with the foam cells ,the rates of cholesterol efflux were significantly in-creased ,the levels of TC ,FC ,CE and CE/TC ratio were significantly decreased(P<0 .05) and expression of ABCA1 was signifi-cantly increased by treatment with H2S in dose-and time-dependent manner(P<0 .05) .Conclusion H2S up-regulates of expres-sion ABCA1 and promotes cholesterol efflux in RAW 264 .7 macrophage-derived foam cells .

Objective Plasma renin concentration (PRC) offers advantages in processing and standardization as compared with plasma renin activity (PRA). The aim of the study is to compare the sensitivity and specificity of plasma aldosterone concentration ( PAC)/PRA (ARR) and PAC/PRC (AARR) in screening primary aldosteronism ( PA ) in hypertensive patients and to observe the influence of different postures on PRC and AARR. Method ( 1 ) PAC and PRC in the supine position and after 1-hour and 2-hour upright posture were determined in 28 patients with PA and 51 patients with essential hypertension. The diagnostic efficacies during different postures were compared according to the ROC curve analysis. (2) 31 patients with PA, 242 patients with essential hypertension, and 145 normotensitive subjects were recruited in the study. The diagnostic efficacy of AARR in screening PA from hypertensive patients was evaluate. PAC, PRA, and PRC were measured by radioimmunoassay. Results ( 1 ) The AUC of AARR in the supine position, 1-hour and 2-hour upright posture were0.950 (95% CI0.906-0.994, P<0. 01), 0.979 (95% CI0.956-1.000, P<0.01) and 0.917 (95% CI 0. 856-0. 979, P<0. 01 ) respectively. AARR of 1 -hour upright yielded the highest screening efficiency. ( 2 ) The correlation coefficient index of Log-PRA and Log-PRC was 0. 705 ( P< 0. 01, n = 418 ), whereas the correlation coefficient index of Log-ARR and Log-AARR was 0.705 (P<0.01, n=418). The AUC of ARR and AARR were 0.998 (95% CI0. 981-1. 000, P<0.01 ) and 0.957 (95% CI0. 929-0.985, P<0.01 ) respectively according to the ROC curve. The optimal cutoff of AARR during upright 1 hour was 42.36 ng · dl-1/ng ·dl-1 ( sensitivity 87.10%, specificity 93.75% ). Conclusion The screening efficacy of AARR in screening PA in hypertensive patients was comparable with ARR. AARR measured after keeping upright 1 hour yielded the highest screening efficiency. The optimal cutoff of AARR was 42.36 ng · dl-1/ng ·dl-1.

The ratio of plasma aldosterone concentration to plasma renin activity (ARR) is a practical parameter in screening for primary aldosteronism (PA).However,variations of the cutoff value of ARR in different studies have been reported due to plenty of influential factors that may affect the secretions of renin and aldosterone. Lack of standardization of assays for ARR also makes direct comparisons among different studies difficult.The associated influential factors on ARR were introduced in this review.