OBJECTIVE: To compare the effectiveness and shoulder function of reverse total shoulder arthroplasty (RTSA) and open reduction and internal fixation (ORIF) in the treatment of Neer three/four-part proximal humeral fractures in the elderly. METHODS: Randomized controlled analysis was conducted on 68 patients over 70 years old with Neer three/four-part proximal humeral fractures treated with RTSA or ORIF between January 2020 and June 2022. The patients were randomly divided into RTSA group ( n=32) and ORIF group ( n=36). There was no significant difference ( P>0.05) in the baseline data such as age, gender, body mass index, injured side, Neer classification, and preoperative Charlson comorbidity index, visual analogue scale (VAS) score, Constant shoulder score, Oxford shoulder score (OSS), and hemoglobin (Hb). The operation time, intraoperative blood loss, reduction of Hb on the 3rd day after operation, hospital stay, total cost of hospitalization, complication incidence, range of motion of shoulder joint at 2 years after operation, VAS score before operation and at 5 days and 1 month after operation, Constant shoulder score and OSS score before operation and at 2 years after operation, and imaging results during follow-up were recorded and compared between the two groups. RESULTS: Compared with the ORIF group, the RTSA group had longer operation time, less intraoperative blood loss, and higher total cost of hospitalization ( P<0.05). There was no significant difference in Hb reduction on the 3rd day after operation between the two groups ( P>0.05). The VAS scores significantly improved in both groups at 5 days and 1 month after operation ( P<0.05), but there was no significant difference between the two groups ( P>0.05). All patients were followed up 26-35 months, with an average of 31.2 months. In the RTSA group, there were 2 cases of poor healing of superficial incision and 1 case of transient nerve injury. There was no complication such as bone resorption around the prosthesis, lucent band, prosthesis loosening, or periprosthetic fracture in all patients. In the ORIF group, there was 1 case of poor healing of superficial incision, 3 cases of nonunion of fracture, 1 case of arthritis secondary to humeral head necrosis, and 1 case of bone absorption of large tuberosity, and no displacement or fracture failure of internal fixation was found in all patients. There was no significant difference in the incidence of complications [9.4% (3/32) vs 16.7% (6/36)] between the two groups [ OR (95% CI): 0.828 (0.171, 4.014), P=0.814]. In the RTSA group, 28 cases were graded 0 and 4 cases were graded 1 at 2 years after operation. Constant and OSS scores of RTSA group were significantly better than those of ORIF group ( P<0.05). The Constant score was significantly better than ORIF group in activity and strength, range of motion, lifting, abduction, and external rotation ( P<0.05), and there was no significant difference in pain, daily function, and internal rotation between the two groups ( P>0.05). The RTSA group had a significantly greater range of motion in lifting, abduction, and external rotation than ORIF group ( P<0.05), but there was no significant difference in internal rotation between the two groups ( P>0.05). CONCLUSION Application of RTSA as the initial treatment of Neer three/four-part proximal humeral fractures in the elderly can achieve better rehabilitation of joint activity and lower risk of early reoperation, and improve the quality of life of elderly fracture patients. However, the difficulty of revision and the high cost of treatment require the surgeon to pay full attention and strictly grasp the indications.
Humans ; Fracture Fixation, Internal/instrumentation* ; Male ; Female ; Shoulder Fractures/surgery* ; Arthroplasty, Replacement, Shoulder/methods* ; Aged ; Bone Plates ; Open Fracture Reduction/methods* ; Range of Motion, Articular ; Treatment Outcome ; Shoulder Joint/physiopathology* ; Aged, 80 and over ; Operative Time ; Postoperative Complications/epidemiology* ; Length of Stay

BACKGROUND:At present,traditional drug delivery routes(oral or intravenous injection)in clinical practice face the problem of difficulty in penetrating the blood-brain barrier,and the clinical treatment of open severe traumatic brain injury is often lower than expected.Hydrogels are a class of extremely hydrophilic three-dimensional network structure gels,which swell rapidly in water and can be maintained in the swelling state.Hydrogels swell rapidly in water and can remain in this swollen state.At present,some experimental studies have applied injectable functional hydrogel injection into the injured site to achieve the purpose of repairing damaged brain tissue,but this treatment strategy has not been applied in clinic.OBJECTIVE:To analyze the role of functional hydrogels in tissue repair after traumatic brain injury,discuss the promotion of nerve tissue regeneration after traumatic brain injury through different action modes,so as to propose new ideas for clinical treatment and basic research of traumatic brain injury.METHODS:English key words"hydrogels,functional hydrogel,composite hydrogels,traumatic brain injury,tissue repair,neural regeneration"and Chinese key words"functional hydrogels,traumatic brain injury,tissue repair,nerve regeneration"were used to search the relevant articles published from August 2000 to March 2024 in PubMed,Web of Science,CNKI,and WanFang databases.The inclusion and exclusion criteria were formulated,and 60 relevant articles were finally included after being screened by reading the title,abstract,and full text of articles.RESULTS AND CONCLUSION:(1)The hydrogel based on molecular design can simulate the neural microstructure,promote regeneration and repair,and simulate the neurovascular unit to promote vascular regeneration.(2)Hydrogels based on the principle of combined drug therapy can deliver endogenous neuroregulatory factors,coating drugs to promote nerve regeneration.(3)Hydrogels based on stem cell recovery strategies can be used as molecular scaffolds to deliver cell therapy.(4)Future researchers need to further explore functional hydrogels related to nerve tissue repair to provide effective strategies for therapeutic function reconstruction in traumatic brain injury patients.

Objective:To analyze the factors affecting quality of life in patients with early esophageal cancer after endoscopic submucosal dissection (ESD) .Methods:Convenience sampling was used to select 162 early esophageal cancer patients with ESD in Cangzhou Central Hospital from August 2021 to July 2023 who had an on-time follow-up six months as study subjects. General Information Questionnaire and Quality of Life Instruments for Cancer Patients-Esophageal Cancer (QLICP-ES) were used to investigate the patients. Factors affecting the quality of life of patients after ESD for early esophageal cancer were analyzed using univariate analysis and multiple linear regression analysis.Results:Univariate analysis showed statistically significant differences in QLICP-ES scores among patients with different gender, age, marital status, annual income, medical payment method, concomitant diseases, degree of infiltration, vascular invasion, surgical complications, and positive margins ( P<0.05). Multiple linear regression analysis showed that age, marital status, concomitant diseases, vascular invasion, surgical complications, and positive margins were the factors influencing the QLICP-ES scores of patients with ESD for early esophageal cancer, and the differences were statistically significant ( P<0.05) . Conclusions:Quality of life at six months after ESD in patients with early esophageal cancer is at an intermediate to high level. Patients of advanced age, unmarried/divorced/widowed, concomitant diseases, vascular invasion, surgical complications and positive margins have low QLICP-ES scores after ESD for early esophageal cancer. It is recommended that clinical attention be focused on these factors and that targeted nursing measures be taken when necessary.

BACKGROUND:At present,traditional drug delivery routes(oral or intravenous injection)in clinical practice face the problem of difficulty in penetrating the blood-brain barrier,and the clinical treatment of open severe traumatic brain injury is often lower than expected.Hydrogels are a class of extremely hydrophilic three-dimensional network structure gels,which swell rapidly in water and can be maintained in the swelling state.Hydrogels swell rapidly in water and can remain in this swollen state.At present,some experimental studies have applied injectable functional hydrogel injection into the injured site to achieve the purpose of repairing damaged brain tissue,but this treatment strategy has not been applied in clinic.OBJECTIVE:To analyze the role of functional hydrogels in tissue repair after traumatic brain injury,discuss the promotion of nerve tissue regeneration after traumatic brain injury through different action modes,so as to propose new ideas for clinical treatment and basic research of traumatic brain injury.METHODS:English key words"hydrogels,functional hydrogel,composite hydrogels,traumatic brain injury,tissue repair,neural regeneration"and Chinese key words"functional hydrogels,traumatic brain injury,tissue repair,nerve regeneration"were used to search the relevant articles published from August 2000 to March 2024 in PubMed,Web of Science,CNKI,and WanFang databases.The inclusion and exclusion criteria were formulated,and 60 relevant articles were finally included after being screened by reading the title,abstract,and full text of articles.RESULTS AND CONCLUSION:(1)The hydrogel based on molecular design can simulate the neural microstructure,promote regeneration and repair,and simulate the neurovascular unit to promote vascular regeneration.(2)Hydrogels based on the principle of combined drug therapy can deliver endogenous neuroregulatory factors,coating drugs to promote nerve regeneration.(3)Hydrogels based on stem cell recovery strategies can be used as molecular scaffolds to deliver cell therapy.(4)Future researchers need to further explore functional hydrogels related to nerve tissue repair to provide effective strategies for therapeutic function reconstruction in traumatic brain injury patients.

Objective:To analyze the factors affecting quality of life in patients with early esophageal cancer after endoscopic submucosal dissection (ESD) .Methods:Convenience sampling was used to select 162 early esophageal cancer patients with ESD in Cangzhou Central Hospital from August 2021 to July 2023 who had an on-time follow-up six months as study subjects. General Information Questionnaire and Quality of Life Instruments for Cancer Patients-Esophageal Cancer (QLICP-ES) were used to investigate the patients. Factors affecting the quality of life of patients after ESD for early esophageal cancer were analyzed using univariate analysis and multiple linear regression analysis.Results:Univariate analysis showed statistically significant differences in QLICP-ES scores among patients with different gender, age, marital status, annual income, medical payment method, concomitant diseases, degree of infiltration, vascular invasion, surgical complications, and positive margins ( P<0.05). Multiple linear regression analysis showed that age, marital status, concomitant diseases, vascular invasion, surgical complications, and positive margins were the factors influencing the QLICP-ES scores of patients with ESD for early esophageal cancer, and the differences were statistically significant ( P<0.05) . Conclusions:Quality of life at six months after ESD in patients with early esophageal cancer is at an intermediate to high level. Patients of advanced age, unmarried/divorced/widowed, concomitant diseases, vascular invasion, surgical complications and positive margins have low QLICP-ES scores after ESD for early esophageal cancer. It is recommended that clinical attention be focused on these factors and that targeted nursing measures be taken when necessary.

Objective: To investigate the early clinical effects of tantalum augment assisted with 3D technology in treating acetabular bone defects of Paprosky type III in revision total hip arthroplasty (THA). Methods: From May 2013 to July 2017, a total of 16 patients (18 hips) undergoing revision THA were retrospectively analyzed, including 11 males and 5 females aged 58.06±8.29 years (range 44-69 years). There were 3 cases with infective loosening and 15 cases with aseptic loosening, 13 cases with Paprosky IIIA type bone defects and 5 cases with IIIB type bone defects. 3D technology was used for precise planning before operation. The tantalum augment and cup were used to repair acetabular bone defects during operation. Cup anteversion, abduction angle, ratio of the lateral and contralateral vertical distance of the center of rotation, ratio of the lateral and contralateral horizontal distance of the center of rotation and femoral offset were measured preoperatively and postoperatively. The percentages of hips located in Lewinnek safe zone were calculated preoperatively and postoperatively. Postoperative radiographic evidence of loosening and Harris score were collected at the end of the follow-up. Results: The percentage of the hips located in Lewinnek safe zone increased from 22% (4/18) preoperatively to 61% (11/18) postoperatively. The mean anteversion of the operative side was 11.99°±6.91° (range 1.71°-26.36°) postoperatively. The mean abduction angle of the operative side was 44.91°±5.93° (range 35.6°-56.0°). The mean ratio of the lateral and contralateral vertical distance of the center of rotation was 1.10±0.20 (range 0.87-1.62). The mean ratio of the lateral and contralateral horizontal distance of the center of rotation was 1.00±0.18 (range 0.69-1.46) and the mean ratio of the lateral and contralateral femoral offset was 1.01±0.66 (range 0.51-3.56). All the patients were followed-up for an average of 27.72±12.18 months (range 14-53 months). No complications, such as periprosthetic joint infection, dislocation or aseptic loosening, were observed in all patients. The mean Harris score was 77.28±4.80 (range 65-85) at 6 months postoperatively and 80.9±5.2 (range 69-89) at the end of the follow-up. Conclusion Using tantalum augmentassisted with 3D technology to re construct Paprosky type III severe bone defects of the hip can increase the accuracy of the acetabular cup positioning. The short-term outcomes are satisfying and no early prosthetic loosening was observed.

Objective:To study the feasibility of extraction of impacted mandibular wisdom teeth using turbine drill and new instruments. Methods: 600 patients with impacted mandibular third molars were divides into 2 groups. A group used turbine drill and new instruments to extract the impacted mandibular third molar. B group used the dental chisel to extract the impacted mandibular third molar. The operation time, intraoperative and postoperative complications were recorded to assess the effects of the methods. Results: The operation time of group A and group B was (22.285±12.025 01) min and (16.115±12.078 62) min respectively. The operation time of group A was shorter(P<0.05). The intraoperative and postoperative complication incidence rate was lower(P<0.05). Conclusion: Turbine drill and new instruments method is superior to dental chisel method in the extraction of impacted mandibular wisdom teeth.

Two highly conserved and with abundant quantity of lipoproteins in outer membrane of pathogenic species,but not in saprophytic species of leptospira ,LipL32 and LipL21,were selected to construct the fusion gene DNA vaccine pVAX1/LipL21-LipL32,and its ability to induce immune responses in BALB/c mice inoculated with this recombinant DNA vaccine was investigated in the present study.Expression of the fusion-protein LiPL21-LiPL32 was demonstrated in HEK293 cells following transfection with the fusion gene DNA vaccine and the immune responses induced after intramuscular inoculation with this DNA vaccine in BALB/c mice was then evaluated by microscopic agglutination test (MAT),meanwhile the ELISA assay was used to detect the cytokines induced.It was demonstrated that significant level of specific antibodies agglutinating antigens of Leptospira interrogans could be detected by MAT after DNA vaccine inoculation.The production of cytokines IL-10 and TNF-β in mice inoculated with DNA vaccine pVAX1/LipL21-LipL32 was significantly increased in comparison with that of the group inoculated with pVAX1 alone.These results indicate that the recombinant DNA vaccine pVAX1/LipL21-LipL32 may be of potential value to design and develop new generation of vaccines against leptospirosis.