Candida Infection-caused Lumbar Vertebral Osteomyelitis:Report of One Case / 中国医学科学院学报

Candida vertebral osteomyelitis,a rare but challenging clinical disease without specific clinical manifestations,is prone to delay in diagnosis,with potential risks of serious complications.Therefore,early diagnosis is the key to improving the cure rate of this disease.A case of invasive candida lumbar osteomyelitis after gastrointestinal surgery is reported in this paper.We analyzed the clinical characteristics of the patient and reviewed the relevant literature,aiming to improve the early diagnosis and treatment of this disease.

Clinical Features and Risk Factors of Systemic Lupus Erythematosus Complicated with Cytomegalovirus Infection / 中国医学科学院学报

Objective To explore the clinical characteristics and risk factors of systemic lupus erythematosus(SLE)complicated with cytomegalovirus infection(CMV). Methods The medical records of patients diagnosed with SLE at discharge in the Department of Immunology at Peking Union Medical College Hospital between July 1,2017 and April 1,2019 were retrospectively reviewed,and the clinical and laboratory data related to CMV infection were analyzed. Results Of the 231 patients with SLE,115(49.8%)had CMV infection.Among them,78(67.8%)were asymptomatic CMV infection and 37(32.2%)were diagnosed with CMV disease.Univariate analysis showed the number of organs involved(

Clinical and Laboratory Characteristics of Disseminated Non-tuberculous Mycobacterial Disease / 中国医学科学院学报

Objective To explore the clinical and laboratory characteristics and the prognosis of disseminated non-tuberculous mycobacteria(NTM)diseases in human immunodeficiency virus(HIV)negative patients. Methods Cases of disseminated NTM disease were retrospectively collected in Peking Union Medical College Hospital from January 2012 to October 2018.Clinical manifestations,laboratory findings,treatment,and prognosis of these cases were retrieved from the electronic medical record system. Results Among the 23 HIV negative patients with disseminated NTM disease,21 had underlying diseases,with rheumatoid immune disease(n=7)as the most common one.The main clinical manifestation was fever(n=23).Laboratory tests showed anemia [hemoglobin(85.78±25.47)g/L],hypoalbuminemia [albumin 29(27-32)g/L],elevated erythrocyte sedimentation rate [(85.73±43.78)mm/h] and hypersensitive C-reactive protein [(112.00±70.90)mg/L],and reduction of lymphocyte count [0.69(0.29-2.10)×10 /L].Lymphocyte subset analysis indicated reduction in CD4 T cells [213(113-775)/μl],CD8 T cells [267(99-457)/μl],B cells [39(4-165)/μl],and NK cells [88(32-279)/μl] and elevation of human leukocyte antigen-D related(HLA-DR),and CD38 expression in CD8 T cells [HLA-DR CD8 /CD8 ,60(40-68)%;CD38 CD8 /CD8 ,81(65-90)%].The most common species of NTM was Mycobacterium intracellular(n=6).Lymphocyte,CD8 T cell,B cell,and NK cell counts were significantly lower in dead patients than surviving patients(P =0.045,P=0.045,P=0.032,and P=0.010,respectively). Conclusions Disseminated NTM disease in HIV negative patients is mainly manifested as fever,anemia,hypoalbuminemia,and elevated inflammatory indicators.It is more likely to occur in immunocompromised patients.Patients with decreased lymphocytes,CD8 T cells,B cells and NK cells tend to have a poor prognosis.

Verification, comparison and melioration of different prediction models for solitary pulmonary nodule / 中国胸心血管外科临床杂志

@#Objective     To identify risk factors that affect the verification of malignancy in patients with solitary pulmonary nodule (SPN) and verify different prediction models for malignant probability of SPN. Methods     We retrospectively analyzed the clinical data of 117 SPN patients with definite postoperative pathological diagnosis who underwent surgical procedure in China-Japan Friendship Hospital from March to September 2017. There were 59 males and 58 females aged 59.10±11.31 years ranging from 24 to 83 years. Imaging features of the nodule including maximum diameter, location, spiculation, lobulation, calcification and serum level of CEA and Cyfra21-1 were assessed as potential risk factors. Univariate analysis was used to establish statistical correlation between risk factors and postoperative pathological diagnosis. Receiver operating characteristic (ROC) curve was drawn by different predictive models for the malignant probability of SPN to get areas under the curves (AUC), sensitivity, specificity, positive predictive values, negative predictive values for each model. The predictive effectiveness of each model was statistically assessed subsequently. Results     Among 117 patients, 93 (79.5%) were malignant and 24 (20.5%) were benign. Statistical difference was found between the benign and malignant group in age, maximum diameter, serum level of CEA and Cyfra21-1, spiculation, lobulation and calcification of the nodules. The AUC value was 0.813±0.051 (Mayo model), 0.697±0.066 (VA model) and 0.854±0.045 (Peking University People's Hospital model), respectively. Conclusion     Age, maximum diameter of the nodule, serum level of CEA and Cyfra21-1, spiculation, lobulation and calcification are potential independent risk factors associated with the malignant probability of SPN. Peking University People's Hospital model is of high accuracy and clinical value for patients with SPN. Adding serum index into the prediction model as a new risk factor and adjusting the weight of age in the model may improve the accuracy of prediction for SPN.

Case-control study on two suturing methods for the repairing of complete rupture of the deltoid ligament / 中国骨伤

<p><b>OBJECTIVE</b>To compare clinical outcomes between two suturing methods using non absorbable materials through drilling the bone and suturing anchors for the treatment of complete rupture of the deltoid ligament.</p><p><b>METHODS</b>From January 2009 to January 2013, 58 hospitalized patients with ankle fracture combined with complete rupture of the deltoid ligament were treated with suturing using non absorbable materials through drilling the bone or suturing anchors. There were 29 patients who received suturing treatments using non absorbable materials through drilling the bone (Group A), including 18 males and 11 females, with an average age of (39.76 +/- 11.81) years old. According to the Lauge-Hansen classification, 12 patients had supination external rotation (SER) injuries with IV degree, 5 patients had pronation external rotation (PER) injuries with III degree, 10 patients had PER injuries with IV degrss, and 2 patients had pronation abduction injuries with III degree. There were 29 patients who received treatments with suturing using anchors (Group B), including 14 males and 15 females, with an average age of (41.79 +/- 13.28) years old. According to the Lauge-Hansen classification,9 patients had SER injuries with IV degree, 6 patients had PER injuries with III degree,13 patients had PER injuries with IV degree, and 1 patient had pronation abduction injuries with III degree. All the patients were treated with open reduction and internal fixation, as well as reconstruction of deltoid ligaments to restore the stability of the medial ankle structures. The clinical examination, imaging evaluation, American society for ankle surgery (AOFAS) ankle-hindfoot score and visual analogue scale (VAS) were used to evaluate the clinical results after operation, and the results of the two groups were compared and analyzed statistically.</p><p><b>RESULTS</b>The follow-up duration of the 58 patients ranged from 23 to 40 months,with an average of 27.3 months. All the patients had fracture union, and the mean healing time was 12.3 weeks (ranged, 10 to 17 weeks). There were no incision complications and ankle instability. There were no significant differences between two groups in AOFAS (P=0.666) and the VAS (P=0.905).</p><p><b>CONCLUSION</b>Treatments of complete rupture of the deltiod ligaments with the two suturing methods get similar good clinical effects, but the suturing using non absorbable materials through drilling the bone has several advantages such as reducing the financial burden of patients, saving social medical resources and avoiding the shortcoming in difficult removal of anchor suture.</p>

Major causes of fever of unknown origin at Peking Union Medical College Hospital in the past 26 years / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Despite the recent advances in medicine, fever of unknown origin (FUO) remains a diagnostic and therapeutic challenge even to expert physicians. To increase the knowledge of FUO, we conducted a retrospective study to investigate the causes of FUO and the change of major causes of FUO during the past 26 years.</p><p><b>METHODS</b>The clinical data were retrospectively analyzed from 997 patients with FUO hospitalized at the Peking Union Medical College Hospital (PUMCH) between January 2004 and October 2010. Furthermore, the results were compared to that reported in previous studies of FUO in PUMCH since 1985.</p><p><b>RESULTS</b>Of the 997 FUO cases, definite diagnosis was eventually achieved in 797 (79.9%) patients. The most common cause of FUO was infectious diseases (479 cases, 48.0%), with tuberculosis accounting for 45.3% (217/479) of the cases of infections. One hundred and sixty-eight (16.9%) patients were diagnosed with connective tissue diseases, with Still's disease and vasculitis accounted for 31.5% (53/168) and 24.4% (41/168) of this category, respectively. Neoplasms and miscellaneous causes were found in 7.9% (79/997) and 7.1% (71/997), respectively. However, no definite diagnosis had been made in the remaining 200 (20.1%) cases until they were discharged from the hospital.</p><p><b>CONCLUSIONS</b>During different periods, infectious diseases, especially tuberculosis, were the leading etiology of FUO and the proportion of tuberculosis had no significant difference. While the frequency of neoplasms was descending, the proportion of lymphoma in neoplasm was ascending; the frequency of undiagnosed cases was increasing, but in most FUO cases the causes can be diagnosed eventually after careful analysis of clinical data.</p>

Treatment strategy for the floating shoulder injury / 中国骨伤

<p><b>OBJECTIVE</b>To explore the clinical features and operative treatment of floating shoulder injuries.</p><p><b>METHODS</b>The clinical data of 25 patients with floating shoulder injuries that had been admitted to the hospital from July 2000 to May 2011 were retrospectively analyzed. There were 18 males and 7 females,wirh an average age of (36.2 +/- 2.3) years ranging from 17 to 56 years. The scapular neck fractures associated with clavicle fractures were in 21 cases and acromioclavicular joint dislocation in 4 cases. All cases were accompanied by associated injuries. Among of them, 7 cases were conservative treatment, 7 cases were fixed clavicle only, 11 cases were clavicle and scapular. All datum were rated according to Herscovici, Constant and Murley, Rowe rate system.</p><p><b>RESULTS</b>All patients were followed up for 4.6 years (range 11 months to 10 years). All fractures were healed except for 1 clavicle was delay healed. There were not infections and fixation fracture,2 of conservative treatment were dropping shoulder, 2 of 3 brachial plexus injuries were recovered 3 months later, 1 was 6 months. Suprascapular nerve injury was recoved 1 year later. Herscovici evaluation: 18 excellent, 5 good, 1 fair, 1 poor;Constant and Murley shoulder score: (83.2 +/- 5.7), pain score (12.1 + 2.5), activities of daily living score (17.2 +/- 3.2), range of motion score (32.1 +/- 3.5), strength score (18.5 +/- 2.1); Rowe evaluation: 18 excellent, 5 fair, 2 poor.</p><p><b>CONCLUSION</b>Floating shoulder injuries is high energy injury, destroy superior shoulder suspensory complex stability ,appropriate treatment should be choosen according to fractures displacement and smash level, patients' professional and anticipation</p>

Serum HBV DNA level at week 12 is superior to viral response at week 24 in predicting long-term treatment outcome of telbivudine for chronic hepatitis B patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Telbivudine, one of the five nucleos(t)ide antiviral drugs, was reported to be superior to lamivudine in a better biochemical, virological, and histological response for treatment-naive patients in the GLOBE trial. The aim of this study was to determine the antiviral potency, viral resistance, and the signifcance of early response for long-term telbivudine treatment.</p><p><b>METHODS</b>We recruited 161 patients of chronic hepatitis B (CHB) on telbivudine between January 2009 and September 2011 in Macau, China. The serum hepatitis B virus DNA levels, hepatitis B e antigen (HBeAg) seroconversion, alanine aminotransferase (ALT) normalization, and viral resistance were analyzed.</p><p><b>RESULTS</b>The median age and follow-up duration were 48 years and 16.9 months. All patients were followed up for at least 6 months, while data were collected for 132, 120, 95, and 53 patients at 12, 24, 48, and 96 weeks respectively. The cumulative HBeAg seroconversion rate was 20.8% and only three patients (1.9%) presented with telbivudine low level resistance. The ALT normalization rates were 76.9% at 48 weeks and 77.6% at 96 weeks. Undetectable HBV DNA was achieved by 1.8%, 31.6%, 60%, and 74.1% in HBeAg positive patients and 29.3%, 60.3%, 84%, and 84.6% in HBeAg negative patients at each time point. Week 12 HBV DNA level < 1000 copies/ml (< 200 IU/ml) was a better predictor of viral suppression at 2-year follow-up (P = 0.001, OR = 27.00) than undetectable HBV DNA level at week 24 (P = 0.120, OR = 4.81).</p><p><b>CONCLUSIONS</b>Two-year telbivudine treatment yielded high rates of viral suppression and ALT normalization. Serum HBV DNA level at week 12 is a superior predictor for long-term viral suppression.</p>

Clinical outcome of surgical treatment of terrible triad of elbow / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the clinical outcome of surgical treatment of the posterior dislocation of the elbow with coroniod and radial head fractures.</p><p><b>METHODS</b>From January 2004 to March 2009, 9 patients with terrible triad of the elbow were reviewed. There were 7 males and 2 females (4 left elbows and 5 right elbows), with an average age of 41.2 years, ranged from 21 to 67 years. The radial head fractures were classified according to the Schatzker-Tile criteria: 4 patients had the fractures of type I, 3 patients had type II and 2 patients had type III. The ulnar coronoid fractures were classified according to the Regan-Morrey criteria: 2 patients had the fractures of type I, 5 patients had type II and 2 patients had type III. The general approach was used to repair the damaged structures sequentially from deep to superficial, through coronoid, anterior capsule, radial head, and lateral ligament complex to common extensor origin. If there was valgus instability in the elbow after the operation, the medial collateral ligament should be repaired with nonabsorption sutures. The plaster was applied for 7 to 10 days with elbow flexion in 90 degrees and the forearm in full pronation. Unrestricted motions and rehabilitation began at the 8th week after operation. Recovery of regular occupation depended on the degree of physical activity required, and it typically took 3 months for heavy physical laborers to return to work.</p><p><b>RESULTS</b>All the patients were followed up from 6 months to 5 years, with a mean duration of (31 +/- 6) months. At the 3rd month after operation, the mean rang of motion in flexion and extension of the elbow was (102 +/- 3) degrees (ranged from 80 degrees to 110 degrees), and the mean range of motion in pronation and supination of the forearm was (135 +/- 6) degrees (100 degrees to 150 degrees). According to the criteria of the Mayo scoreing system, the results were excellent in 5 cases, good in 3 cases, and fair in 1 case. Three patients had heterotopic ossification at the 6th month after operation. Among them, 2 patients had no effects on elbow function and were not treated, 1 patient had effects on flexion-extension of the elbow and was treated with resection of heterotopic ossification through lateral approach combined with early rehabilitation, the MEP score of the patient improved from fair to good.</p><p><b>CONCLUSION</b>The key points for treating the terrible triad of the elbow are to restore the elbow normal anatomy and early rehabilitation to avoid the elbow stiff.</p>

Diagnosis and treatment of infective endocarditis in chronic hemodialysis patients / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To analyze the clinical features of hemodialysis patients complicated by infective endo carditis.</p><p><b>METHODS</b>The clinical features of six such patients admitted to Peking Union Medical College Hospital during the year 1990 to 2009 were analyzed. All of them were diagnosed based on Chinese Children Diagnostic Criteria for Infective Endocarditis.</p><p><b>RESULTS</b>The average age of the six patients was 52.3 +/- 19.3 years old. Four were males. Vascular accesses at the onset of infective endocarditis were as follows: permanent catheters in three, temporary catheters in two, and arteriovenous fistula in one. Three were found with mitral valve involvement, two with aortic valve involvement, and one with both. Five vegetations were found by transthoracic echocardiography, and one by transesophageal echocardiography. Four had positive blood culture results. The catheters were all removed. Four of the patients were improved by antibiotics treatment, in which two were still on hemodialysis in the following 14-24 months and the other two were lost to follow-up. One patient received surgery, but died of heart failure after further hemodialysis for three months. One was well on maintenance hemodialysis for three months after surgery.</p><p><b>CONCLUSIONS</b>Infective endocarditis should be suspected when hemodialysis patients suffer from long-term fever, for which prompt blood culture and transthoracic echocardiography confirmation could be performed. Transesophageal echocardiography could be considered even when transthoracic echocardiography produces negative findings. With catheters removed, full course of appropriate sensitive antibiotics and surgery if indicated could improve the outcome of chronic hemodialysis patients complicated by infective endocarditis.</p>

Effectiveness of combined therapies using two types of peginterferon and ribavirin in treating chronic hepatitis C virus genotypes 1b/6a infections / 中国医学科学院学报

<p><b>OBJECTIVE</b>To explore the effectiveness of a combined therapy using two types of peginterferon (PEG-IFN) and ribavirin in treating chronic hepatitis C virus (HCV) genotypes 1b/6a infections.</p><p><b>METHODS</b>The clinical data of 171 patients with chronic HCV genotypes 1b/6a infection in Common Hospital Centre S. Januario, Macau SAR, China, were retrospectively analyzed. Of these patients, 145 (84.8%) were infected with HCV genotype 1b and 26 (15.2%) with HCV genotype 6a. Patients were divided into two groups based on drug therapies: PEG-IFN-2b group (n=140), in which patients were treated with PEG-IFN-2b 1.5 g/kg QW plus ribavirin 800-1 200 mg/d and PEG-IFN-2a group (n=31), in which patients were treated with PEG-IFN-2a 180g QW plus ribavirin 800-1 200 mg/d. Patients was treated for 48 weeks and then followed up for 24 weeks.</p><p><b>RESULTS</b>All patients completed their therapies. The rates of early viral response (EVR) and sustained virologic response (SVR) were 78.95% and 69.59%, respectively . The two groups were not significantly different in terms of EVR P=0.091 end of treatment virological response (ETVR) (P=0.542), SVR P=0.079, relapse (P=0.497). And the two HCV genotypes patients were not significantly different in terms of EVR (P=0.268), ETVR (P=0.276), SVR (P=0.479), and relapse (P=1.000).</p><p><b>CONCLUSIONS</b>PEG-IFN combined with ribavirin can achieve high viral response in treating chronic hepatitis C. PEG-IFN-2a and PEG-IFN-2b basically are similarly effective in treating HCV genotype 1b or 6a infections.</p>

Clinical features of initial cases of 2009 pandemic influenza A (H1N1) in Macau, China / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The first case of pandemic influenza A (H1N1) virus infection in Macau Special Administrative Region (SAR) of the People's Republic of China was documented on June 18, 2009. Subsequently, persons with suspected infection or of contact with suspected cases received screening. All the confirmed cases were hospitalized and treated with oseltamivir. Their clinical features were observed. This may help for better management for later patients and be of benefit to the government of Macau SAR to adjust its strategy to combat the pandemic influenza A (H1N1) virus infection more efficiently.</p><p><b>METHODS</b>From June to July 2009, the initial 72 cases of influenza A (H1N1) in Macau were hospitalized in Common Hospital Centre S. Januario (CHCSJ). The infection was confirmed by real-time reverse-transcriptase polymerase chain reaction (RT-PCR). The clinical features of the disease were closely observed and documented. Oseltamivir was given to all patients within 48 hours after the onset of disease and maintained for 5 days.</p><p><b>RESULTS</b>The mean age of the 72 patients was 21 years old. Forty of them were men and 32 were women. The median incubation of the virus was 2 days (1 to 7 days). The most common symptoms were fever (97.2%) and cough (77.8%). The rate of gastrointestinal symptoms including nausea, vomiting, and diarrhea was 2.8%. Fever typically lasted for 3 days (1 to 9 days). The median time from the onset to positive results of real-time RT-PCR was 6 days (3 to 13 days). After treatment with oseltamivir, most patients became afebrile within 48 hours. Only one aged patient with a history of glaucoma and hypothyroidism was found to have lung infiltration on chest X-ray.</p><p><b>CONCLUSIONS</b>The initial cases of pandemic influenza A (H1N1) virus infection in Macau SAR showed that most of the infected persons had a mild course. The virus could be detected by real-time RT-PCR within a median of 6 days from the onset. Oseltamivir was effective.</p>

Initial experiences of maintaining atrioventricular intrinsic conduction during cardiac resynchronization therapy in non-responders / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Cardiac resynchronization therapy (CRT) is a major breakthrough in therapy for advanced heart failure patients; however, a number of key clinical research questions remain, perhaps most importantly the issue of why apparently suitable patients do not respond to CRT.</p><p><b>METHODS</b>Seven patients, six males and one female, aged (56.43 +/- 6.13) years, all diagnosed with dilated cardiomyopathy, were included in this study. They were all non-responders to CRT who underwent routine optimization postoperatively, and received optimal drug therapy. On the basis of biventricular pacing, titrating various atrioventricular (AV) intervals were performed to get the true fusional QRS complexes composed of biventricular pacing and AV intrinsic conduction. Then, the effects of AV intrinsic conduction during CRT were evaluated.</p><p><b>RESULTS</b>On the setting of AV intrinsic conduction during CRT, the true fusional QRS complexes were the narrowest, and all patients showed alleviation of symptoms, improvement of exercise tolerance, life quality and hemodynamic parameters during more than 6 months of follow-up.</p><p><b>CONCLUSIONS</b>Titrating AV intervals to get the true fusional QRS complexes composed of biventricular pacing and AV intrinsic conduction will be beneficial for non-responders to CRT. Maintaining AV intrinsic conduction during CRT may decrease the rates of non-responders to CRT.</p>

Clinical analysis of otogenic intracranial complications / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To analyze the clinical features and treatment protocols of otogenic intracranial complications in Peking Union Medical College Hospital.</p><p><b>METHODS</b>Retrospective study of 14 patients (10 males and 4 females, aged between 12 - 62 years, mean age 32.1 years) hospitalized from 1982 - 2006. Twelve cases were otitis media (OM) with cholesteatoma, the other 2 cases were non-cholesteatomatous OM. All the otogenic intracranial complications located at the same sides as otologic disorders. Brain abscess was the most common type of otogenic complications and Proteus was the most common microorganism detected. Suppurative ear discharge, headache, high fever and nausea with vomiting were the most common clinical manifestations with very high incidences. All the patients received combined protocols of mastoid surgeries and antibiotics treatment.</p><p><b>RESULTS</b>All the 14 patients recovered clinically. For patients discharged before 1987, there were 4 patients followed up for 22.5 - 24.4 years with a mean time of 23.8 without recurrence, 1 patient died of cardiovascular disease 19.2 years later after discharge, 4 patients lost follow-up. For the 5 patients discharged after 1997, brain abscess recurred in one patient with pseudo-recovery after 24 days and he fully recovered after re-hospitalization and treatment. All the five patients were followed up for 1.5 years to 10.6 years with a mean time of 6.5 years without recurrence.</p><p><b>CONCLUSIONS</b>Youngsters and males seemed to be more vulnerable. Brain abscess was the most common intracranial complication and Proteus was the most common pyogenic microorganism. Combination of mastoid surgery and antibiotics were essential for effectively controlling the intracranial complications and improving the recovery. CT and MRI were essential for correct diagnosis bedtimes and MRI seemed to have a better performance.</p>

Prophylaxis against venous thromboembolism in orthopedic surgery / 中华创伤杂志(英文版)

Venous thromboembolism (VTE), which is manifested as deep vein thrombosis (DVT) and pulmonary embolism (PE), represents a significant cause of death, disability, and discomfort. They are frequent complications of various surgical procedures. The aging population and the survival of more severely injured patients may suggest an increasing risk of thromboembolism in the trauma patients. Expanded understanding of the population at risk challenges physicians to carefully examine risk factors for VTE to identify high-risk patients who can benefit from prophylaxis. An accurate knowledge of evidence-based risk factors is important in predicting and preventing postoperative DVT, and can be incorporated into a decision support system for appropriate thromboprophylaxis use. Standard use of DVT prophylaxis in a high-risk trauma population leads to a low incidence of DVT. The incidence of VTE is common in Asia. The evaluation includes laboratory tests, Doppler test and phlebography. Screening Doppler sonography should be performed for surveillance on all critically injured patients to identify DVT. D-Dimer is a useful marker to monitor prophylaxis in trauma surgery patients. The optimal time to start prophylaxis is between 2 hours before and 10 hours after surgery, but the risk of PE continues for several weeks. Thromboprophylaxis includes graduated compression stockings and anticoagulants for prophylaxis. Anticoagulants include Warfarin, which belongs to Vitamin K antagonists, unfractionated heparin, low molecular weight heparins, factor Xa indirect inhibitor Fondaparinux, and the oral IIa inhibitor Melagatran and ximelagatran. Recombinant human soluble thrombomodulin is a new and highly effective antithrombotic agent. Prophylactic placement of vena caval filters in selected trauma patients may decrease the incidence of PE. The indications for prophylactic inferior vena cava filter insertion include prolonged immobilization with multiple injuries, closed head injury, pelvic fracture, spine fracture, multiple long bone fracture, and attending discretion. Multiple-trauma patients are at increased risk for DVT but are also at increased risk of bleeding, and the use of heparin may be contraindicated. Serial compression devices (SCDs) are an alternative for DVT prophylaxis. Compression devices provide adequate DVT prophylaxis with a low failure rate and no device-related complications. Immobilization is one of important reasons of VTE. The ambulant patient is far less likely to develop complications of inactivity, not only venous thrombosis, but also contractures, decubitus ulcers, or osteoporosis (with its associated fatigue fractures), as well as bowel or bladder complications.

The association between the“Tip-Apex Distance”value and cut-out of the lag screw from the femoral head:a clinical retrospective study / 中华创伤骨科杂志

Objective To confirm the association between the“Tip-Apex Distance (TAD)”and cut-out of the lag screw from the femoral head.and to analyze other factors leading to the cut-out.Methods The complete radiographic and clinical data of 106 patients with femoral intertrochanteric fractures were available for this study. They were 65 men and 41 women,with an average age of 52.4 years (range,20 to 83 years).According to Evans classification.19 cases belonged to typeⅡ.25 to typeⅢ,32 to typeⅣ,29 to typeⅤ,and one to type R.The bone quality was classified by Singh rating system:44 cases were rated as typeⅥ.34 as typeⅤ,23 as typeⅣand five as typeⅢ.They were treated with open reduction and fixation with 135?dynamic hip screw (DHS).According to the finding of Baumgaertner that“TAD”beyond 25 mm would grcatly increase the risk of cut-out,the patients could be divided into two groups:59 cases with“TAD”less than 25 mm and 47 greater than 25 mm.Results The mean duration of follow-ups was 14.45 months (range,4.5 to 28.0 months).Of the 15 cases whose“TAD”was more than 30 mm,one had the cut-out.Of the seven cases whose“TAD”was more than 40 mm,two had the cut-out (P=0.000). The average age of the three patients was 78.7 years (range:75 to 83 years) and 27.1 years older than that of the 103 patients whose fracture healed (P=0.000).They belonged to the unstable intertrochanteric fracture of the femur (two to Evans type V and one to type R).The reduction was assessed as excellent in 43 cases,good in 47 cases,fair in nine cases (of whom one had the cut-out),poor in seven cases (of whom two had the cut-out). Conclusions The cut-out of the lag screw from the femoral head can be caused by age,fracture type and stability of reduction and“TAD”.The greater the“TAD”value,the greater possibility of cut-out.

Chinese traditional medicine yi kang ling to treat immunity infertility caused by anti-sperm antibody: the experimental research II / 中华男科学杂志

<p><b>OBJECTIVE</b>To observe the effects of Chinese traditional medicine Yi Kang Ling (YKL) on immunity infertility caused by anti-sperm antibodies (AsAb).</p><p><b>METHODS</b>With the AsAb infertile rabbit as the experimental model, seventy-five pairs of New zealand rabbits were divided into three group including YKL treatment group (sub-divided into mini-, midi- and maxi-dosage groups), prednisone treatment group and non-treatment group. Rabbits of the YKL treatment sub-groups were further divided into M+F- (male positive, female negative), M-F+, (male negative, female positive) and M+F+ (male positive, female positive) pairs according to their initial AsAb detection results. The control group consisted of five pairs of normal rabbits. When the expected AsAb reversing ratio was achieved, the rabbits were matted and observed for the number of the pregnant and the weight of the newborn.</p><p><b>RESULTS</b>Statistics showed that in M+F- pairs both the midi-dosage of YKL and prednisone treatment groups had fertility, in the mini- and maxi-dosage of YKL treatment groups, 20% of the female rabbits failed to be pregnant, while in the non-treatment group, 60% female rabbits remained sterile. The sterile ratios of the M-F+ pairs in the mini-, midi- and maxi-dosage of YKL and prednisone treatment groups were 0, 20%, 25% and 25%, respectively, while the sterile ratio in the non-treatment M-F+ group was 40%. In M+F+ groups, the sterile ratios of the three YKL sub-groups, prednisone treatment and non-treatment groups were 20%, 20% and 60% respectively. In the control group the sterile ratio was 20%. The weight of the newborn rabbits were around 50 grams with no visible malformation.</p><p><b>CONCLUSIONS</b>YKL can effectively reverse the AsAb positive results, and restore the fertility of female rabbits. Mini-dosage of YKL for 45 days produced the best results and maxi-dosage of YKL had no negative effects on the weight of the newborn rabbit.</p>

Detection and clinical significance of phospholipase A2 in semen of male infertile patients / 中华男科学杂志

<p><b>OBJECTIVES</b>To explore the clinical application of anti-human seminal plasma phospholipase A2 (PLA2) monoclonal antibody (McAb) for male infertility.</p><p><b>METHODS</b>Enzyme-linked immunoabsorbent assay (ELISA), immunocytochemistry(ICC), as well as flow cytometry (FCM) analysis were established using two strains anti-human seminal plasma PLA2 McAb prepared by our laboratory to detect the PLA2 content in human seminal plasma and the anterior head region of spermatozoa, respectively. Then the PLA2 content in male infertile patients were compared with that in normal control with fertility. The seminal routine analysis was performed by computer-assisted semen analysis (CASA).</p><p><b>RESULTS</b>The PLA2 content of infertile groups were (31.13 +/- 14.49) ng/ml in azoospermic patients, (17.71 +/- 12.45) ng/ml in oligospermic patients and (16.46 +/- 11.31) ng/ml in patients with normal sperm density, which were all higher than that of normal controls [(8.09 +/- 3.15) ng/ml, P < 0.01]; There was significantly negative correlation between PLA2 content in seminal plasma and sperm density(r = -0.602, P < 0.05), while there was insignificant correlation between PLA2 and sperm motility or percentage of motility. The PLA2 content in the anterior head region of spermatozoon of male infertile groups was significantly lower than that of normal controls by ICC and FCM(P < 0.01).</p><p><b>CONCLUSIONS</b>PLA2 in human seminal plasma is closely related to male fertility, and the PLA2 deficiency in the head of spermatozoa may be one of the reasons causing male infertility. The methods detecting PLA2 content in seminal plasma and the head of spermatozoa can provide powerful evidences for exploring the mechanism of male infertility.</p>

External bracket fixation for tibia diaphysis complex fracture involving proximal and distal articular fractures / 中华创伤杂志

Objective To evaluate the clinical outcome of external bracket fixation in the treat- ment of complex tibia diaphysis fracture involving intra-articular fractures.Methods Forty-two cases of complex tibia diaphysis fracture with proximal and distal intra-articular fractures treated surgically in our hospital from January 1999 to January 2004 were analyzed.The complex tibia diaphysis fractures were categorized according to the AO classification as type C2 (multiple segments fracture) and type C3 (ir- regular fracture),proximal and distal intra-articular fractures in 23 and 19 cases,respectively.Definite operation was done within one week.Twenty-two cases were treated with simple external fixator,and 20 cases treated with screws and external fixator.Results All the 42 cases were followed-up regularly. According to AO evaluation of the knee and ankle joint movement,83% (35/42 cases) of the cases gained satisfactory functional outcome,14% (6/42 cases) had quite satisfactory results and 2% (1/42 case) had unsatisfactory functional outcome.Conclusion External bracket fixation can obtain outcome of relative length of the tibia and fibula,tube structure reconstruction,smoothness of the articular surface and the parallel and symmetric relation of knees and ankles for complex tibia diaphysis fracture with proxi- mal and distal intra-articular fracture.The arthritis resulting in pain in movement and restriction of func- tion is considered to be the most important factor affecting the joint function.Early functional exercise is important for best recovery of knee and ankle function.

Construction and identification for cell strain of anti-human seminal plasma phospholipase A2 monoclonal antibody / 中华男科学杂志

<p><b>OBJECTIVES</b>To establish and evaluate the anti-human seminal plasma phospholipase A2 (PLA2) monoclonal antibody (McAb).</p><p><b>METHODS</b>After having been separated and purified from human seminal plasma by PEG precipitation, Sephacryl S-300 column chromatography, DEAE-Sephadex A-25 column chromatography and HA column chromatography, PLA2 was regarded as an antigen to immune BALB/C mouse to produce anti-human seminal plasma PLA2 McAb. The PLA2 McAb sensitivity and specificity were performed by ELISA technique and Western-blot analysis, respectively.</p><p><b>RESULTS</b>The molecular weight of PLA2 depurated with 245 fold purification from human seminal plasma was about 34,900, while the sensitivity and typing of its McAb were 1:5(6)-1:5(8) and IgM (kappa) with a satisfied Western-Blot results.</p><p><b>CONCLUSIONS</b>The PLA2, which had not been reported in international and domestic papers, may be a new type of PLA2. The establish of its McAb will provide significant tools for the research of the relationship between PLA2 in human seminal plasma and male fertility.</p>