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Objective:To identify the key genes affecting the outcome of sepsis using weighted gene co-expression network analysis.Methods:The peripheral blood gene chip data GSE54514 from septic patients and healthy volunteers were obtained from the gene expression database of the American Center for Biotechnology Information.An R package for weighted gene co-expression network analysis was used to construct a co-expression network of differentially expressed genes between sepsis patients and healthy volunteers to identify key modules associated with the outcome of sepsis.Then gene functional enrichment analysis was performed to figure out the possible behavior of genes in the most significant modulerelated tooutcomes of sepsis.Hub genes were selected from the most significant module according to module membership and degree of protein-protein interaction network.Results:A total of 622 differentially expressed genes identified from the microarray data of GSE36895 in septic patients and healthy volunteers were used to construct a co-expression network, and the module with the most significant correlation with the outcome of sepsis was identified.GO enrichment analysis showed that the genes in this module were related to activation of myeloid cells and neutrophils, however, the KEGG pathway enrichment analysis showed that these genes played an important role in virus infection processes.Fifteen hub genes were finally selected from the module with the most significant correlation with the outcome of sepsis by constructing a protein-protein interaction network.Conclusion:Fifteen key genes related to the outcome of sepsis are identified via bioinformatics methods, and the mechanism is related to regulating the immune response to infection.
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Objective To investigate the value of enhanced recovery after surgery (ERAS)in the perioperative period of intertrochanteric femoral fractures in elderly patients. Methods A retrospective analysis of 100 elderly patients with intertrochanteric femoral fractures at Shenyang Shengjing Hospital from January 2014 to January 2017 was conducted. According to the treatment , patients were divided into two groups :an ERAS group and a routine group (n = 50 ,each ). Hospitalization times ,postoperative pain visual analogue scales (VAS ) ,complication rates ,operation times ,evaluated byHarris hip scores and other parameters were compared between the two groups. Results All patients were followed up for 20 months(mean=18.7 months). The hospitalization time and postoperative pain VAS score were shorter or lower in the ERAS group than in the routine group [(6.06±1.89)d vs. (8.02 ± 1.89)d ,3.02 ± 1.79 vs.3.66 ± 1.06 ,both P＜ 0.05].There was a significant difference in rates of complications (delirium and urinary tract infection )between the groups (P＜ 0.05).There was no statistically significant difference in operation time or Harris hip score between the groups one year after surgery (both P ＞ 0.05 ). Conclusions ERAS in treating intertrochanteric femoral fractures in the elderly can significantly reduce the length of hospital stay , postoperative pain and complications ,and should be recommended.
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Objective To compare the curative effects of Pauwels cannulated screws (PCS) and DHS-blade plus anti-rotation screw +anti-rotation screw(DHSA +AS) in the treatment of Pauwels type Ⅲ femoral neck fractures.Methods From December 2013 to December 2015,46 patients with fresh Pauwels type Ⅲ femoral neck fracture were treated with internal fixation at our department.They were divided into 2 groups according to different fixation methods.In the DHSA + AS group of 25 patients,13 were male and 12 female,with an average age of 49.2 ± 8.2 years,and there were 3 cases of Garden type Ⅱ,4 cases of Garden type Ⅲ and 18 cases of Garden type Ⅳ.In the PCS Group of 21 patients,11 were male and 10 female,with an average age of 48.7 ± 6.2 years,and there were 2 cases of Garden type Ⅱ,6 cases of Garden type Ⅲ and 13 cases of Garden type Ⅳ.The 2 groups were compared in terms of operation time,intraoperative blood loss,reduction quality,hospital stay,union time,postoperative complications and Harris hip score.Results DHSA + AS group needed significantly longer operation time (54.0 ± 7.3 minutes) and incurred significantly more intraoperative blood loss (102.3 ± 10.5 mL) than PCS group (46.3 ± 5.4 minutes & 77.4 ±9.1 mL,respectively) (P ＜ 0.05).There were no significant differences between the 2 groups in reduction quality,hospital stay,or union time (P ＞ 0.05).DHSA + AS group and PCS group obtained an average follow-up of 14.1 ± 1.6 months and 13.7 ± 1.2 months,respectively.For DHSA + AS group and PCS group,the rate of postoperative complications was respectively 12.0％ (3/25) versus 4.8％ (1/91),and the Harris hip score at the last follow-up respectively 83.6 ± 5.4 versus 85.1 ± 5.5,showing no significant differences between the 2 groups (P ＞ 0.05).Conclusions DHSA + AS and PCS are both suitable internal fixation options for patients with Pauwels type Ⅲ femoral neck fracture when reduction is fine.Compared with DHSA + AS,PCS may need less operation time and incur less intraoperative blood loss.
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Objective To investigate the surgical strategies for management of unstable fractures of intertrochanteric lateral wall.Methods From July 2012 to June 2014,50 patients with unstable fractures of intertrochanteric lateral wall received osteosynthesis with proximal femoral nail anti-rotation.They were 37 men and 13 women,with an average age of 65.6 years (range,from 42 to 87 years).According to our morphology classification,25 patients belonged to type Ⅰ (comminuted fracture of lateral wall),4 to type Ⅱ (split fracture of lateral wall with loss of medial support),21 to type Ⅲ (comminuted fracture of lateral wall and subtrochanteric part with loss of medial support).The fractures were managed differently according to our classification.Type Ⅰ were treated by intramedullary fixation with compression screws to reconstruct the lateral wall,type Ⅱ by intramedullary fixation after reconstruction of the lateral wall lby cables,and type Ⅲ by intramedullary fixation after optimal reduction of the coronal plane and neck-shaft angle because the lateral wall could not be reconstructed.Results The 50 patients obtained an average follow-up of 17 months (range,from 5 to 24 months).No deep infection or wound dehiscence happened.Deep vein thrombosis occurred in 2 patients.No nonunion,cutout of the sliding screw,or coxa vara occurred.The operation time,blood loss,time of weight loading after operation and time of union increased with our increased classification.One patient died from a heart disease 5 months after operation.Functional outcome of the other 49 patient was assessed by Harris hip score one year after operation.Forty patients were excellent,6 good and 3 fair,giving an excellent to good rate of 93.9％.Conclusion Unstable fractures of intertrochanteric lateral wall should be treated using different surgical strategies based on the morphology classification system.
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Objective To evaluate effect of construction with dual plates via olecranon osteotomy approach in treatment of type C distal humeral fractures.Methods The study involved 19 patients with type C distal humeral fractures treated by olecranon osteotomy and double plate fixation between July 2008 and April 2010,including 11 males and 8 females at a mean age of 49.2 years (range,27-71 years).Fractures were causes by traffic accidents in 10 patients,tumble in seven and fall from height in two.According to Association for Osteosynthesis/Orthopaedic Trauma Association (AO/OTA) classification,there were nine patients with type C2 and 10 with type C3 fractures.Besides,two patients were complicated by ulnar nerve injuries and one by radial nerve injury.Results Primary wound healing was achieved in all patients after operation.All patients were followed up for average 15.9 months (range,12-20 months).X-ray films revealed that both fracture and olecranon osteotomy sites were healed in average 12 weeks (range,8-18 weeks).No fixation failure,myositis ossificans,malunion,delayed union or disunion occurred during the follow-up.Average Mayo elbow performance score (MEPS) was 94.8 points (range,75-100 points) at the last follow-up,which showed excellent results in 14 patients,good in three,and fair in two,with excellence rate of 90％.Conclusions Double plate fixation via olecranon osteotomy gains advantages of solid fixation and early functional exercise in treatment of comminuted intercondylar fractures of humerus.Moreover,postoperative outcome is satisfactory.