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Objective: To compare the effectiveness of proximal femoral nail anti-rotation (PFNA) in the treatment of intertrochanteric fracture of femur in traction bed supine position and non-traction bed lateral position. Methods: A retrospective analysis of 102 elderly patients with intertrochanteric fracture of femur who met the selection criteria between January 2013 and April 2018 was made. According to the different operative positions, the patients were divided into two groups: group A (50 cases, PFNA internal fixation in traction bed supine position) and group B (52 cases, PFNA internal fixation in non-traction bed lateral position). There was no significant difference in age, gender, fracture side, cause of injury, AO classification, complications, and time from injury to operation between the two groups ( P>0.05). The preoperative preparation time, incision length, operation time, intraoperative blood loss, intraoperative X-ray fluoroscopy times, fracture healing time, and complications were recorded and compared between the two groups, and the effectiveness was evaluated by Harris hip score at 1 year after operation. Results: There was no significant difference in incision length between groups A and B ( t=1.116, P=0.268). In addition, the preoperative preparation time, operation time, intraoperative blood loss, and intraoperative X-ray fluoroscopy times in group A were significantly greater than those in group B ( P<0.05). Both groups were followed up 12-14 months, with an average of 13 months. There were 3 postoperative complications in group A and group B respectively. In group A, there were 2 cases of hip joint pain and 1 case of local fat liquefaction (healed after dressing change); in group B, there were 2 cases of hip joint pain and 1 case of deep vein thrombosis in lower extremity; there was no significant difference in the incidence of postoperative complications between the two groups ( P=0.642). The patients of the two groups had a good result of fracture reduction and the internal fixation quality, and there was no main nail loosening, screw fracture, spiral blade cutting, withdrawal, and the nail breakage occurred, and no nonunion of bone, coxa vara, and other complications occurred. X-ray showed that the fracture healed in both groups, and there was no significant difference in fracture healing time between the two groups ( t=1.515, P=0.133). There was no significant difference in Harris hip score between the two groups at 1 year after operation ( t=0.778, P=0.438). Conclusion: Compared with the traction bed supine position, PFNA internal fixation for intertrochanteric fracture of femur in the non-traction bed lateral position has the advantages of short preparation time, short operation time, less intraoperative blood loss, less X-ray fluoroscopy times, and satisfactory postoperative recovery effect.
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BACKGROUND: Neuropeptides, a kind of endogenous active substance in nerve tissues, can modulate physiological functions of multiple body systems.OBJECTIVE: To observe the effects of vascular bundles or sensory nerve tracts implanted into tissue-engineered bone for rabbit large bone defects on the expression levels of calcitonin gene-related peptide (CGRP) and neuropeptide-Y.METHODS: Fifty-four New Zealand rabbits were enrolled to make model of large bone defects, and then, the animal models were randomly divided into three groups, including sensory nerve tract, vascular bundle, and control groups (n=18 per group), followed by implanted with sensory nerve tracts, vascular bundle, and tissue-engineered bone without sensory tracts or vascular bundle, respectively. The defected bone received gross and Masson staining at 4, 8 and 12 weeks after modeling, to compare the expression levels of CGRP and neuropeptide-Y in each group.RESULTS AND CONCLUSION: mRNA expression levels of CGRP and neuropeptide-Y in the sensory nerve tract and vascular bundle groups were significantly higher than those in the control group at different time points after modeling (P < 0.05). mRNA expression levels of CGRP and neuropeptide-Y in the tissue-engineered bone began to be increased and peaked at the 8th week, and then decreased (P < 0.05), which were the lowest at the 4th week (P < 0.05).Immunohistochemical staining results showed that CGRP was mainly found in the bridge, periosteum of newly born bones and around blood vessels; while neuropeptide-Y mainly localized in the medullary cavity and around blood vessels. These results indicate that the implantation of vascular bundle and sensory nerve tracts for bone defects can upregulate the expression levels of CGRP and neuropeptide-Y, and promote bone repair. However, sensory tract implantation may cause sensory impairment; thereafter, vascular bundle implantation is more suitable for ideal tissue-engineered construction to meet physical requirements.
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Objective To compare patellar ring,Kirschner wire tension band and patellar ring plus Kirschner wire in fixation for treatment of patella fractures.Methods A retrospective analysis was conducted on the 285 patients with patellar fracture who had been treated between September 2009 and January 2016.They were 155 men and 130 women,with an average age of 45.5 years (from 18 to 70 years).Their fractures included 176 transverse,28 longitudinal split and 81 comminuted ones.They were divided into 3 groups according to their different internal fixation methods:patellar ring fixation (98 cases),Kirschner wire tension band (92 cases),patellar ring plus Kirschner wire fixation (95 cases).The 3 groups were compared in terms of operative time,intraoperative bleeding,fracture healing time,knee function by B(o)stman score at the last follow-up and postoperative complications.Results The operative time in the patellar ring group(58.9 ±6.4 min) was significantly shorter than in the Kirschner wire group (71.8 ± 7.8 min) and in the patellar ring plus Kirschner wire group (74.4 ± 8.0 min) (P ＜ 0.05).There were no statistical significant differences between the 3 groups in fracture healing time and intraoperative bleeding (P ＞ 0.05).The good to excellent rate of knee function at the last follow-up in the Kirschner wire tension band group was 100.0％ (92/92),significantly higher than in the patellar ring group (90.8％,89/98) and in the patellar ring plus Kirschner wire group (91.6％,87/95) (P ＜ 0.017).There was no significant difference in postoperative complication rate between the patellar ring fixation group (2.0％,2/98),Kirschner wire tension band fixation group (1.1％,1/92) and the patellar ring plus Kirschner wire group (2.1％,2/95) (P ＞ 0.05).Conclusion Internal fixation with Kirschner wire tension band has definite curative effect on patellar fractures,showing the advantages of less operative invasion,fewer postoperative complications,better functional recovery of the affected knee joint,and lower price over the other 2 internal fixation methods.
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Objective To investigate the relationship between serum soluble B7-H4(sB7-H4) expression and clinical pathological characteristics in patients with non small cell lung cancer(NSCLC),and its clinical significance.Methods 65 patients with NSCLC were selected as NSCLC group,58 patients with benign lung disease were selected as the benign lung disease group,another 45 healthy people of the same period in our hospital outpatient physical examination were selected as healthy control group.By enzyme-linked immunosorbent assay(ELISA) method,serum sB7-H4 and vascular endothelial growth factor(VEGF) were detected.The serum embryonic antigen(CEA) and cancer antigen-125(CA125) were detected by chemiluminescence method.The relationship between sB7-H4 and NSCLC and other pathological features,and the relationship of the tumor markers CEA,CA125,VEGF were analyzed.Results The level of serum sB7-H4 of the NSCLC group was (59.47±8.76)μg/L,which was significantly higher than (17.38±3.72)μg/L of the lung benign lesion group and (15.26±3.17)μg/L of the health control group,the differences were statistically significant(t=18.276,19.872,all P<0.01).The serum CEA,CA125,VEGF levels of the NSCLC group were higher than those of the lung benign lesion group and healthy control group,the differences were statistically significant(t=9.447,14.883,33.467;t=11.374,15.137,37.759,all P<0.01).The level of serum sB7-H4 of the NSCLC group after treatment was (35.47±7.46)μg/L,the difference was statistically significant compared with before treatment[(59.47±8.76)μg/L](t=4.372,P<0.01).The serum sB7-H4 level was correlated with NSCLC tissue differentiation degree,clinical stage,whether with lymph node metastasis (F=3.786,t=4.821,4.172,all P<0.01).In NSCLC patients,sB7-H4 level was positively correlated with serum CEA,CA125 and VEGF levels (r=0.643,0.727,0.586,all P<0.05).Conclusion The sB7-H4 may be involved in the occurrence and development of NSCLC,and it is expected to become a new target for NSCLC diagnosis and treatment.
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Objective To investigate the clinical value of multi-slice spiral CT in the evaluation of esophageal variceal bleeding .Methods 50 cirrhosis patients with esophageal varices received multi-slice spiral CT and gastroscopy detection .The application value of multi-slice CT in the assessment of esophageal bleeding was evaluated according to the results of gastroscopy detection .Results CT angiography score had significantly positive correlation with the severity of endoscopic varices and endoscopic red color sign (r=0.762,0.687,all P<0.01).The sensitivity and specificity of CT angiography score in diagnosis of endoscopic red signs RC 3 were 76.92% and 92.50%. Conclusion The results of multi-slice CT and gastroscopy are positively correlated with the severity of esophageal varices,which can be used to predict the risk of esophageal bleeding .
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[Objective]To explore the application value of vascularized fibular graft in the repairment of maxillofacial defects.[Methods] Forty-five patients with maxillofacial defects caused by various reasons were enrolled and treated by vascularized fibular graft.The related disease history,survival situation of blood vessels and tissue flaps of all the patients were recorded.[Results]All the patients were followed up for 3-6 months after surgery.All the patients could eat by mouth and without no obvious obstacle.There was no facial asymmetry,healthy side bite jaws deflection and so on.The maxillofacial appearance and functions almost returned back to normal.Oral panoramic radiography showed that the osseous healing of transplanted fibular and mandibular was good,and there was no bone nonunion,osteonecrosis,titanium plate rejection or fracture happened.Three-dimensional CT scàn revealed that the recovery of mandibular appearance was good.There was 1 case with leg wound drainage and 1 case with cervical wound effusion,which were all healed after the second phase by dressing change and necessary treatment.The rest of the patients were all healed at the first phase.There was no free tissue flap necrosis and calf obvious dysfunction.[Conclusions] Using vascularized fibular graft for the repairment of maxillofacial defects,the maxillofacial appearance and functions of patients almost return to normal after surgery.The surgery can satisfy the requirements of patients on postoperative oral and maxillofacial appearance and function with lower incidence of complications and hig her survival rate of free tissue flap.Therefore,it is worthy of clinical application.
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Objective To explore the effect of immunogenicity of freeze-dried bone allograft on different in vitro experimental models. Methods The lymphocytes were obtained respectively from 10 healthy young human volunteers, 10 Balb/c and 10 C57 mice and 10 New Zealand rabbits. The experiment was carried out in 6 groups: positive control group (PHA/ConA+lymphocyte), negative control group (Hydroxyapatite powder + lymphocyte), allogeneic bone group A (Freeze-dried bone powder 2. 0 g/L + lym-phocyte), allogeneic bone group B (Freeze-dried bone powder 1.0 g/L + lymphocyte), allogeneic bone group C (Freeze-dried bone powder 0.5 g/L + lymphocyte), and negative control group (culture solution + lym-phocyte). Lymphocyte transformation test (Alamarblue) was conducted to culture the 6 kinds of experimental materials in vitro. After 72 hours, samples were scanned with ELISA muhiscan at wave lengths 570 nm and 600 nm to fetal the light absorption value. Pearson analyses were performed 10 determine the relationships a-mong the 3 animals and 1 human groups and find out which animal would be highly correlated to human. Results In the human and Balb/c mice lymphocyte transformation tests, there was no significant difference (P > 0.05) between allogeneic bone groups A, B, C and negative control group (HA) ; but there was sig-nificant difference (P < 0.001) between allogeneic bone groups A, B, C and positive control group (PHA/ConA); there was no significant difference between the 3 allogeneic bone groups (P > 0.05). There was no significant difference among the 6 groups of C57 mice and New Zealand rabbits (P > 0.05). The coefficient r between Balb/c mice and human groups was 0.959, P = 0.003, showing a highly positive correlation. The coefficient r between C57 mice and human groups was 0.527, P = 0.283, while the coefficient r between New Zealand rabbits and human groups was 0.866, P =0.026. Conclusions The immunogenicity of freeze-dried bone powder in this experiment may not be sufficient enough to induce significanrt immunologic response. Balb/c mice may be preferable for immunogenicity related experiments.
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Objective To explore whether the respective implantation of vascular bundles and sensory nerve tracts into a tissue-engineered bone will affect the expression of CGRP (Calcitonin gene related peptide) and its receptor. Methods Fifty-four New Zealand rabbits were randomly divided into 3 even groups for implantation of sensory nerve tracts (group A),implantation of vascular bundles (group B),and a control group of simple tissue-engineered bone (group C) . Animals were sacrificed 4,8,12 weeks after implantation,respectively. Masson staining was conducted to observe the process of bone formation and re-molding. CGRP and CGRPR-1 expressions in the new bone were measured by immunohistochemistry and Real-time PCR at 4,8 and 12 weeks after implantation. Results At all time points,the CGRP and CGRPR-1 expressions in groups A and B were significantly higher than in group C (P<0.05),and those in group A were higher than in group B too (P<0.05) . Over time,the expressions of CGRP and CGRPR-1 mRNA in each group in the new bone tissue were gradually reduced after an initial increase. The neuropeptide expression at the 8th week was higher than those at the 4th and 12th weeks. The neuropeptide expression at the 4th week was the lowest. The expression of CGRP was mainly localized in the periphery of newly generated bone,periosteum and the blood vessels. The expression of CGRPR-1 was mainly localized in the periphery of osteoblasts. Conclusions Implantation of either vascular bundles or sensory nerve tracts can promote neuropeptide secretion. The vascular bundle implantation may result in higher expressions of CGRP and CGRPR-1 than sensory nerve tract implantation.
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Objective To compare the histological fates and the effects of autologous fat and fascia used as augmentative materials to treat unilateral vocal fold paralysis (UVFP). Methods Vocal fold augmentation with autologous fat and fascia was performed on 2 dogs (group A) to cure glottic insufficiency caused by left vocal fold paralysis. Autologous fat and fascia 0.4 ml were injected respectively into left and right vocal folds of 9 dogs (group B). The dogs of group B were killed after 1,3 and 5 months and the dogs of group A were killed after 8 months. The histology of both substances and the effect of treatment were evaluated. Results Surviving autologous fat grafts was found in the canine vocal fold after 8 months, but the absorption was too rapid to maintain the bulk of grafts, the effect could last no more than 5 months. Autologous fascia also survived after 8 months, Conclusion The results showed that these two augmentative materials were both effective in the treatment of IJVFP. Autologous fat can only be used as short - term augmentative material. However, autologous fascia has a potential use for long - term application to correct glottic insufficiency caused by UVFP and other diseases.