Post-Marketing Surveillance of Qishe Pill () Use for Management of Neck Pain in a Chinese Patient Cohort to Determine its Safety, Tolerability and Effectiveness / 中国结合医学杂志

OBJECTIVE@#To evaluate the safety and effectiveness of Qishe Pill () on neck pain in real-world clinical practice.@*METHODS@#A multi-center, prospective, observational surveillance in 8 hospitals across Shanghai was conducted. During patients receiving 4-week Qishe Pill medication, Visual Analogue Scale (VAS) and Neck Disability Index (NDI) assessments have been used to assess their pain and function, while safety monitoring have been observed after 2 and 4 weeks.@*RESULTS@#Results from 2,023 patients (mean age 54.5 years) suggest that the drug exposure per unit of body mass was estimated at 3.41 ± 0.62 g/kg. About 8.5% (172/2,023) of all participants experienced adverse events (AEs), while 3.8% (78/2,023) of all participants experienced adverse reaction. The most common AEs were gastrointestinal events and respiratory events. The VAS score (pain) and NDI score (function) significantly decreased after 4-week treatment. An effect-quantitative analysis was also conducted to show that the normal clinical dosage may be consider as 3-4 g/kg, at which dosage the satisfactory pain-relief effect may achieve by 40-mm reduction in VAS.@*CONCLUSION@#These findings showed that patients with cervical radiculopathy who received Qishe Pill experienced significant improvement on pain and function. (Registration No. NCT01875562).

Simple nucleus pulposus removal for the treatment of prolapsed and displaced lumbar disc herniation / 中国骨伤

OBJECTIVE@#To explore the clinical effect of the simple nucleus pulposus removal and small incision interlaminar window in the treatment of prolapsed and displaced lumbar disc herniation.@*METHODS@#From February 2016 to February 2018, 35 patients with single-segment prolapse and displaced lumbar disc herniation were treated by the simple nucleus pulposus removal and small incision interlaminar window under general anesthesia. Among them, there were 21 males and 14 females;aged (42±17) years;27 cases of L@*RESULTS@#All the operations were successful and the operation time was 30 to 60 min with an average of 40 min, the intraoperative blood loss was 10 to 30 ml with an average of 20 ml. All the patients were followed up for 1 to 3 years with an average of 1.2 years. Thirty-five patients with low back pain and lower limb symptoms were significantly relieved or disappeared. According to modified Macnab standard, 29 cases obtained excellent results, 5 good, and 1 fair.@*CONCLUSION@#Applying the concept of minimally invasive operation, small incision interlaminar window and simple nucleus pulposus removal for the treatment of prolapsed and displaced lumbar disc herniation has the advantages of short operation time, definite curative effect, and less trauma. And it is a safe and effective surgical method under the premise of strict control of the indications.

Simultaneous bilateral fractures of the femoral neck caused by high energy: A case report and literature review / 中华创伤杂志(英文版)

Simultaneous bilateral fractures of the femoral neck are rare injuries, which are reportedly induced by low-speed energy with predisposing factors including systemic diseases, medications and eclamptic seizures. Those caused by high energy are even rarer. High energy-induced bilateral fractures of the femoral neck conceive of high incidence of mortality and present great challenges in the early management. We report one case of a 52-year-old man with simultaneous bilateral fractures of the femoral neck which resulted from a motor pedestrian accident. One-stage closed reduction and internal fixation was done following the emergent resuscitation and neurosurgical management for concomitant brain injuries. The fractures united. There was no pain in the hips, and they had a normal range of motion. The treatment protocol, mechanism of the injury and possible postoperative complications were discussed to expand a comprehensive understanding about these infrequent types of fractures.

Subtrochanteric femur fracture treated by intramedullary fixation / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>To discuss surgical technique, operative efficacy and clinical outcome of intramedullary fixation in the treatment of subtrochanteric femur fractures.</p><p><b>METHODS</b>From February 2011 to February 2013, 76 cases of subtrochanteric femur fractures were treated by intramedullary fixation in our hospital, including 53 males and 23 females, with the age range of 37 -72 years (mean 53.5 years). According to Seinsheimer classification, there were 2 cases of type I, 7 type II, 15 type III, 23 type IV and 29 type V. Firstly, all patients underwent closed reduction with the guidance of C-arm fluoroscopy in a traction table. Two cases of type I and 3 cases of type III fractures had ideal closed reduction followed by internal fixation. The others needed additional limited open reduction. Radiographic examination was used to evaluate callus formation and fracture healing in postoperative 1, 3, 6 and 12 months follow-up. Functional recovery was evaluated by Harris Hip Scoring (HHS) system.</p><p><b>RESULTS</b>Patients were followed up for 6-12 months. All fractures were healed except one patient with delayed union. The average bone union time was 4.5 months. According to HHS system, 65 cases were considered as excellent in functional recovery, 8 good, 2 fair and 1 poor. The proportion of the patients with excellent and good recovery was 96.05%.</p><p><b>CONCLUSION</b>Intramedullary fixation is feasible for the treatment of subtrochanteric femur fracture. The accuracy of intraoperative reduction and surgical skill are important for the clinical outcome and the patients' prognosis.</p>

Biomechanical advantages of medial support screws in locking plate for treating proximal humerus fractures / 医用生物力学

Objective To evaluate the biomechanical advantages of medial support screws (MSSs) in locking proximal humeral plate for treating proximal humerus fractures. Methods Thirty synthetic left humeri were randomly divided into 3 groups to establish the fracture models. Group A was fixed with a locking proximal humerus plate with medial cortical support, but without MSSs; group B was fixed with 3 MSSs, but without medial cortical support; group C was fixed with neither medial cortical support nor MSSs. Axial compression, torsion, shear stiffness and failure tests were applied on the specimens of the three groups. Results For axial compression tests, the maximum load of group A, B, C was (240.88±19.13), (169.04±19.26), (128.58±17.53) N, respectively; the axial stiffness of group A, B, C was (424.4±101.2), (230.7±40.54), (147.0±29.2) N/mm, respectively, showing significant differences (P0.05). For shear stiffness tests, the maximum load of group A, B, C was (444.71±20.87), (228.79±28.95), (188.73±26.15) N, respectively; the shear stiffness of group A, B, C was (70.0± 54.4), (183.89±29.64), (140.2±32.1) N/mm, respectively, showing significant differences (P0.05). Conclusions Using three MSSs in locking plate for proximal humerus fractures shows optimal biomechanical properties, as compared to the situation without restoration of the medial column support. The reconstruction of the medial cortical support or MSSs for proximal humerus fractures helps to enhance the mechanical stability of the humeral head and prevent failure after internal fixation.

Finite element analysis on titanium elastic nail and reconstruction plate fixation for midshaft clavicular fractures / 医用生物力学

Objective To analyze the stress distribution and peak stress on midshaft clavicular fractures fixed by titanium elastic nail (TEN) or reconstruction plate, respectively. Methods CT data of the clavicle was adopted to reconstruct the intact clavicle model and the midshaft clavicular fracture models with the TEN and reconstruction plate fixation by using Mimics software. All the three dimensional finite element models were analyzed using Abaqus 6.9 software. The distal displacement, the peak stress and stress distribution on the distal clavicle under the axial load (250 N) and vertical load (250 N) were calculated for the three models. Results The axial displacement of the distal clavicle under the axial load showed TEN (0.23 mm)>intact clavicle (0.14 mm)>reconstruction plate (0.11 mm), respectively. While the vertical displacement of the distal clavicle under the vertical load was 5.12 mm for TEN, 3.71 mm for intact clavicle and 2.25 mm for reconstruction plate, respectively. But the peak stress of the clavicle under the axial load was 33.1 MPa for TEN, 18.7 MPa for reconstruction plate, and 15.5 MPa for intact clavicle model, respectively. And the peak stress under the vertical load was 146.3, 64.1, 56.1 MPa in the TEN, intact clavicle model, and reconstruction plate model, respectively. The stress distribution in TEN model under both kinds of loads was similar to that in intact clavicle model, while under the vertical load, the stress distribution in reconstruction plate model was clearly different with that in intact clavicle model. For the implants under the axial load, the peak stresses were 191.5, 52.3 MPa in the TEN model and reconstruction plate model, respectively, and the peak stress on implants under the vertical load was 1 248.0, 421.7 MPa in the TEN model and reconstruction plate model, respectively. Conclusions The TEN for treating midshaft clavicular fractures showed a stress distribution similar to the intact clavicle, with a higher peak stress and a higher peak implant stress at the fracture site. The reconstruction plate fixation for midshaft clavicular fractures was shown to be more stable, but with obvious stress shielding. Therefore, TEN is generally preferable for treating the simple displaced fractures of midshaft clavicle. However, the ipsilateral shoulder should avoid excessive exercise and weight bearing in the early postoperative period.

The role of primary cilium in bone tissue mechanotransduction / 医用生物力学

Bone tissues constantly receive the mechanical stimulation and maintain the dynamic balance of bone formation and resorption. Currently, the mechanism of how bone tissues sense the mechanical stimulation is still unknown. An increasing number of studies have shown that primary cilium may be the mechanical sensor of bone tissues. The primary cilium maybe transfer the extracellular mechanical signals into intracellular biochemical message through them, and the mechanical stimulation received by bone tissues can regulate bone remodeling finally. This article reviews the current researches on primary cilium, predicts the research tendency and tries to lay some foundation for the use of primary cilium to prevent and treat osteoporosis.

Blood loss closely correlates with body mass index in total hip arthroplasty performed through direct lateral approach

To investigate total blood loss [TBL], intraoperative blood loss [IBL], post-operative drainage [POD], and other related variables in total hip arthroplasty [THA] performed through direct lateral approach. This study was completed in Shanghai Sixth People's Hospital, Shanghai, China, between January and December 2010. We analyzed 113 patients treated by THA through direct lateral approach. Recordable blood loss [RBL] was measured and TBL was calculated according to the Gross formula. Ordinal logistic regression analysis was used for TBL, IBL, and POD, with gender, age, body mass index [BMI], disease duration, and operative time as independent variables. The average operative time was 51.5 +/- 10.4 [range: 35-70] minutes, with an average RBL of 454 +/- 144 [range: 150-180] ml. Average TBL was significantly higher [975 +/- 355, range: 430-2020 ml; p<0.001]. In the analysis of variables, BMI closely correlated with TBL, IBL, and POD, with odds ratios of 4.80 [95% CI: 2.63-8.78 [TBL]], 5.39 [95% CI: 2.84-10.25 [IBL]], and 4.37 [95% CI: 2.43-7.89 [POD]]. Moreover, TBL [54.172], IBL [55.198], and POD [39.139] correlated with trend test BMI. The TBL, IBL, and POD closely correlate with BMI in patients undergoing THA through direct lateral approach

Prevalence of nutritional risk among in-patients with liver diseases in Beijing, China / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To investigate the prevalence of nutritional risk and malnutrition among in-patients with liver diseases in Beijing, China, and to evaluate the relationship between nutritional risk and prognosis.</p><p><b>METHODS</b>A total of 331 in-patients with liver diseases under care at the Artificial Liver Center of Beijing Youan Hospital were consecutively enrolled for study between April 2012 and December 2012. Nutritional status was determined by calculating each patient's ratio of real weight to clinically ideal weight, the triceps skin fold (TSF), and the mid-upper arm muscle circumference (MAMC). Nutritional risk was estimated using the Nutritional Risk Screening questionnaire 2002 (NRS-2002). In addition, each patient's Child-Pugh stage, body mass index (BMI), power of gripping, serum albumin and pre-albumin levels, lymphocyte count, hospital length of stay, complications, alcoholism history, and outcome after discharge were recorded for analysis.</p><p><b>RESULTS</b>One-hundred-and-thirteen of the patients (34.1%) were defined as at nutritional risk upon hospital admission. The ratio of nutritional risk was lowest in patients with chronic hepatitis (17.0%) and highest in patients with acute on chronic liver failure (56.5%). The ratios of malnutrition evaluated by TSF and MAMC were 36.9% and 38.7%, respectively. Among the patients with liver cirrhosis or hepatocellular carcinoma, the ratio of Child-Pugh stage C was higher for individuals defined as at nutritional risk than for those without. When TSF-based ratio of malnutrition was higher for individuals with a history of alcoholism than for those without. BMI, power of gripping, serum albumin level, serum pre-albumin level, and lymphocyte count were all lower for individuals defined as at nutritional risk than for those without. Hospital stay, ratio of complication onset, and ratio of death were all higher for individuals defined as at nutritional risk than for those without.</p><p><b>CONCLUSION</b>TSF and MAMC can be used to evaluate the nutritional status of in-patients with liver diseases. Patients with nutritional risk (as determined by the NRS-2002) have poorer prognosis and may benefit from nutritional intervention.</p>

Correlation study on biomechanics of three-foot weight bearing canine model with femoral head osteonecrosis / 医用生物力学

Objective To study changes in biomechanical characteristics of the femoral head during the progression of avascular osteonecrosis and investigate the mechanism of these biomechanical changes. Methods Twenty-four three-foot weight bearing canine models with osteonecrosis of the femoral head (ONFH) were established by fixing one fore limb of the canine. Osteonecrosis was induced in all experimental animals by randomly injecting 5 mL pure ethanol into one side of the femoral head, and the contralateral femoral head was injected with an equal amount of normal saline as the control group. The canines were killed at 1st, 3rd, 6th, and 12th week after the injection of ethanol, with six canines in each group. The radiographic, histological changes and biomechanical characteristics of the femoral head were observed and analyzed. Results At 3rd week, 29% reduction of indentation stiffness and 32.9% reduction of elastic modulus in the cancellous bone were found in the infected femoral heads compared to the control heads, and a low density area was detected only in MRI and osteonecrosis was the main histological characteristics. At 6th and 12th week, the indentation stiffness in the infected femoral heads was reduced by 45.5% and 48.7%, respectively, and the elastic modulus of the cancellous bone in the infected femoral heads was reduced by 34.1% and 32.4%, respectively, compared to the control heads. At 6th week, uneven bone density of the femoral head was detected in radiographs, and the progression of osteonecrosis and bone healing was found at the same time. At 12th week, areas of reduced bone mineral density beneath the load bearing position of the femoral head were observed on radiographs. Collapse of the articular cartilage surface and narrowing of the joint space were the main histological findings. Conclusions Biomechanics is an important factor in the progression of ONFH. The decreased mechanical properties may be a direct reason leading to the late collapse of the femoral head. The treatment of ONFH should focus not only on acceleration of the bone healing, but also on provision of a favorable and stable biomechanical environment for the infected femoral head.

Application of inferior vena cava filters in prevention of peri-operative pulmonary embolism in patients with bone fracture combined with deep venous thrombosis: a report of 572 cases / 中华外科杂志

<p><b>OBJECTIVES</b>To evaluate the application of inferior vena cava filter (IVCF) in prevention of peri-operative pulmonary embolism in patients with bone fracture combined with deep venous thrombosis (DVT).</p><p><b>METHODS</b>From July 2007 to April 2011, 572 cases of bone fractures consequent with DVT that confirmed by Duplex were deployed IVCF to avoid fatal pulmonary embolism in the para-operative period. There were 318 male and 254 female patients with a mean age of (51±23) years (ranging from 16 to 94 years).</p><p><b>RESULTS</b>All the operations of deployment of the IVCFs were successfully. There were 174 permanent and 399 temporary IVCFs deployed. In all 399 temporary filters, 389 filters were taken out successfully. The mean station time in the IVC of the temporary filters was 22.8 days (7 to 60 days), among which, 118 were found of captured thrombus. After the follow-up of mean 16 months (3 to 40 months) of 566 patients, no pulmonary embolism occurred, but symptomatic DVT were revealed in 15 patients, and the conditions were improved after anticoagulation treatment. No serious complication of post thrombotic syndrome occurred.</p><p><b>CONCLUSION</b>IVCF deployment can prevent the trauma patients with deep vein thrombosis of fatal pulmonary embolism in the peri-operative period, which may also offer a safe condition to the orthopedic operations.</p>

Biomechanical study on the novel minimally invasive anterior anatomic locking plate for mid-distal humeral shaft fractures / 医用生物力学

Objective To test the mechanical properties of a self-developed novel anterior mid-distal humerus anatomic locking plate (hereinafter referred to as the new plate) and to improve its design to provide theoretical support for its clinical application. Methods Twenty intact humerus from embalmed human cadavers were obtained and used for the biomechanical test on mid-distal humeral shaft fracture models by using the new plate (group A) and 4.5 mm LC DCP（limited contact dynamic compression plate）(group B), respectively. Both groups were compared under axial compression, medial-lateral bending, medial-lateral three-point bending and external rotation torque. Results The stiffness, strength and stress shielding of the new plate for mid-distal humeral shaft fractures under four different loads were superior to those of 4.5 mm LC-DCP, and the differences were statistically significant(P<0.05). Conclusions The new plate can satisfy the requirements of physical training at early stage for fixed mid-distal humeral shaft fractures, which gives great clinical values.

Natural herbal medicine Lianhuaqingwen capsule anti-influenza A (H1N1) trial: a randomized, double blind, positive controlled clinical trial / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The 2009 influenza A (H1N1) virus infection is associated with the high risk of severe complications and is spreading more rapidly throughout the world than other reported seasonal influenzas. This study aimed to evaluate the efficacy and safety of the nature herbal medicine Lianhuaqingwen capsule (LHC) in patients infected with influenza A (H1N1) virus.</p><p><b>METHODS</b>A total of 244 patients aged 16 - 65 years confirmed with influenza A (H1N1) virus infection by the real time RT-PCR were randomized to one of two treatment groups of 122 patients each. Each group assigned to receive either LHC or Oseltamivir for five days and observation for seven days. The patients were enrolled within 36 hours of illness onset if they had an axillary temperature of ≥ 37.4°C and with at least one of the following symptoms: nasal obstruction, runny nose, cough, sore throat, fatigue, headache, myalgia, chills and sweating. The primary end point was the duration of illness.</p><p><b>RESULTS</b>Of 244 patients, 240 (98.36%) patients with a median age 21 years completed the study between October 24, 2009 and November 23, 2009. There were no significant overall differences between LHC treated and Oseltamivir treated patients in the median duration of illness (LHC 69 hours vs. Oseltamivir 85 hours P > 0.05) or the median duration of viral shedding (LHC 103 hours vs. Oseltamivir 96 hours, P > 0.05). However, it was worthwhile to note that LHC significantly reduced the severity of illness and the duration of symptoms including fever, cough, sore throat, and fatigue (P < 0.05). Both study medications were well tolerated. No drug related serious adverse events occurred during the study.</p><p><b>CONCLUSIONS</b>Compared with Oseltamivir, LHC achieved a similar therapeutic effectiveness reduction of the duration of illness and duration of viral shedding. Therefore, LHC might be an alternative therapeutic measure for influenza A (H1N1) virus infections.</p>

Early results of reverse less invasive stabilization system plating in treating elderly intertrochanteric fractures: a prospective study compared to proximal femoral nail / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Intertrochanteric femur fracture is common in elderly population. Though multiple treatment options are available, the choice of implant remains controversial. The reverse less invasive stabilization system (LISS) plating was introduced for treatment of a patient with ipsilateral intertrochanteric and midshaft femoral fractures. The aim of this research was to compare such technique to intramedullary nailing (proximal femoral nail, PFN) for intertrochanteric fractures.</p><p><b>METHODS</b>Fifty-six patients with an age of at least sixty-five years and an AO/OTA type-A1 or A2 fractures were included and divided into LISS and PFN treatment group.</p><p><b>BACKGROUND</b>parameters, fracture and surgery details were documented. Follow-up time was at least 12 months. Radiology, complication, Harris Hip Score and Rapid Disability Rating Score (RDRS) were recorded to evaluate fixation status and hip function for each patient during follow-up.</p><p><b>RESULTS</b>There was no significant difference between the two groups in surgical time ((48.0 ± 8.6) minutes, vs. (51.8 ± 10.8) minutes, P = 0.3836) and intraoperative blood loss ((149.1 ± 45.1) ml vs. (176.4 ± 25.4) ml, P = 0.0712). The LISS group had less postoperative haemoglobin (Hb) reduction ((10.2 ± 4.5) g/L Hb, vs. (15.1 ± 5.9) g/L Hb, P = 0.0475). There was no complication observed in PFN group. All 31A1 type fracture in LISS group showed 100% maintenance of reduction. One nonunion with locking screw breakage and 2 varus union were found in the LISS group. Postoperative hip function was similar between the two groups.</p><p><b>CONCLUSIONS</b>Though reverse LISS plating may not be recommended as a routine fixation method for elderly unstable intertrochanteric fractures compared to PFN, it may possibly be reserved for rapid fixation and damage control in polytrauma patients and ORIF of subtrochanteric and reverse oblique intertrochanteric fractures.</p>

Surgical treatment of tarsometatarsal joint complex injury / 中华外科杂志

<p><b>OBJECTIVE</b>To report the outcome of surgical treatment of tarsometatarsal joint complex injury.</p><p><b>METHODS</b>In the period from January 2003 to December 2008, 167 cases of closed tarsometatarsal joint injury were treated, including 35 cases of tarsometatarsal joint complex injury. Diagnosis was made by X-ray examination or/and CT scan. Either close or open reduction was performed and followed by internal fixation with screw or/and plate. X-ray examination was done in the regular follow-up and functional evaluation was carried out by AOFAS midfoot score system.</p><p><b>RESULTS</b>In this series 135 cases got a mean follow-up of 48 months, ranging from 12 to 75 months. Therein the 26 cases of tarsometatarsal joint complex injury had a mean postoperative AOFAS midfoot score of 67 (ranging from 48 to 75), and secondary post-traumatic arthritis in 16 cases, 12 of which had arthrodesis as a result of severe pain. The 109 cases of pure tarsometatarsal joint injury had a mean postoperative AOFAS midfoot score of 82 (ranging from 70 to 95), and secondary post-traumatic arthritis in 17 cases, only 5 of which had arthrodesis finally. Those cases of pure tarsometatarsal joint injury treated by close reduction and internal fixation with percutaneous screw got a mean postoperative AOFAS midfoot score of 87 (ranging from 82 to 95), demonstrating a significant deference (t = 2.651, P < 0.05) when compared with that of metatarsal joint complex injury.</p><p><b>CONCLUSION</b>The tarsometatarsal joint complex injury has a prognosis inferior to that of the pure tarsometatarsal joint injury, and the keys to its successful treatment are appropriate diagnosis, anatomical reduction and secure fixation of all the components of the complex.</p>

Detection of nasopharyngeal carcinoma using surface-enhanced laser desorption and ionization mass spectrometry profiles of the serum proteome / 癌症

<p><b>BACKGROUND AND OBJECTIVE</b>Early diagnosis of nasopharyngeal carcinoma (NPC) is difficult due to the insufficient specificity of the conventional examination method. This study was to investigate potential and consistent biomarkers for NPC, particularly for early detection of NPC.</p><p><b>METHODS</b>A proteomic pattern was identified in a training set (134 NPC patients and 73 control individuals) using the surface-enhanced laser desorption and ionization-mass spectrometry (SELDI-MS), and used to screen the test set (44 NPC patients and 25 control individuals) to determine the screening accuracy. To confirm the accuracy, it was used to test another group of 52 NPC patients and 32 healthy individuals at 6 months later.</p><p><b>RESULTS</b>Eight proteomic biomarkers with top-scored peak mass/charge ratios (m/z) of 8605 Da, 5320 Da, 5355 Da, 5380 Da, 5336 Da, 2791 Da, 7154 Da, and 9366 Da were selected as the potential biomarkers of NPC with a sensitivity of 90.9% (40/44) and a specificity of 92.0% (23/25). The performance was better than the current diagnostic method by using the Epstein-Barr virus (EBV) capsid antigen IgA antibodies (VCA/IgA). Similar sensitivity (88.5%) and specificity (90.6%) were achieved in another group of 84 samples.</p><p><b>CONCLUSION</b>SELDI-MS profiling might be a potential tool to identify patients with NPC, particularly at early clinical stages.</p>

Management of intra-articular fracture of the fingers via mini external fixator combined with limited internal fixation / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Intra-articular fractures of the fingers are common problems to emergency physicians and hand surgeons. Inappropriate management of these injuries may result in chronic pain, stiffness, deformity, or post traumatic arthritis. Ideal treatment necessitates the restoration of a stable and congruent joint that will allow early mobilization. The purpose of this study was to investigate the results of intra-articular fracture of the fingers by mini external fixator combined with limited internal fixation.</p><p><b>METHODS</b>From May 2005 to May 2007, a total of 26 patients with intra-articular fracture of the fingers were treated by mini external fixator combined with limited internal fixation. Of the 26 cases, 11 involved in metacarpophalangeal joint, and 15 interphalangeal joint in proximal interphalangeal. Kirschner wire, mini wire and absorbable suture were used for limited internal fixation. All patients were followed up and patients were accomplished with total active motion (TAM) of fingers.</p><p><b>RESULTS</b>All patients were reviewed by an independent observer. The mean follow up was 13 months (range 9 to 24 months). Subjective, objective and radiographic results were evaluated. X-ray films revealed fracture union and the average radiographic union time was 7 weeks with a range of 5 - 12 weeks and the phalange shortening or rotation in 2 cases, joint incongruity (less than 1 mm) and joint space narrowing in 3 cases respectively. Phalangeal shortening or rotation was observed in 2 cases and joint incongruity or joint space narrowing was observed in 3 cases. An artificial implant was performed on one case for traumatic arthritis 1.5 years after surgery. Based on TAM the overall good-excellent rate of joint motion function was 80.8%.</p><p><b>CONCLUSION</b>Mini external fixator combined with limited internal fixation is a reliable and effective method for treatment of intra-articular fracture of the fingers.</p>

Clinical significance of regulatory T cells proportion in the peripheral blood and tumor tissue in primary hepatocellular carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the clinical significance of the amount of regulatory T cells (Treg) in the peripheral blood CD4+ cells and tumor tissue in primary hepatocellular carcinoma (HCC).</p><p><b>METHODS</b>From January 1999 to December 2000, 63 HCC patients underwent radical resection in Sun Yatsen University Cancer Center. Tregs in those patients were detected in the samples of preoperative peripheral blood by flow cytometry and also in tissue samples of the resected tumors by immunohistochemistry. All patients had been followed up till Dec 30, 2005. The correlations of Treg amount in the peripheral blood CD4+ cells and tumor tissue with clinicopathologic characteristics and prognosis of HCC were analyzed.</p><p><b>RESULTS</b>The proportion of Treg/CD4+ in the peripheral blood was significantly higher in the patients with HCC than that in those with HBsAg positive (P < 0.01) and in the normal controls (P < 0.01). The mean number of Treg in tumor tissue was (15.69 +/- 13.29)/mm2, but none or very few Treg was detected in the normal liver tissue, para-cancerous liver tissue, and HBV-infected liver tissue. The proportion of Treg/ CD4+ in the peripheral blood was significantly positively correlated with the number of Treg in tumor tissue (P = 0.024). The 5-year survival in patients with high amount of Treg in both peripheral blood and tumor tissue was significantly poorer than that in the patients with low amount of Treg (P = 0.042, 0.019). The 5-year disease-free survival rate was significantly lower in the patients with high amount of Treg in tumor tissue than that in the patients with lower amount (P = 0.001).</p><p><b>CONCLUSION</b>Regulatory T cells in the circulatory blood and tumor tissue are increased in patients with hepatocellular carcinoma. The increased amount of regulatory T cells either in peripheral blood or in the tumor tissue is pertaining to poor prognosis. Detection of regulatory T cells both in the preoperative peripheral blood CD4+ cells and tumor tissue may be used as a potential immunological prognostic indicator for the hepatocellular carcinoma patients after radical resection.</p>

Treatment of old femoral neck and nonunion with free vascularized fibular grafting / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the clinical result of the treatment of old femoral neck fracture and nonunion with free vascularized fibular grafting.</p><p><b>METHODS</b>From November 2000 to December 2005, 29 cases with old femoral neck fracture and nonunion had been treated by free vascularized fibular grafting with an average follow-up of 28.5 months.</p><p><b>RESULTS</b>All the fracture were healed without any severe complications. And the healing time was 4-6 months (5.6 months on average). During the follow-up, the hips of 28 cases got well-function, and the average Harris hip score was 88.2. One case came about with osteonecrosis of femoral head after one year and finally accepted THA after 2 years.</p><p><b>CONCLUSIONS</b>The free vascularized fibular grafting is a valuable procedure to treat old femoral neck fracture and nonunion.</p>

The surgical technique and follow-up of the treatment with locking internal fixation on long bone nonunion of extremities / 中华外科杂志

<p><b>OBJECTIVE</b>To report the outcome of long bone nonunion of humerus, femur and tibia treated with locking internal fixation and bone graft.</p><p><b>METHODS</b>From February 2003 to October 2006, locking internal fixation and bone grafting were employed to treat 5 cases at humerus, 33 cases at femur, 23 cases at tibia. Forty-four of the patients were men, and 17 were women. The mean age was 38 years (range 7-70 years). The nonunion had resulted from failure of internal fixation in 47 cases, failure of external fixation in 5 cases, infection in 9 cases. The history of nonunion lasted from 10 to 156 months (mean 19 months). There were 42 patients treated with locking compression plate (LCP), and 19 patients with less invasive stabilization system (LISS). For bone grafting, autogenous ilium was used in 55 patients, autogenous ilium and allograft bone was used in 3 patients, allograft bone and Wright DBM artificial bone was used in 3 patients.</p><p><b>RESULTS</b>All the 61 patients were followed up for an average 12 months (range 6-24 months) only to reveal solid bone union in all the fracture, with a mean healing time of 4.8 months (ranged from 4 to 6 months). No loosening or breakage of the implants occurred in this series. The Knee Society Scores (KSS) was used to evaluate knee function in 47 patients with peri-knee joint nonunion, excellent result were seen in 35 patients, good in 7 patients, fare in 1 patients, poor in 4 patients.</p><p><b>CONCLUSION</b>Locking internal fixation can be used to treat effectively bone nonunion at the humerus, femur and tibia.</p>