Early changes within the lymphocyte population are associated with the long term prognosis in severely injured patients / 北京大学学报(医学版)

OBJECTIVE@#To investigate the relationship between early lymphocyte responses and the prognosis in severely injured patients.@*METHODS@#Consecutive patients with severe trauma who were treated in Peking University People's Hospital Trauma Medical Center between June 2017 and June 2020 were enrolled in this restropective chart-review study. According to the responses of lymphocyte after severe injury, the patients were divided into three groups, group 1: lymphopenia-returned to normal; group 2: persistent lymphopenia; group 3: never lymphopenic, and the outcome of 28 d were recorded. Clinical data such as gender, age, base excess, mechanism of injury, Glasgow coma scale (GCS), injury severity score (ISS) and massive blood transfusion were collected. Perform statistical analysis on the collected clinical data to understand the trend of lymphocyte changes in early trauma and the relationship with prognosis. In order to eliminate the interference of age, stratification was carried out according to whether the age was ≥ 65 years old, in different age groups, they were grouped according to whether the length of stay was ≥ 28 d, and the relationship between lymphocyte trend and length of stay was discussed.@*RESULTS@#A total of 83 patients were included, 66 males and 17 females. The main injury mechanisms were traffic accident injuries and high-altitude fall injuries. The average ISS was (30±11) points. 65 patients had lymphopenia on the day of injury, 32 of them returned to normal on the 5th day, and the rest did not recover; the other 18 patients had normal lymphocyte levels after injury. Patients which are failure to normalize lymphopenia within the first 5 days following admission was related with the long hospitalization time and higher 28 d mortality rate. After further stratification by age, failure to normalize lymphopenia within the first 5 days following admission in the elderly group (age ≥65 years) was a risk factor for prolonged hospital stay (≥28 d), P=0.04. While in younger group, a high level of neutrophils within the first 5 d following admission was a risk factor for bad outcome.@*CONCLUSION@#A failure to normalize lymphopenia in severely injured patients is associated with significantly higher mortality and longer hospital stay. This study reveals lymphocytes can be used as a reliable indicator for the prognostic evaluation.

A rare complication of pelvic perforation by an excessive medial slide of the helical blade after treatment of an intertrochanteric fracture with proximal femoral nail anti-rotation: A case report and literature review / 中华创伤杂志(英文版)

Intertrochanteric fractures have become a severe public health problem in elderly patients. Proximal femoral nail anti-rotation (PFNA) is a commonly used intramedullary fixation device for unstable intertrochanteric fractures. Pelvic perforation by cephalic screw is a rare complication. We reported an 84-year-old female who fell at home and sustained an intertrochanteric fracture. The patient underwent surgery with PFNA as the intramedullary fixation device. Routine postoperative examination revealed medial migration of the helical blade that eventually caused pelvic perforation. We performed a cemented total hip arthroplasty as the savage procedure. At the latest follow-up of 12 months after total hip arthroplasty, the patient had no pain or loosening of the prosthesis in the left hip. Pelvic perforation should be considered when choosing PFNA as the intramedullary fixation device, especially in patients with severe osteoporosis wherein the helical blade can be easily inserted during the operation. The lack of devices to avoid oversliding of the helical blade in PFNA is an unreported cause of this complication and should be considered in such cases.

Development and internal validation of China mortality prediction model in trauma based on ICD-10-CM lexicon: CMPMIT-ICD10 / 中华医学杂志(英文版)

BACKGROUND@#Models to predict mortality in trauma play an important role in outcome prediction and severity adjustment, which informs trauma quality assessment and research. Hospitals in China typically use the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) to describe injury. However, there is no suitable prediction model for China. This study attempts to develop a new mortality prediction model based on the ICD-10-CM lexicon and a Chinese database.@*METHODS@#This retrospective study extracted the data of all trauma patients admitted to the Beijing Red Cross Emergency Center, from January 2012 to July 2018 (n = 40,205). We used relevant predictive variables to establish a prediction model following logistic regression analysis. The performance of the model was assessed based on discrimination and calibration. The bootstrapping method was used for internal validation and adjustment of model performance.@*RESULTS@#Sex, age, new region-severity codes, comorbidities, traumatic shock, and coma were finally included in the new model as key predictors of mortality. Among them, coma and traumatic shock had the highest scores in the model. The discrimination and calibration of this model were significant, and the internal validation performance was good. The values of the area under the curve and Brier score for the new model were 0.9640 and 0.0177, respectively; after adjustment of the bootstrapping method, they were 0.9630 and 0.0178, respectively.@*CONCLUSIONS@#The new model (China Mortality Prediction Model in Trauma based on the ICD-10-CM lexicon) showed great discrimination and calibration, and performed well in internal validation; it should be further verified externally.

Trends and characteristics in pre-hospital emergency care in Beijing from 2008 to 2017 / 中华医学杂志(英文版)

BACKGROUND@#We aimed to describe and analyze the pre-hospital emergency medical service (EMS) in Beijing and provide information for the government and medical institutions to optimize EMS.@*METHODS@#We collected all pre-hospital emergency data in Beijing from 2008 to 2017. The chief complaint in each case was classified according to the Medical Priority Dispatch System (MPDS). The sites' administrative districts were determined through geo-encoding of addresses and then classified into four functional regions. We analyzed the demand for EMS, emergency response times (ERT), and disease spectrum for Beijing as a whole, and for each functional region.@*RESULTS@#A total of 4,192,870 pre-hospital EMS cases met the inclusion criteria, with a significant increase (P < 0.001) of 51.60% from 2008 to 2017. EMS demand was positively associated with population (r = 0.946, P < 0.001). The pre-hospital EMS demand rate was 1907.05 in 2008 and 2172.23 in 2017 per 100,000, with no significant change (P = 0.57). ERT increased significantly (P = 0.001), from 19.18 min in 2008 to 24.51 min in 2016. According to MPDS classifications, the demand for pre-hospital care increased for 14 diseases, remained stable for 19, and decreased for only 1 disease. Cases of injury-related disease increased significantly from approximately 90,000 in 2017, accounting for 20% of all pre-hospital EMS cases, and the demand rate decreased in the core region but increased in the sub-urban regions. Cases of heart problems and stroke/transient ischemic attack also increased significantly in the four functional regions, with the highest demand rate in the Core Functional Region.@*CONCLUSIONS@#More resources and effort should be devoted to pre-hospital EMS according to the increased pre-hospital EMS demand and prolonged ERT in Beijing over our 10-year study period. Changes in disease spectrum and differences between functional regions should also be considered.

Effects of ulnar styloid and sigmoid notch fractures on postoperative wrist function of patients with distal radius fracture / 北京大学学报(医学版)

OBJECTIVE@#To study the effects of ulnar styloid and sigmoid notch fractures on postoperative wrist function in patients with distal radius fracture.@*METHODS@#In total, 139 patients treated for distal radius fracture in the Department of Orthopedic Trauma at Peking University People's Hospital from Jan. 2006 to June 2016 were selected for outpatient follow-ups. Evaluation was based on Sartiento's modification of the Gartland and Werley scores. Efficacy was assessed with wrist pain as the focus.@*RESULTS@#The excellent and good efficacy rate was 97.1% (excellent: n=107, 77.0%; good: n=28, 19.4%; and fair: n=4, 2.9%). Gender, age, and whether the ulnar styloid fracture achieved union did not significantly impact the scores (P>0.05). The scores of the basal fracture group were significantly different (P=0.001). Internal fixation of ulnar styloid fracture was associated with a significant difference in scores (P=0.005). The effect of sigmoid notch fracture was also associated with a significant difference in scores (P=0.024). This study included 22 cases of ulnar wrist pain, and the overall incidence of ulnar wrist pain was 15.8%. Gender, age, whether the ulnar styloid fracture achieved union, and whether internal fixation was conducted for ulnar styloid fracture and sigmoid notch fracture had no significant effect on the occurrence of ulnar wrist pain (P>0.05). The incidence of ulnar wrist pain was higher in basal fractures than that in tip fractures. Among ulnar styloid fractures, the union rate of basal fracture was higher than that of tip fractures. The union rates of basal fracture and tip fracture were significantly different (P<0.001). Basal fractures were significant risk factors for ulnar wrist pain (P=0.028). Basal fracture of the ulnar styloid group and sigmoid notch fracture group had poor wrist function scores. Wrist function score improved significantly after internal fixation of ulnar styloid fracture. The incidence of ulnar wrist pain was higher in basal fracture group. The union rate in basal fracture group was higher than in tip fracture group.@*CONCLUSION@#The overall effect of surgical treatment of distal radius fracture is satisfactory. Ulnar styloid basal fracture and sigmoid notch fracture are risk factors for postoperative wrist dysfunction in patients with distal radius fracture, and the basal fracture is one of the risk factors of ulnar wrist pain. The union rate of ulnar styloid basal fractures is better than that of tip fractures. Internal fixation of ulnar styloid fracture can improve wrist function.

Infection prevention and control of bedside blood purification treatment in patients with COVID-19 / 北京大学学报(医学版)

OBJECTIVE@#To explore the infection prevention and control strategy of bedside blood purification treatment in corona virus disease 2019 (COVID-19) isolation ward, and to evaluate the effect of infection prevention and control management measures.@*METHODS@#We summarized and analyzed the clinical features, infection status, outcome and infection prevention and control measures of bedside blood purification treatment patients in COVID-19 isolation ward from February 8, 2020 to March 31, 2020, analyzed the COVID-19 cross-infection between the patients and medical staffs, and the blood-borne pathogens cross-infection situation between the patients, and analyzed the effect of bundle prevention and control measures in controlling the occurrence and spread of cross-infection.@*RESULTS@#A total of 101 COVID-19 patients were hospitalized in this COVID-19 isolation ward, of whom 10 patients (9.90%) received bedside blood purification treatment and the blood purification treatment method was continuous hemodialysis filtration (CVVHDF), and the 10 patients received 79 times of blood purification treatment in total. The prevention and control management measures adopted included divisional isolation, patient behavior isolation and patient placement, operator personal protection and hand hygiene, dialysis waste fluid disposal, isolation room air purification, object surfaces, medical devices and medical fabrics dis-infection management. There were no occurrence and spread of COVID-19 in the medical healthcare workers and blood-borne pathogens cross-infection in the patients. And all the twice throat swabs (two sampling interval > 1 day) of the medical staffs in COVID-19 virus nucleic acid test were negative. The 2 suspected COVID-19 patients' throat swab virus nucleic acid test and the COVID-19 IgG, IgM were always both negative, the chest CT showed no viral pneumonia.@*CONCLUSION@#Bedside blood purification treatment in the COVID-19 isolation ward, the occurrence and spread of healthcare associated infection can be effectively controlled through effective infection prevention and control management, including divisional isolation, patient behavior isolation and patient placement, operator personal protection and hand hygiene, dialysis waste fluid disposal, isolation room's air purification, object surfaces, medical devices and medical fabrics disinfection, which can provide experience for diagnosis, treatment and prevention and control of patients in the respiratory infectious disease ward.

Application of multidisciplinary team (MDT) in the treatment of severe trauma / 北京大学学报(医学版)

OBJECTIVE@#To explore the effect of multi-disciplinary team (MDT) in general hospitals on severe trauma patients.@*METHODS@#This study reviewed the treatment of patients with severe trauma in trauma center of Peking University People's Hospital from March 2017 to April 2019. The baseline information: the patients' gender, age, injury mechanism, etc.; the start indicators: the Glasgow coma scale (GCS), trauma index (TI), injury severity score (ISS); the start related indicators: time for activation, time for MDT to arrive, time for CT scan, time for damage control surgery; patient treatment and prognosis: ICU (intensive care unit) length of stay, number of cured and discharged patients, number of dead cases, number of patients transferred to rehabilitation hospital, were all analyzed. It discussed the composition of MDT, the initiation scheme, the indicators of initiation of MDT for severe trauma, and analyzed the correlation between the application of MDT and the prognosis of patients.@*RESULTS@#From March 2017 to April 2019, 112 trauma patients were treated by MDT in Peking University People's Hospital. There were 69 males and 43 females. The minimum age was 15 years, the maximum age was 89 years, most of them were 36-55 years old. The main injury mechanism was traffic accident injury. The GCS, TI, ISS were 13.0±2.9, 13.0±2.8, and 21.5±11.9, respectively. It took 3.7±0.8 minutes to start the call, 6.1±0.9 minutes for MDT personnel to arrive at the emergency rescue area, 23.8±3.0 minutes for fast CT and 92.6±15.4 minutes for injury control operation. All the hospitalized patients were treated effectively. ICU (Intensive care unit) hospitalization time was 12.6±6.7 days. 55 discharged patients were cured, 5 died (1 died of hemorrhagic shock, 4 died of severe brain injury) and 52 transferred to rehabilitation hospital.@*CONCLUSION@#The treatment of severe trauma patients by MDT in trauma center of general hospitals can greatly improve the ability and level of treatment of severe trauma patients, make up for the lack of treatment of severe trauma especially multiple trauma patients in large general hospitals, and improve the treatment effect of severe trauma patients. It provides a reference model for large general hospitals to treat patients with severe trauma and multiple trauma and for the construction of trauma centers.

Effects of surgical and nonoperative treatment on wrist function of patients with distal radius fracture / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>To study the effects of surgical and nonoperative treatment on wrist function in patients with distal radius fracture.</p><p><b>METHODS</b>In total, 97 patients treated for distal radius fracture in the Department of Orthopedic Trauma at the People's Hospital of Peking University from Jan. 2010 to Jun. 2016 were selected for outpatient follow-up, including manipulative reduction and dorsal splint fixation in 24 cases, bivalve cast fixation in 19 cases and open reduction and internal fixation in 54 cases. Evaluation was based on Sartiento's modification of the Gartland and Werley score. Efficacy was assessed with wrist pain as the focus.</p><p><b>RESULTS</b>The wrist function scores of the surgical group were better than nonoperative groups. There was no significant difference in wrist function scores between the dorsal splint group and the bivalve cast group. The ulnar wrist pain incidence had no significant difference in surgical and nonoperative groups. The displace rate in dorsal splint group was higher than other groups.</p><p><b>CONCLUSION</b>The overall effect of surgical treatment of distal radius fracture is better than nonoperative treatment. The ulnar wrist pain incidence has no significant difference in these groups. Dorsal splint fixation is more prone to displace than bivalve cast fixation.</p>

Evaluation of the effects of standard rescue procedure on severe trauma treatment in china / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>This study aimed to evaluate the effects of standard rescue procedure (SRP) in improving severe trauma treatments in China.</p><p><b>METHODS</b>This study was conducted in 12 hospitals located in geographically and industrially different cities in China. A standard procedure on severe trauma rescue was established as a general rule for staff training and patient treatment. A regional network (system) efficiently integrating prehospital rescue, emergency room treatments, and hospital specialist treatments was built under the rule for information sharing and improving severe trauma treatments. Treatment outcomes were compared between before and 1 year after the implementation of the SRP.</p><p><b>RESULTS</b>The outcomes of a total of 74,615 and 12,051 trauma cases were collected from 12 hospitals before and after the implementation of the SRP. Implementation of the SRP led to efficient cooperation and information sharing of different treatment services. The emergency response time, prehospital transit time, emergency rescue time, consultation call time, and mortality rate of patients were 24.24 ± 4.32 min, 45.69 ± 3.89 min, 6.38 ± 1.05 min, 17.53 ± 0.72 min, and 33.82% ± 3.87% (n = 441), respectively, before the implementation of the standardization and significantly reduced to 10.11 ± 3.21 min, 22.39 ± 4.32 min, 3.26 ± 0.89 min, 3.45 ± 0.45 min, and 20.49% ± 3.11%, separately (n = 495, P < 0.05) after that.</p><p><b>CONCLUSIONS</b>Staff training and SRP can significantly improve the efficiency of severe trauma treatments in China.</p>

Case-control study on effects of fracture of processus styloideus ulnae on prognosis after plate fixation for the treatment of distal radial fractures / 中国骨伤

<p><b>OBJECTIVE</b>To analyze effects of fracture of processus styloideus ulnae on prognosis in the treatment of distal radial fracture of type C according to AO classification.</p><p><b>METHODS</b>This was a retrospective case-control study, and the information was got ten through case evaluation and follow-up, including sex, age, patient satisfaction, Gartland & Werley score and radiographic score. There were 76 patient treated with open reduction and plate fixation in People's Hospital Affiliated to Peking University from July 2006 to July 2011. All the patients were divided into two groups: no combination with fracture of processus styloideus ulnae (group A, 56 cases), combination with fracture of processus styloideus ulnae (group B, 20 cases). The patients in group A and B were treated with open reduction and internal fixation; however the fracture of processus styloideus ulnae was not fixed. The indexes such as clinical data, bone grafting, joint movement, Gartland & Werley score and radiographic score were compared between two groups.</p><p><b>RESULTS</b>The ulnaris pain of patients in group B was more obvious than that in group A. The local VAS, palmar and dorsal flexion degree of wrist joint, motion VAS, patients satisfaction score, radial and ulnar deviation degree, pronation and supination of forearm degree, Gartland & Werley score and radiographic score were separately 0.1 ± 0.1, (51.1 ± 1.9)°, (60.2 ± 1.9)°, 0.6 ± 0.1 (23.1 ± 0.9)°, (28.7 ± 1.3)° (81.5 ± 2.6)°, (68.2 ± 2.7)° 1.9 ± 0.3, 89.6 ± 12.3 in group A; and separately 0.3 ± 0.3, (51.4 ± 2.3)°, (66.6 ± 1.7)°, 0.5 ± 0.2, (24.5 ± 2.0)°, (26.9 ± 1.8)°, (80.3 ± 2.5)°, (70.3 ± 3.7)°, 1.2 ± 0.4, 92.5 ± 7.5 in group B; there were no statistical differences in above indexes between two groups.</p><p><b>CONCLUSION</b>Whether the distal radial fracture with a concomitant unrepaired ulnar styloid fracture or not exerts no influence on mainly outcomes including function, radiography and motion of the wrist.</p>

Prehospital road traffic injuries among the elderly in Beijing, China: data from the Beijing Emergency Medical Center, 2004-2010 / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Road traffic injuries (RTIs) are a worldwide issue associated with increasing development and motorization. However, statistical studies do not include any analyses of Beijing's geriatric population. Using data from the Beijing Emergency Medical Center, we present the main characteristics of traffic injuries involving the elderly in Beijing. We also provide objective information for those concerned with the safety of traffic systems and the prevention of traffic injuries.</p><p><b>METHODS</b>In a longitudinal, retrospective study, data were collected on 1706 victims aged 65 years and older who sustained traffic injuries in Beijing between 2004 and 2010. Personal information, time of injury event, emergency care response time, road user type, striking vehicle type, injury site, and severity of injury were analyzed using χ(2) tests and Logistic regression analysis.</p><p><b>RESULTS</b>The annual rate of traffic injuries was 21.80 per 100 000 elderly people in Beijing, and the morbidity rate decreased from 2004 to 2010 (P < 0.001). The mean age was (72.92 ± 5.67) years, and 911 (53.40%) of the victims were male. The majority of victims sustained head and lower limb injuries and were classified as being of medium severity. Traffic collisions occurred most frequently in the daytime excluding rush hours; these collisions included being hit by a car (85.64%) and pedestrian victim injuries (79.19%). Our statistical analysis found three factors for injury severity: abdominal injuries (P < 0.001), number of injury sites (P = 0.027), and head injuries (P = 0.034). The decline in traffic injuries is due to a decrease in victims aged 65-74 years and pedestrians; the severity of RTIs also decreased.</p><p><b>CONCLUSIONS</b>This study highlights the declining trend in traffic injuries among older adults in Beijing. However, traffic injuries remain a serious public health problem for the elderly and effective measures are required to reduce their incidence.</p>

Minimally invasive treatment of the KobyGard system for plantar fasciitis: a retrospective study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Calcodynia is a persistent condition that podiatric surgeons frequently see among their patients, and plantar fasciitis is the main reason for pain. When systematic conservative treatments fail to alleviate these conditions, it requires surgical intervention, mainly plantar fascia release surgery, which used to be an open heel release surgery. This study aimed to investigate whether minimally invasive treatment of the KobyGard system is more safe and effective for plantar fasciitis.</p><p><b>METHODS</b>From May 2009 to May 2012, a total of nine patients, three males and six females with plantar fasciitis, were treated in the Peking University People's Hospital with minimally invasive instruments, the KobyGard system, for the release of plantar fascia. Three patients, experiencing bilateral calcaneodynia, underwent bilateral surgery. One patient had bilateral calcaneodynia with enthesiopathy of Achilles tendon, and underwent Achilles tendon surgery. Preoperative and postoperative Visual Analogue Scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot scores, Roles and Maudsley scores and SF-36 questionnaires were evaluated.</p><p><b>RESULTS</b>The nine patients were successfully followed up. The average postoperative follow-up time was 13.2 months and it varied from 2.0 months to 21.0 months. Pre- and postoperative average scores of VAS was 9.3 and 1.9 (P < 0.001), respectively. Pre- and postoperative average scores of AOFAS hind foot was 36.0 and 82.0 (P < 0.001), respectively. There was also a statistically significant amelioration in SF-36 scores and the Roles and Maudlesy scores. Eight patients were satisfied with the surgery outcome.</p><p><b>CONCLUSION</b>Minimally invasive surgery treatment of the KobyGard system for plantar fasciitis has the advantages of shorter operation time, ease of operation, and similar satisfaction rates with open surgery, but with smaller surgical incision.</p>

Clinical effect of distal radius fracture treated with open reduction and internal plate fixation / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>For some specific comminuted unstable intra-articular fracture, the plaster cast can not maintain the alignment of the articular surface effectively. The aim of this study was to evaluate the clinical effects of distal radius fracture treated with open reduction and internal plate fixation retrospectively.</p><p><b>METHODS</b>From January 2002 to March 2010, 539 cases of distal radius fracture were treated with open reduction and internal fixation, including 184 males and 355 females aging 21 - 72 years (mean 57 years). Fractures were caused by falling to the ground in 459 cases, by traffic accident in 62 cases and by athletic injuries in 18 cases. Of 539 cases, there were 523 cases of closed fracture and 16 cases of open fracture. According to Arbeitsgemeinschaft fur Osteosynthesefragen (AO) standards of classification, there were 14 cases of A2 type, 22 of A3 type, 18 of B1 type, 24 of B2 type, 62 of B3 type, 91 of C1 type, 162 of C2 type and 146 of C3 type. The time from injury to operation was 1 - 16 days (mean 5 days). All patitents received open reduction and internal plate screw fixation. Forty-seven patients with bone defect were given 6 - 15 g autologous ilium and 75 cases were given 5 ml calcium sulphate artificial aggregate after reduction.</p><p><b>RESULTS</b>All incisions healed by first intention after operation. Patients were followed up for 15 to 32 months postoperatively (mean 22 months). The fractures healed within 10 - 18 weeks after operation (mean 12 weeks). During the last follow-up, the mean palmar tilt was (7.0 ± 0.9)° and the mean ulnar variance was (21.0 ± 4.2)°, showing significant difference when compared with preoperation ((-5.0 ± 1.2)° and (8.0 ± 3.8)°). The radial heights were not abbreviated. According to Gartland and Werley assessment system, the results were excellent in 314 cases, good in 163 cases, fair in 46 cases, and poor in 16 cases 12 weeks after operation, the excellent and good rate was 88.5%.</p><p><b>CONCLUSIONS</b>The clinical effect of distal radius fracture treated with open reduction and internal plate fixation was relatively satisfactory. Meticulous operation procedure and individual rehabilitation strategy contribute to the wrist joint functional recovery.</p>

Three kind of scoring system for proximal humeral fractures in patients with postoperative functional review of evaluation: a multicenter study / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the ASES, Constant and HSS score systems and their significance on postoperative function of the shoulder.</p><p><b>METHODS</b>Totally 172 cases of proximal humeral fracture of five affiliated hospital from September 2004 to September 2008 were analyzed. All the functional outcome of the involved shoulder were evaluated by ASES, Constant, HSS score and patient self score. The correlations and agreement of three shoulder scales were analyzed with Pearson correlation test and Bland-Altman plot in different age groups and fracture types.</p><p><b>RESULTS</b>(1) The Constant score were lower than other two scores in the same age group and fracture type (F = 13.62 and 4.80, P < 0.05). (2) The correlations between three shoulder scales: ASES and Constant (r = 0.754, P = 0.0003), ASES and HSS (r = 0.755, P = 0.0001), Constant and HSS (r = 0.858, P = 0.0002). The correlations between three shoulder scales and patient self evaluation: ASES (r = 0.602, P = 0.0002), Constant (r = 0.705, P = 0.0001), HSS (r = 0.663, P = 0.0037). The Bland-Altman plot shows three shoulder scales have good agreement. (3)The correlation between Constant score and patient self evaluation decreased in the elder group and severe fracture type.</p><p><b>CONCLUSIONS</b>ASES, Constant, HSS shoulder score systems are all fit to evaluate the functional outcome of the shoulder, they have good correlation and agreement. Constant score in recommended for its high correlation coefficient with patient self evaluation score. However, its age bias must be paid attention in clinical practice. ASES shoulder score can be used in remote follow-up.</p>

Multicenter follow-up study of ankle fracture surgery / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Few data on ankle fractures in China from large multicenter epidemiological and clinical studies are available. The aim of this research was to evaluate the epidemiological features and surgical outcomes of ankle fractures by reviewing 235 patients who underwent ankle fracture surgery at five hospitals in China.</p><p><b>METHODS</b>This study included patients who underwent ankle fracture surgery at five Chinese hospitals from January 2000 to July 2009. Age, gender, mechanism of injury, Arbeitsgemeinschaft für Osteosynthesefragen (AO) fracture type, fracture pattern, length of hospital stay and treatment outcome were recorded. Statistical analyses were conducted using SPSS software. The American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, visual analogue scale (VAS), and arthritis scale were used to evaluate outcome.</p><p><b>RESULTS</b>Of 235 patients with ankle fractures, 105 were male with an average age of 37.8 years and 130 were female with an average age of 47.3 years. The average follow-up period was 55.7 months. There were significant differences in the ratios of patients in different age groups between males and females, and in mechanisms of injury among different age groups. There were also significant differences in the length of hospital stay among different fracture types and mechanisms of injury. In healed fractures, the average AOFAS ankle-hindfoot score was 95.5, with an excellence rate of 99.6%, the average VAS score was 0.17, and the average arthritis score was 0.18. Movement of the injured ankle was significantly different to that of the uninjured ankle. There were no significant differences between AO fracture types, fracture patterns or follow-up periods and AOFAS score, but there were some significant differences between these parameters and ankle joint movements, pain VAS score and arthritis score.</p><p><b>CONCLUSIONS</b>Ankle fractures occur most commonly in middle-aged and young males aged 20 - 39 years and in elderly females aged 50 - 69 years. The most common mechanisms of injury are twisting injuries and falls from a standing height or less. The results of surgical treatment are satisfactory.</p>

Clinical features analysis of femoral neck fractures in 219 patients / 中华外科杂志

<p><b>OBJECTIVES</b>To investigate the clinical features of femoral neck fractures and analyze related causes.</p><p><b>METHODS</b>The clinical data of patients with femoral neck fractures from June 2002 to August 2009 were retrospectively analyzed. The gender, age, fracture side, fracture type, basic social data, activities before injury, injury causes and treatment were analyzed.</p><p><b>RESULTS</b>A total of 219 patients (106 male and 113 female) was analyzed. All patients were divided into children group (age < 16 years), adult group (age ranged from 16 to 60 years) and older group (> 60 years). There were 5 patients (2.3%) in the children group, 81 patients (37.0%) in the adult group and 133 patients (60.7%) in the older group. There were 11 patients (5.0%) with Garden I fractures, 32 patients (14.6%) with Garden II fractures, 90 patients (41.1%) with Garden III fractures and 86 patients (39.3%) with Garden IV fractures. Fall damage and traffic injury were the main injury types. Home and public place were the main injury sites.</p><p><b>CONCLUSIONS</b>The incidence of femoral neck fracture shows the highest in the old persons. The male patients with femoral neck fractures are more than female patients in children and adult group, while the male patients with femoral neck fractures are less than female patients in older group. The dominant fractures type according to Garden classification is Garden III fractures in children and adult groups, but Garden IV fractures in older group. Fall damage and traffic injury are the main injury types. Home and public place are the main injury sites.</p>

Calcitonin gene-related peptide induces proliferation and monocyte chemoattractant protein-1 expression via extracellular signal-regulated kinase activation in rat osteoblasts / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Calcitonin gene-related peptide (CGRP), a sensory neuropeptide, affects osteoblast proliferation and bone formation. However, the mechanisms are not fully understood. Monocyte chemoattractant protein-1 (MCP-1) is a chemokine that stimulates the migration of monocytes and plays important roles in regulating bone remolding during fracture repair. In this study, we investigated the effects of CGRP on proliferation and MCP-1 expression in cultured rat osteoblasts.</p><p><b>METHODS</b>Primary rat osteoblasts were isolated from fetal rats calvariae. Cells were exposed to gradient concentrations (10(-9) to 10(-7) mol/L) of CGRP. Protein and mRNA levels of MCP-1 were quantified by Western blotting and semiquantitative reverse transcription-polymerase chain reaction, respectively. The protein level of MCP-1 was investigated and compared in cell culture media by enzyme linked immunosorbent assay (ELISA). Phospho-extracellular signal-regulated kinase (ERK) expression was detected by Western blotting. Cell proliferative activity was measured by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) and BrdU assay. The effects of MAPK/ERK kinase (MEK)-inhibitor U0126 on CGRP-induced MCP-1 expression in primary rat osteoblasts were examined.</p><p><b>RESULTS</b>CGRP effectively enhanced primary rat osteoblast proliferation and led to significant increases in the expression of MCP-1 mRNA and protein in time- and dose-dependent manners. CGRP activated the ERK pathway. Pretreatment of cultured rat osteoblasts with MEK inhibitor U0126 resulted in dose-dependent inhibitions of CGRP-induced MCP-1 mRNA and protein levels. Thus, CGRP promoted cell proliferation and stimulated MCP-1 expression in cultured rat osteoblasts.</p><p><b>CONCLUSION</b>These studies document novel links between CGRP and MCP-1 and illuminate the effects of CGRP in regulating bone remodeling.</p>

The anatomic study of transferring thoracic nerve roots to lumbar nerve root inside the spinal canal of paraplegia / 中华外科杂志

<p><b>OBJECTIVE</b>To study the fundamental anatomy of transferring T(9-12) nerve roots to L(2-4) nerve root for the quadriceps function recovery inside the spinal canal of paraplegia.</p><p><b>METHODS</b>Thoracic and lumbar spinal canal and spinal dura mater of 5 adult cadavers (male 2 and female 3) were opened and explored. Investigated including: the position which T₉-L₄ nerve root generated from spinal cord; the relation between the position which T₉-L₄ nerve root generated from spinal cord and T₁₂ vertebrae and L₁ vertebrae; The length beginning part of T₉-L₄ nerve root inside the spinal canal. The diameter of T₉-L₄ nerve root. The distance between the T₉-L₄ nerve root separately. The distance between the position which T(9-12) nerve root separately generated from dura mater and the middle of L₂ vertebrae.</p><p><b>RESULTS</b>T₉ nerve root generated from the middle part of T₉ vertebrae; L₄ nerve root generates from middle part of L₂ vertebrae. The average length of T₉-L₄ nerve root inside the spinal canal separately was 16.12, 22.97, 30.43, 43.47, 56.02, 70.03, 88.70 and 113.65 mm. The average diameter of T₉-L₄ nerve root separately was 2.45, 2.04, 1.96, 2.18, 2.32, 2.56, 3.10 and 3.26 mm. The average distance between the beginning part of T₉-L₄ nerve root separately was 22.87, 25.08, 28.47, 27.38, 29.78, 31.93 and 31.00 mm. The average distance between the position which T(9-12) nerve root separately generated from dura mater and the middle of L₂ vertebrae was 118.69, 95.82, 70.74, and 42.27 mm.</p><p><b>CONCLUSIONS</b>T(9-12) nerve root can be used as donor nerve for repair L(2-4) nerve root. The level of L₂ vertebrae can be anastomose site of the recipient nerve.</p>

Comparative study of distal radial fractures in the elderly treated with locking and non-locking plates / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the clinical difference of locking and non-locking plates in the treatment of distal radial fractures in the elderly.</p><p><b>METHODS</b>Forty-nine patients with an average age of 68 years were included. The mean follow-up was 30 months. Five cases were traffic related injury, and others were simple falls. Fractures were classified according to AO classification system: 9 cases of A3, 4 cases of B, 11 cases of C1, 18 cases of C2, 7 cases of C3. Patients were grouped as locking group (29 cases) and non-locking group (20 cases).</p><p><b>RESULTS</b>Significant difference was not found between the two groups in active range of motion, Gartland and Werley score, radiological measurements and score.</p><p><b>CONCLUSION</b>Locking and non-locking plates have the same clinical outcome in the treatment of distal radial fractures in the elderly.</p>

Biomechanical study of flexor tendon repair in an in vivo curvature model / 中华外科杂志

<p><b>OBJECTIVE</b>To compare the biomechanical characteristics of 2 different repair methods:Modified Kessler and Tsuge.</p><p><b>METHODS</b>Eighty-four profound flexor tendons of 3(rd) toe of Sanhuang chicken were severed and repaired by either Modified Kessler or Tsuge method randomly. Six repaired tendons for each repair method were harvested at 0, 1, 4, 7, 10, 14, 21 days after operation and tested in an Instron 1185 biomechanical testing machine. An elongation force-elongation distance curve was obtained, and biomechanical meters (including rupture force and rupture work) were calculated from this curve.</p><p><b>RESULTS</b>Rupture force: rupture force significantly decreased at 10(th) and 14(th) day in both repair groups, and returned to immediate level at 21(st) day in Modified Kessler group but not in Tsuge group; Tsuge method was significantly higher than Modified Kessler group at time-points immediately and 7 days after operation. Rupture work: this work significantly decreased at 10(th) (65.17 mJ) and 14(th) (40.0 mJ) day and resumed to immediate level at 21(st) day in Modified Kessler group; While in Tsuge group, it decreased significantly at 14(th) and 21(st) day. Tsuge method was significantly higher than Modified Kessler group only at time 0.</p><p><b>CONCLUSION</b>The biomechanical properties decrease significantly after 10(th) day at both repair method groups. It resumes to immediate level at 21(st) day in Modified Kessler group. There is no significant difference after 10(th) day between both repair methods.</p>