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Objective:To evaluate the radiological and clinical outcomes of the aged patients with unstable proximal humeral fracture (UPHF) treated with a locking plate and an intramedullary titanium mesh.Methods:A retrospective study was conducted to analyze the 43 aged patients with UPHF who had been admitted to Department of Orthopedics, Zhongda Hospital Affiliated to Southeast University from January 2017 to July 2019. There were 13 males and 30 females with an age of (71.3±10.3) years (from 60 to 83 years). All patients were treated with a locking plate and an intramedullary titanium mesh to support. The postoperative imaging measurements included changes in humeral head height (HHH) and neck-shaft angle (NSA) (the difference between 3 years after surgery and the second day after surgery, taken as an absolute value); the postoperative clinical measurements included visual analogue scale (VAS), range of shoulder motion, Constant-Murley shoulder functional score (Constant score), American Shoulder and Elbow Surgeons (ASES) score, and incidence of complications.Results:All patients were followed up for (39.2±2.3) months after surgery. The change in HHH at 3 years after surgery was (1.5±1.1) mm, and the change in NSA at 3 years after surgery 3.3°±2.6°. At 3 years after surgery, the VAS score was (2.2±1.3) points, the Constant score (79.2±9.1) points, and the ASES score (78.9±9.2) points; the range of forward extension was 143.2°±20.8°, the range of outward extension 139.3°±23.1°, and the range of outward rotation 55.1°±4.7°. Complications after surgery were found in 6 patients, including humeral head necrosis in 2 cases, ectopic ossification in 1 case, and infection in 3 cases.Conclusion:In the treatment of the aged patients with UPHF, a locking plate combined with an intramedullary titanium mesh can help to restore the medial column support, leading to fine radiological and clinical outcomes.
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Objective:To investigate the risk factors for preoperative hypoxemia in geriatric patients with hip fracture.Methods:A case-control study was used to analyze the clinical data of 99 geriatric patients with hip fracture admitted to Zhongda Hospital affiliated to Southeast University between November 2020 and August 2021. There were 29 males and 70 females, aged 67-96 years [(82.6±6.2)years]. The patients were divided into hypoxemia group ( n=51) and non-hypoxemia group ( n=48) using partial arterial partial pressure of oxygen (PaO 2)<80 mmHg while breathing room air at emergency as the reference standard. The two groups were compared in terms of sex, age, fracture types, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, pulmonary diseases diagnosed by preoperative chest CT [atelectasis, pleural effusion, chronic obstructive pulmonary disease (COPD)], time from injury to visit, New York Heart Association (NYHA) classification, Barthel index, KATZ index, modified Medicine Research Council (mMRC) dyspnea scale, numeric rating scale (NRS), smoking, drinking, comorbidities (hypertension, diabetes mellitus, Parkinson′s disease, Alzheimer′s disease, cerebral infarction, coronary atherosclerotic heart disease), body temperature, blood routine test at first examination (erythrocyte count, leukocyte count, C-reactive protein, hemoglobin), biochemistry (serum albumin, blood glucose, blood creatinine, blood urea nitrogen), electrolyte (serum potassium, serum sodium), and other related examinations [D-dimer, brain natriuretic peptide (BNP), lactic acid]. Univariate analysis was performed to the correlation of those indicators with preoperative hypoxemia. Multivariate Logistic regression analysis was used to identify the independent risk factors for preoperative hypoxemia in geriatric patients with hip fracture. Results:Differences in sex, age, fracture types, BMI, pulmonary diseases diagnosed by preoperative chest CT, time from injury to visit, Barthel index, KATZ index, NRS, smoking, drinking, comorbidities, body temperature, first laboratory results of erythrocyte count, biochemistry, electrolyte and other related examinations were not statistically significant between the two groups (all P>0.05). The two groups showed statistical differences in ASA classification, NYHA classification, mMRC dyspnea scale, leukocyte count at first examination, C-reaction protein and hemoglobin (all P<0.05). Univariate analysis indicated that ASA classification, NYHA classification, mMRC dyspnea scale, leukocyte count at first examination and C-reaction protein were correlated with the occurrence of preoperative hypoxemia in geriatric patients with hip fracture (all P<0.05). Multivariate Logistic regressions analysis indicated that higher mMRC dyspnea scale ( OR=2.30, 95% CI 1.10-4.81, P<0.05), higher leukocyte count at first examination ( OR=1.24, 95% CI 1.05-1.45, P<0.05), higher level of C-reaction protein ( OR=1.02, 95% CI 1.01-1.03, P<0.05) and higher level of hemoglobin ( OR=1.04, 95% CI 1.01-1.07, P<0.05) were significantly correlated with the occurrence of preoperative hypoxemia in geriatric patients with hip fracture. Conclusion:Higher mMRC dyspnea scale, higher leukocyte count, higher level of C-reaction protein and higher level of hemoglobin are independent risk factors for preoperative hypoxemia in geriatric patients with hip fracture.
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There are many surgical methods for rectal prolapse,and the choice of transanal or abdominal approach is controversial.There are many factors influencing the choice of surgical approach for rectal prolapse,including the subjective factors such as regional habits,Specialist's experience and difficulty degree of surgery,as well as the objective conditions such as the degree of rectal prolapse,gender,age,basic conditions,anal function evaluation and patient acceptance.Transanal surgery is well tolerated but is usually associated with higher recurrence rates.The recurrence rate of transabdominal approach is relatively low,but the risk and operation duration have some requirements on the basic conditions of patients.Laparoscopic rectal prolapse repair can reduce hospitalization time,postoperative pain and incisional complications.Currently,minimally invasive and individualized treatment are advocated,in which doctors select the surgical approach and procedures that meet the needs of patients and doctors are good at based on the basic conditions and surgical indications of patients.Individualized treatment plan for patients is the development direction of clinical strategy for rectal prolapse.
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Objective To evaluate the effect of ultrasonic speckle technique on cardiac function in patients with acute myocardial infarction (AMI).Methods 30 patients with AMI were selected as observation group,30 healthy people were selected as control group,and they were all detected by ultrasonic speckle technique.The differences of measurement indices of cardiac function with ultrasonic speckle technique were compared between the observation group and control group.The difference between ultrasonic speckle technique and its measured value was observed with single photon emission computed tomography(SPECT) as the gold standard.The correlation between the results of three-dimensional speckle ultrasound and SPECT in patients with AMI was analyzed.Results The parameters of LVEDV [(62.2 ± 6.4) mL vs.(80.3 ± 7.5) mL],LVESV [(21.7 ± 5.6) mL vs.(35.4 ± 7.2) mL] and LVEF [(62.6 ± 5.9)％ vs.(72.8 ± 5.6)％] in the observation group were significantly lower than those in the control group,the IVSTd [(1.1 ± 0.2) cm vs.(0.9 ± 0.2) cm] and LVPWd [(1.2 ± 0.2) cm vs.(0.8 ± 0.1) cm] were significantly higher than those in the control group,the differences were statistically significant(t =8.431,9.865,3.651,8.798,6.654,all P ＜ 0.05).In AMI patients,there were no significant differences in left ventricular parameters LVEDV,LVESV,LVEF measured between ultrasonic speckle technique and SPECT(all P ＞ 0.05).With SPECT as the gold standard,in AMI patients,the ultrasound parameters LVEDV,LVESV and LVEF were positively correlated with SPECT parameters(r =0.912,0.903,0.899,all P ＜ 0.05).Conclusion Ultrasound speckle technique can well evaluate myocardial function in patients with myocardial infarction.
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Objective To investigate the correlation between glucose variability and coronary stenosis in type 2 diabetes mellitus (T2DM) combined with coronary heart disease (CHD) patients.Methods Eighty patients with T2DM who had undergone coronary angiography were selected.According to the result of coronary angiography,the patients were divided into 2 groups:48 T2DM combined with CHD patients as CHD group,and 32 T2DM combined without CHD patients as control group.All patients underwent continuous glucose monitoring (CGM) for 72 h,and the mean blood glucose (MBG),standard deviation of blood glucose (SDBG),daily mean amplitude of glycemic excursion (MAGE),absolute means of daily differences (MODD),largest amplitude of blood glucose excursion (LAGE) and mean postprandial glucose excursion (MPPGE) were computed.The risk factor of coronary stenosis (using Gensini score) was analyzed.Results The LAGE,SDBG,MAGE,MPPGE,MODD in CHD group were significantly higher than those in control group:(11.4 ± 3.6) mmol/L vs.(8.2 ± 1.9) mmol/L,(3.4 ± 1.4) mmol/L vs.(1.9 ± 0.6) mmol/L,(7.1 ± 2.7) mmol/L vs.(4.8 ± 1.4) mmol/L,(6.6 ± 1.8) mmol/L vs.(4.6 ± 1.5) mmol/L,(3.3 ± 1.2) mmol/L vs.(2.5 ± 0.9) mmol/L,and there were statistical differences (P ＜ 0.05).There was no statistical difference in MBG between CHD group and control group:(10.2 ± 2.8) mmol/L vs.(9.3 ± 2.2) mmol/L,P ＞ 0.05.The Pearson correlation analysis result showed that the MPPGE,MODD and LAGE had positive correlation with Gensini score (r =0.509,0.357 and 0.338;P ＜ 0.05);and the LVEF had negative correlation with Gensini score (r =-0.372,P ＜ 0.05).Conclusions Glucose variability in patients with T2DM combined with CHD is markedly enhanced.MPPGE,MODD and IAGE are positively correlated with the severity of coronary stenosis.
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Objective Recent studies show that the PI3K/Akt signaling pathway is a key regulatory signal in both bone for-mation and bone remodeling .The experiment aimed to investigate the effects of inhibiting the PI 3K/Akt signaling pathway on the prolif-eration and cell cycles of MC3T3-E1 cells. Methods We treated MC3T3 -E1 cells with PF-04691502 the inhibitor of the PI3K/Akt signaling pathway .Then we determined the proliferative activity of the cells by MTS assay , detected the cell cycles by flow cytometry , and measured the expression of cell cycle-related proteins by Western blot . Results After inhibition of the PI3K/Akt signaling path-way with PF-04691502 at 30, 150 and 750 nmol/L, the proliferation of MC3T3-E1 cells was reduced in a dose-dependent manner to 0.647 ±0.041, 0.423 ±0.011 and 0.159 ±0.004, respectively, as compared with 1 ±0.056 in the control group (P<0.01).Sim-ultaneously , the percentage of the cells in the sub-G1 phase was significantly higher in the 1 μmol/L group than in the control ([1.45 ±0.43]%vs [0.27 ±0.21]%, P<0.01) and the expression of cyclin D1 was decreased. Conclusion Inhibition of the PI3K/Akt signaling pathway can block MC 3T3-E1 cells in the sub-G1 phase and reduce the proliferation of the cells .
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<p><b>OBJECTIVE</b>To assess the efficacy and safety of compound matrine injection combined with cisplatin chemotherapy for advanced gastric cancer.</p><p><b>METHOD</b>It was searched relevant randomized Controlled trials (RCTs) from Cochrane Library, PubMed, EMBASE, CBM, and CNKI etc. The search was finished in February 11, 2010. And it was traced the related references and experts in this field, besides it was also communicated with other authors in order to obtain some certain information that had not been found. RCTs of compound matrine injection combined with cisplatin chemotherapy versus cisplatin chemotherapy for advanced gastric cancer were included. It was evaluated the quality of these included studies and analyzed data by Cochrane Collaboration's RevMan 5.0 software.</p><p><b>RESULT</b>Ten RCTs were included meta analysis results suggested that compared with chemotherapy alone, the combination had a statistically significant benefit in healing efficacy (OR = 1.99, 95% CI: 1.26-3.13, P < 0.05) and improving quality of life (OR = 3.83, 95% CI: 2.38-6.15, P < 0.001). Besides, the combination also had a statistically significant benefit in myelosuppression, white blood cell (OR = 0.44, 95% CI: 0.32-0.62, P < 0.001), hematoblast (OR = 0.40, 95% CI: 0.26-0.60, P < 0.001), liver function (OR = 0.33, 95% CI: 0.15-0.75, P < 0.05) and in reducing the gastroenteric reaction (OR = 0.32, 95% CI: 0.16-0.63, P = 0.001), decreasing the of CD3 ( MD = 2.96, 95% CI: 1.724. 20, P < 0.001), CD4 (MD = 9.04, 95% CI: 7.87-10.20, P < 0.001), CD4/CD8 (MD = 0.47, 95% CI: 0.41-0.54, P < 0.001) and NK cells (MD = 5.90, 95% CI: 4.53-7.26, P < 0.001).</p><p><b>CONCLUSION</b>Compared with cisplatin chemotherapy, compound matrine injection combined with cisplatin chemotherapy can significantly improve the efficiency, QOL and myelosuppression, and reduce adverse events.</p>