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Objective:To investigate the risk factors for axial deviation in the treatment of tibial defect susing Orthofix unilateral external fixator and proximal tibial osteotomy for bone transport.Methods:A retrospective study was performed to analyze the clinical data of 90 patients who had been treated for tibial bone defects by the Orthofix unilateral external fixator at Department of Microrepair and Reconstruction, The First Hospital Affiliated to Xinjiang Medical University from May 2012 to June 2019. There were 77 males and 13 females with a mean age of 41.2 years (from 17 to 63 years).The bone defects ranged from 4 to 13 cm in length. According to the Paley criteria for axial deviation, the 90 patients were divided into 2 groups: a deviation-free group with no axial deviation or an axial deviation ≤5° and a deviation group with an axial deviation>5°. The 2 groups were compared in terms of age, number of prior surgery, defect length, placement angle of Schanz screws, external fixation time, external fixation index and bending degree of Schanz screws at the last follow-up.The factors with P<0.05 were analyzed by multivariate logistic regression to find the risk factors for coronal axial deviation. Results:The 90 patients were followed up for an average of 23 months (from 12 to 40 months). The incidence of axial deviation in this cohort was 36.7% (33/90).The deviation group had a significantly larger number of prior surgery [5 (3, 6) times], a significantly longer defect length [8 (8, 9) cm], a significantly longer external fixation time [400.0 (341.8, 426.3) d], and a significantly greater bending degree of Schanz screws at the last follow-up [1.2° (0.4°, 3.5°)] than the deviation-free group [3 (2, 3) times, 6 (5, 8) cm, 340.8 (226.5, 422.8) d, and 0.8° (0.2°, 3.7°)] (all P<0.05). Multivariate logistic regression analysis showed that the number of prior surgery ( OR=2.581, 95% CI: 1.496-4.450, P=0.001) and the defect length ( OR=5.310, 95% CI: 1.952-14.442, P=0.001) were the risk factors for the axial deviation. Conclusion:In the treatment of tibial defect susing Orthofix unilateral external fixator and proximal tibial osteotomy for bone transport, the more prior surgeries and the longer a bone defect, the higher the risk for axial deviation.
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Objective To study the treatment of femoral intertrochanteric fractures by reduction without a traction table in a special position and fixation with proximal femoral nail antirotation (PFNA).Methods From May 2016 to May 2017,34 patients with femoral intertrochanteric fracture were treated with PFNA.They were 20 men and 14 women,from 36 to 89 years of age (average,69.9 years).The left side was affected in 15 cases and the right side in 19.By AO classification,there were 10 cases of type AO 31-A1,13 ones of type 31-A2,and 11 ones of type 3 l-A3.Two cases were complicated with other fractures,and 5 with internal system disease,3 of whom had more than 2 concomitant diseases.Preoperative deep venous thrombosis was found in 2 cases.Surgery was performed for them between 2 and 8 days after injury (average,3.7 days).Reduction was performed in a special position without a traction table.The duration of anesthesia,operation time,intraoperative hemorrhage,postoperative complications and hip function by Harris scores were recorded.Results For the 34 patients,the anesthesia time ranged from 57 to 85 min (average,67.5 min),the operation time ranged from 28 to 65 min (average,40.9 min),and the intraoperative hemorrhage from 80 to 150 mL (average,110.6 mL).They received effective follow-up for 6 to 12 months (average,8.4 months).All the fractures healed after 6 to 12 months(average,7.2 months).No failure of internal fixation was observed during follow-ups.By the Harris scores at the final follow-up,the function of the affected hip was rated as excellent in 9 cases,as good in 21 and as fair in 4,giving an excellent to good rate of 88.2％.Conclusion In the treatment of femoral intertrochanteric fractures,reduction without a traction table in a special position and PFNA fixation may reduce anesthesia time,leading to satisfactory clinical outcomes.
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Objective According to radiation therapy (6WV-X line) on experimental gerbils which were successfully infected by echinococcus granulosus,the outcomes of bone hydatid disease after radiation therapy were studied.Methods Totally 240 gerbil models that were infected bone hydatid disease,were randomly divided into three groups (each group was further divided into three-month and six-month groups,40 gerbils per group),one group as a control group,the 40 Gy/5 times and 50 Gy/5 times groups were given 6WV-X line radiation therapy.After 5 consecutive radiation therapies,stopped for two days and then repeated for five times.At the end of three and six months after radiotherapy,the rate of death and the ulceration or infection of the lesions was compared.Fifteen gerbils from each group were randomly selected to observe the deaths of scolex,protein and calcium concentration changes,the maximum diameter changes of the lesions,the changes of hydatid cyst wet weight and the rate of suppressing capsule,the bone destruction,and rebuilding situation of lesions under a microscope.Results At the end of three and six months after radiation therapy,with increasing dosage,the deaths decreased significantly (x2 =10.4,17.4,all P ＜ 0.05);the ulceration or infection of the lesions decreased significantly (x2 =6.0,10.1,all P ＜ 0.05);the mortality rate of scolex increased [3 month:(22.4 ± 3.1),(95.0 ± 5.2),(136.0 ± 5.4);6 month:(23.2 ± 2.2),(98.2 ± 4.6),(169.3 ± 7.0);F =2 252.5,3 220.3,all P ＜ 0.05];the concentration of protein and the calcium ion were changed significantly [3 month:(1.059 ± 0.056),(0.733 ± 0.051),(0.571 ± 0.043)g/L and (2.802 ± 0.157),(3.056 ± 0.060),(3.546 ± 0.135)mmol/L;6 month:(1.088 ± 0.043),(0.753 ± 0.034),(0.340 ± 0.032)g/L and (2.804 ± 0.019),(3.068 ± 0.052),(3.886 ± 0.046)mmol/L;F =366.0,138.9 and 1 550.5,2 727.3,all P ＜ 0.05];the maximum diameters of the lesions reduced significantly [3 month:(2.38 ± 0.14),(1.69 ± 0.05),(1.40 ± 0.09)cm;6 month:(2.65 ± 0.05),(1.69 ± 0.03),(1.03 ± 0.06)cm;F =372.5,3 846.1,all P ＜ 0.05];the hydatid cyst wet weight decreased significantly [3 month:(3.47 ± 0.11),(2.54 ± 0.12),(1.46 ± 0.07)g;6 month:(3.75 ± 0.31),(2.55 ± 0.08),(1.02 ± 0.20)g;F =1 475.6,608.0,all P ＜ 0.05].In the same group with time went on,in the control and 40 Gy/5 times group,the deaths gradually increased (x2 =4.3,4.6,all P ＜ 0.05),but in the 50 Gy/5 times group,the deaths was not significantly increased (x2 =1.1,P ＞ 0.05);in the control and 40 Gy/5 times group,the ulceration or infection of the lesions gradually increased (x2 =5.5,4.3,all P ＜ 0.05),but in the 50 Gy/5 times group,the ulceration or infection of the lesions did not change significantly (x2 =0.3,P ＞ 0.05);in the 50 Gy/5 times group,the mortality rate of scolex was significantly increased (F =212.6,P ＜ 0.05);in 50 Gy/5 times group,the protein (calcium) concentration decreased (increased) significantly (F =271.8,84.7,all P ＜ 0.05);the maximum diameters of the lesions increased gradually in the control group (F =47.1,P ＜ 0.05),in 50 Gy/5 times group,the maximum diameters of the lesions decreased gradually (F =188.3,P ＜ 0.05);in the control group,hydatid cyst wet weight increased significantly (F =10.7,P ＜ 0.05),in the 50 Gy/5 times group,hydatid cyst wet weight was significantly reduced (F =68.5,P ＜ 0.05);with increasing dosage,the damage of the bone matrix and the cells in lacunae of the lesions gradually increased,in the same group with time went on,in the control group,a few amount of bone cells in lacuna died,and in 40 Gy/5 times and 50 Gy/5 times groups,the bone matrix and bone cells were partially repaired.Conclusion The long-term effects of appropriate dosage (50 Gy/5 times) radiation on experiments hydatid diseased gerbils are affirmed,but it is still need a clinical validation.
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To study the current situation of Chinese medicine services from both perspective of supply and demand, looking to promote the healthy development of Chinese medicine community health service strategy. Questionnaire survey was conducted to practitioners of 14 community health service centers in Longhua district (80) and service objects (800). Ratios and SWOT methods were used for analysis. 75 qualified practitioners and 736 qualified service objects questionnaire recoveries showed that there are different degrees of commands from both sides, different options on therapeutic methods and lack of practitioners. It is suggested that community health service center should supply TCM service according to different time, different place and different patient on different type and levels.
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OBJECTIVE: To investigate the safety, efficacy and long-term patency of parallel shunts (PS) in the management of the transjugular intrahepatic portosystemic shunt (TIPS) dysfunction. MATERIALS AND METHODS: Between March 2007 and October 2010, 18 patients (13 men and 5 women) who underwent TIPS revision with the creation of PS were evaluated retrospectively. In the first 10 patients, a 10-mm-diameter Wallgraft endoprosthesis was deployed; in the latter 8 patients, an 8-mm-diameter Fluency endoprosthesis was deployed. RESULTS: The creation of PS was technically successful in all patients. The mean +/- standard deviation portosystemic pressure gradient before and after the procedure was 25.5 +/- 7.3 mm Hg (range, 16-37 mm Hg) and 10.9 +/- 2.3 mm Hg (range, 7-16 mm Hg), respectively. The duration of follow-up was 16.7 +/- 10.8 months (range, 6-42 months). The primary shunt patency rates at 12 months after the creation of PS was 70% with Wallgraft endoprostheses and 87.5% with Fluency endoprostheses. CONCLUSION: TIPS revision with the creation of PS is a safe, effective and durable method for treating shunt dysfunction.
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Adult , Aged , Female , Humans , Male , Middle Aged , Blood Pressure Determination , Polytetrafluoroethylene , Portasystemic Shunt, Transjugular Intrahepatic/adverse effects , Prosthesis Design , Reoperation/methods , Retrospective Studies , StentsABSTRACT
Objective To evaluate the risk factors for early rebleeding (ERB) after elective endoscopic variceal ligation (EVL) in cirrhotic patients and the influence of ERB on the long-term survival.Methods A total of 198 cirrhotic patients who received elective EVL were retrospectively evaluated.Twenty-six patients rebleeded within 6 weeks after initial EVL and were assigned to the ERB group.One hundred and seventy-two other cirrhotic patients were assigned to the control group.Multivariate analysis was used to define the high risk factors of ERB.A Kaplan-Meier analysis was performed to evaluate the cumulative survival rates between two groups.Results The Child-Pugh classification (P =0.016),Child-Pugh scores (P=0.012),and the total bilirubin (P =0.001) were significantly different between ERB and control group.Multivariate analysis showed total bilirubin was the only independent risk factor of ERB (OR =2.02,95％CI:1.04-4.04,P =0.008).The proportional mortality indicator of bleeding-related deaths was 66.7％ (10/15) in ERB group and 13.6％ (6/44) in control group (P ＜0.01).The five-year curmulative survival rate of the control-group was significantly higher than that of the rebleeding group (67.8％ vs.25.3％,P ＜ 0.01).Conclusion Cirrhotic patients with ERB after elective EVL have a poor prognosis.High level of total bilirubin may predict ERB.
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Objective To investigate the incidence of left-sided portal hypertension (LSPH) in chronic pancreatitis (CP) and other accompany conditions of CP and explore the diagnostic value of LSPH in chronic pancreatitis.Methods The clinical,pathological and imaging data of 125 CP patients received at least two imaging examination were retrospectively analyzed.The rates of abnormal pathologic findings,abnormal imaging findings and accompanying LSPH in CP were analyzed.The data were analyzed by chi-square test.Results Among 125 CP patients,29.6％ (37/125) received three or more than three kinds of imaging examinations.The pathological detection rates of pancreatic calcification or lithiasis,pancreatic ductal lesion,abnormal pancreatic morphology,pancreatic lesion and LSPH were 58.4％ (73/125),60.8％ (76/125),35.2％ (44/125),48.8％ (61/125) and 24.8％ (31/125),respectively.The sensitivities of imaging examination in those lesions were 68.5 ％(50/73),96.1％ (73/76),95.5％ (42/44),95.1％ (58/61) and 90.3％ (28/31),respectively.The detection rates of pancreatic calcification or lithiasis and pancreatic ductal lesion in pathological examination were significantly higher than those of the others,and differences were statistically significant (x2=33.764 and 37.932,both P＜0.01).The sensitivity of imaging examination in pancreatic calcification or lithiasis was lower than those of the others and the differences were statistically significant (x2 =36.526,P＜0.01).Among 125 CP patients with 223 pancreatic lesions detected by imaging examination,the rates of patients with 0,1,2,3,4 lesions accounted for pancreatic were 5.6％ (7/125),40.0％ (50/125),28.8％ (36/125),21.6％ (27/125) and 4.0％ (5/125),respectively.Of patients with pancreatic calcification or lithiasis,pancreatic ductal lesions,abnormal pancreatic morphology and pancreatic lesions detected by pathological examination,there were 23.7 ％(17/73),20.0％ (15/76),22.6％ (10/44) and 27.9％ (17/61) cases accompanied with LSPH,there was no difference between these groups (x2 =1.262,P=0.738).Conclusion LSPH may be a reference for CP diagnosis by imaging examination.
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Objective To research the expression change and the sense of histone acetylation and p21WAF1 protein in breast cancer. Methods Pathological morphologic changes of breast cancer were identified by H. E. staining. Immunohistochemical study for p21WAF1 protein expression was performed on 80 breast cancers and 80 normal breast tissues. The expressions of acetylated histone H3, H4 and p21WAF1 protein in 80 breast cancers and 80 normal breast tissues were analyzed by Western blot. Results H.E. staining discovered that the tissue structure and cell morphous of breast cancer had visible atypia, compared with normal breast tissues. The immunohistochemical results displayed that the positive expression of p21 WAF1 in 80 breast cancers and 80 normal breast tissues was 49 cases(61.25 %) or 3 cases (3.75%), respectively. There was significantly difference in the expression level between the 80 breast cancers and 80 normal breast tissues (P ＜ 0. 05). The expression levels of p21WAF1 protein in breast cancer tissues were higher than that in normal breast tissues, 0. 78 ± 0. 095 or 0. 65 ± 0. 055, respectively. The expression levels of acetylated histone H3, H4 protein in normal breast tissues were higher than those in breast cancer tissues. H3 was 2. 35 ± 0. 340 or 1.07 ± 0. 067, respectively, H4 was 3.44 ± 0. 202 or 1.11 ± 0. 086, respectively. There was significantly difference in the expression levels between the 80 breast cancers and 80 normal breast tissues (P ＜0. 01). Conclusions The occurrence and development of breast cancers may be related to the expression change of histone acetylation and p21WAF1 protein.