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Objective: To investigate the role of the distal fourth fixation factor in the treatment of unstable femoral intertrochanteric fractures with intramedullary nails. Methods: A total of 108 patients with unstable femoral intertrochanteric fractures (AO type: A2.2-A.3.3) treated from Jun. 2014 to Jun. 2018 in our hospital were selected and divided into three groups. The injury was fixed with short intramedullary nails and had matched medullary cavity in group A (n=42). The injury was fixed with short intramedullary nails and had mismatched medullary cavity in group B (n=40). The injury was fixed with long intramedullary nails in group C (n=26). Operation time, intraoperative blood loss, fracture healing time, postoperative complications and clinical efficacy were compared among the three groups. The efficacy was evaluated by the Harris hip score. Results: There was no significant difference in the age, gender composition, or causes of injury between groups (P>0.05), but there was statistic difference in the AO type between groups (P0.05). The amount of intraoperative bleeding in group A was (149.19 ± 45.97) mL, which was significantly less than that in group C ([230.77 ± 57.40] mL, P0.05). The fracture healing time in group B was (14.10 ± 2.22) months, which was significantly longer than that in group A ([11.43 ± 2.95] months) and group C ([12.35 ± 4.47] months, P<0.05). At the last follow-up, the Harris score in group B was 77.33 ± 8.18, which was significantly lower than that in group A and C (85.52 ± 10.76, 89.12 ± 9.14, P<0.05). Two patients in group A developed coxa vara. Eight patients had lost restoration in group B. No complications occurred in group C. There was significant difference in the incidence of complication among the three groups (Fisher exact test, P=0.013). Conclusion: The technique using the distal fourth fixation factor can reduce the complications of unstable femoral intertrochanteric fractures such as postoperative loss of restoration and internal fixation failure, shorten the fracture healing time, and achieve early weight-bearing exercise.
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BACKGROUND@#The efficacy of entecavir (ETV) add-on peg-interferon therapy compared with ETV monotherapy in treatment-naïve hepatitis B virus (HBV) patients remains controversial. We investigated whether adding peg-interferon to ongoing ETV treatment leads to a better curative effect or not.@*METHODS@#All patients have been recruited between August 2013 and January 2015 from the Shanghai Public Health Clinical Center and Zhongshan Hospital (China). Eligible HBV patients (n = 144) were randomly divided (1:1) to receive either ETV monotherapy (n = 70) or peg-interferon add-on therapy from week 26 to 52 (n = 74). Patients were followed-up for at least 2 years. Indexes including hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) seroconversion rate, sustained virologic response, transient elastography value, and histological scores were evaluated every 3 months until the end of the study. The rate of patients with HBsAg loss was defined as the primary endpoint criteria.@*RESULTS@#At week 26, no patient achieved HBsAg seroconversion in either group. At week 52, one patient in the monotherapy group was HBsAg-negative but there was none in the combination therapy group. The monotherapy group showed significantly better liver function recovery results than the combination therapy group. At week 78, one patient in the combination group had HBsAg seroconverted. At week 104, only three patients in the combination therapy group were HBsAg-negative compared with one patient in monotherapy. The mean alanine aminotransferase and aspartate aminotransferase levels and transient elastography values decreased significantly compared with baseline. Both groups showed a favorable decrease in alpha-fetoprotein (monotherapy: 4.5 [2.8, 7.1] vs. 2.2 [1.8, 3.1] ng/mL, P < 0.001; combination therapy: 5.7 [3.0, 18.8] vs. 3.2 [2.0, 4.3] ng/mL, P < 0.001) and an improved result of liver biopsy examination scores. The combination group showed a better improvement in histology compared with the monotherapy group (mean transient elastography value 6.6 [4.9, 9.8] vs. 7.8 [5.4, 11.1] kPa, P = 0.028). But there was no significant difference in HBsAg conversion rate (1.8% [1/56] vs. 4.1% [3/73], P = 0.809) and HBeAg conversion rate (12.5% [7/56] vs. 11.0% [8/73], P = 0.787), as well as HBV-DNA, sustained virologic response (93.2% vs. 98.5%, P = 0.150) between the two groups.@*CONCLUSIONS@#Both therapies supported liver function recovery and histology improvement. Combination therapy did not show better anti-viral efficacy in HBsAg or HBeAg seroconversion compared with monotherapy. However, combination therapy played a more positive role in reversing hepatic fibrosis compared with monotherapy.@*TRIAL REGISTRATION@#ClinicalTrials.gov: NCT02849132; https://clinicaltrials.gov/ct2/show/NCT02849132.
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AIM To explore analgesic mechanism of Yaobitong Capsules (Notoginseng Radix et Rhizoma,Chuanxiong Rhizoma,Corydalis Rhizoma,etc.) on lumbar intervertebral discs.METHODS An array of data mining,molecular docking and network analysis were employed to investigate the active compounds and key target protein.RESULTS Among the forty-six active hits identified by virtual screening,most compounds displayed good oral bioavailability and might confer an optimal CNS exposure.And eleven molecules (coptisine,diligustilide,corypalmine,chuanxiongterpene,etc.) were further confirmed to alleviate lumbar intervertebral discs through their targeting at nineteen proteins (such as p38,CGRP,MMPs,TNFα) to inhibit the inflammatory response and the infiltration of microvasculature,to reduce the nociceptors sensitivity,and to modulate the balance of Collagen and proteoglycans in catabolic and anabolic responses.CONCLUSION Yaobitong Capsules' clear molecular working mechanism and the key active compounds are revealed by this network-assisted investigation highlight the subsequent experiments on targets and active compounds.