Effects of Chronic Salt Loading on Plasma Inflammatory Factors in Normotensive Adults / 中国循环杂志

Objectives: To observe the effects of dietary sodium intake on plasma inflammatory factors including tumor necrosis factor alpha (TNF-α), high-sensitivity C-reactive protein (CRP) and monocyte chemoattractant protein -1 (MCP-1) in normotensive adults. Methods: Thirty normotensive volunteers, aged 18 to 60 years old, were selected to undergo baseline survey, low-sodium diet (51.3 mmol per day) for 7 days, followed by high-sodium diet (307.8 mmol per day) for 7days. Subjects were classified as salt sensitive (SS, 10 subjects) or non-salt sensitive (NSS, 20 subjects) based on their mean arterial blood pressure (MAP) increase (SS: more than 10 percent increase at the end of the high-sodium phase compared with the end of low-sodium phase). Fasting blood samples were taken on the first day of baseline and on the sixth day of the two intervention phases. Plasma TNF-α and MCP-1 concentration was measured using an enzyme-linked immunosorbent assay system, plasma hs-CRP concentration was measured by immune nephelometry. Results: The prevalence of SS is 33%. After salt loading, no significant change was found in the plasma hs-CRP concentrations; Whereas plasma TNF-α level increased significantly in both of the SS and NSS groups(pg/ml, [168.4±67.8 vs 42.1±26.7], P<0.01 and [129.8±24.1 vs 37.7±15.8], P<0.01, respectively) ; Plasma MCP-1 was also significantly higher during the high-sodium than the low-sodium phase in both SS and NSS groups(pg/ml, [205.2±64.2 vs 166.3±48.5], P<0.01and [212.3±52.2 vs 143.6±55.9], P<0.01). Conclusions: High-sodium diet can induce an inflammatory state independent of the salt sensitivity in normotensive subjects.

Comparative study of antegrade and retrograde intramedullary nailing for the treatment of humeral shaft fractures / 中国骨伤

<p><b>OBJECTIVE</b>To compare therapeutic effects between antegrade intramedullary nailing and retrograde intramedullary nailing for the treatment of humeral shaft fractures.</p><p><b>METHODS</b>From March 1999 to October 2006, 105 patients with humeral shaft fractures were treated with locked intramedullary nail and were adequately followed up. There were 82 antegrade nailing and 23 retrograde nailing. The follow-up parameters included operation time, blood loss,fracture healing rate, healing time, complications, Constant-Murley shoulder score and Mayo elbow performance score.</p><p><b>RESULTS</b>The mean follow-up period was 31.2 months. Antegrade intramedullary nailing had significantly less blood loss than that in retrograde intramedullary nailing (P=0.002). The differences in operation time, complications, healing time and bone healing rate between he two groups had no statistical significance. Complications in the antegrade intramedullary nail group included 4 patients with nonunions, 1 patient with radial nerve palsy, and 8 patients with shoulder pains and decrement in shoulder range of motion. Complications in the retrograde intramedullary nail group included 1 patient with radial nerve palsy and 3 patients with iatrogenic fractures. For shoulder joints,the difference in the average Constant-Murley shoulder score between the two groups was statistically significant (P=0.04). For elbow joints, the average postoperative Mayo elbow performance score between these two approaches did not differ significantly.</p><p><b>CONCLUSION</b>Both the antegrade intramedullary nailing and the retrograde intramedullary nailing are good alternatives for the treatment of humeral shaft fractures. Because of higher incidence of iatrogenic fractures, the insertion point of retrograde intramedullary nailing should be carefully prepared. With antegrade insertion, it important to bury the humeral nail below the rotator cuff to prevent the subacromial impingement, and the rotator cuff should be carefully repaired to avoid shoulder pain and improve shoulder function.</p>

Antibiotic-PMMA beads combined with external fixator for treating the infected fracture nonunion / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the effects of antibiotic-PMMA (polymethyl-methacrylate) beads combined with external fixator in treatment of infected fracture nonunion.</p><p><b>METHODS</b>Twenty-two cases of infected fracture-nonunions were reviewed involving 20 male and 2 female with an average age of 34.68 years (ranging 21 to 74 years). The data consisted of 9 cases of tibial fractures, 2 distal fractures of the femur, 6 femoral shaft fractures, 3 intertrochanteric fracture of the femur and 2 humeral shaft fractures. The procedure included thorough debridement to wipe out dead bone and granulation tissue, then antibiotic-PMMA bead chains imbedded into the dead space. One week later, secondary debridement was performed, antibiotic-PMMA bead chains were changed according to result of bacterial culture and susceptibility test, and fractures were stabilized with external fixator. Three months after debridement, antibiotic-PMMA bead chains were taken out and bone graft with autogenous iliac cancellous bone chips was performed.</p><p><b>RESULTS</b>The mean follow-up period was 19.98 months (ranging 15 to 28 months). Infection was controlled in 20 cases. One tibial fracture and 1 intertrochanteric fracture of the femur needed repeated debridement 2 and 3 months after bone grafting respectively,because of infection recurrence and sinus formation. All 22 cases achieved bony union averaged 15.09 weeks after bone grafting with a range of 8 to 24 weeks.</p><p><b>CONCLUSION</b>Thorough debridement, imbedding antibiotic-PMMA bead chains combined with external fixator and staged bone grafting has proven to be effective and simple for treatment of infected fracture nonunion. The antibiotic bead delivers high tissue levels,obliterates dead space, aids bone repair.</p>