[Comparison of long Gamma 3 nail and proximal femur locking plate for the treatment of femoral subtrochanteric fractures].

OBJECTIVE: To compare clinical efficacy of long Gamma 3 nail and proximal femur locking plate (PFLP) in treating femoral subtrochanteric fractures. METHODS: From January 2010 to January 2017, clinical data of 58 patients with subtrochanteric fractures followed more than 12 months were retrospective analyzed. Among them, 35 patients were treated with long Gamma 3 nail including 18 males and 17 females aged from 25 to 78 years old with an average of(66.5±23.5) years old;Causes of injury included fall on the ground in 18 cases, traffic accidents in 7 cases, and fall from height in 10 cases. The other 23 patients were treated with PFLP fixation including 8 males and 15 females aged from 31 to 81 years old with an average of (63.4±22.4) years old;Causes of injury included fall on the ground in 12 cases, traffic accidents in 6 cases, and fall from height in 5 cases. Operative time, blood loss (intraoperative and hidden blood loss), hospital stays, bone healing and complications were observed and compared. Harris hip score after 1-year following-up was used to evaluate postoperative clinical effect. RESULTS: Fifty-one patients were followed up from 14 to 36 months with an average of 24.8 months, including 31 patients were treated with long Gamma 3 and 20 patients were treated with PFLP. Blood loss(intraoperative and hidden blood loss) in PFLP group was less than that of long Gamma 3 nail group(P<0.05). There was no significant in operative time, hospital stays and complications between two groups(P>0.05). There was no significant differences in healing time of fractures between long Gamma 3 nail group (17.2±2.4) weeks and PFLP group (18.1±2.6) weeks(P<0.05). At 1-year following-up, there was no significant differences in Harris hip score between long Gamma 3 nail group(80.29±10.28) and PFLP group (76.49±12.28)(P<0.05). No complications such as pulmonary embolism and nonunion occurred. Two patients were treated with fitler whose occurred deep vein thrombosis. Postoperative pulmonary infection curred in 4 cases and was cured by anti-infection therapy. CONCLUSIONS: Both of long Gamma 3 nail and PFLP in treating patients with femoral subtrochanteric fractures can receive good clinical effects, long Gamma 3 nail is not suitable for the patients of the narrow medullary cavity and prominent anterior arch. PFLP is eccentric fixation, so early weight-bearing was not stress.

[Advanced progress on the treatment of anterior approach to the thoracolumbar vertebral fractures].

Thoracolumbar fractures are common and severe traumas. Anterior approaches can achieve adirect spinal cord decompression and reconstruct anterior column height what load bearing the major load distribution of the spine. Therefore, anterior approach is an important method in the treatment of thoracolumbar fractures. With the application of pedicle screw, most of the patients were treated with posterior approaches.Because of the unique advantages of anterior approach, the posterior approach can not be replaced it.The review summarizes the biomechanical characteristics? indications? fixation devices? bone grafting method and technique of the anterior approach and in order to provide better evidence for clinical treatment of thoracolumbar fractures.

Controlled study on Gamma nail and proximal femoral locking plate for unstable intertrochanteric femoral fractures with broken lateral wall.

The gamma nail and proximal femoral locking plate (PFLP) are both used for fractures. A controlled study was performed to determine the optimal implant. To assess and analyze the clinical effects of gamma nails and PFLPs for patients with unstable intertrochanteric femoral fractures, specifically with broken lateral walls. Thirty-six patients with unstable intertrochanteric femoral fractures and broken lateral walls were treated with gamma nails or PFLPs and retrospectively studied. The clinical data were compared. Duration of surgery and early full weight-bearing time were significantly longer in the PFLP group compared to the gamma nail group (P < 0.05). However, intraoperative fluoroscopy frequency and total blood loss in the PFLP group were significantly less than those in the gamma nail group (P < 0.05). No significant differences were found in hospitalized days, Parker Palmer mobility scores, Harris hip scores, and complications between the two groups. No difference in hip-functional recovery was found between the gamma nail group and the PFLP group, indicating that both the gamma nail and PFLP were effective for unstable intertrochanteric femoral fractures with a broken lateral wall. However, early weight bearing on the fractures was not encouraged in patients treated with PFLP.

[A medium term therapeutic effects of anatomic locking plate for femoral intertrochanteric with lateral femoral wall fractures].

OBJECTIVE: To retrospectively study medium term follow-up outcomes of the femoral intertrochanteric with lateral femoral wall fractures using anatomic locking plate fixation. METHODS: From June 2010 to January 2013, 18 cases of the unstable femoral intertrochanteric with lateral femoral wall fractures were treated with the anatomic locking plate, included 8 males and 10 females with an average age of 75.5 years ranging from 19 to 83 years old. There were 8 cases of traffic accident injuries, 6 cases of falls injuries, and 4 cases of falling from high place. The time from injury to operation was ranged from 1 to 14 days with an average of 4.5 days. The operation time, intraoperative blood loss and the length of hospitalization were recorded and analyzed. The fracture union was assessed by follow-up radiographs and hip functional recovery by PPMS and Harris hip scoring. RESULTS: All patients were followed up from 36 to 68 months with a mean of(44.8±8.8) months. The mean operative time was (61.02±38.28) min;the mean blood loss was (226.00±162.52) ml;the mean length of hospitalization was (10.8±9.2) days. During the follow-up period, no infection, deep veintllrombosis, screwed cut-out and implant failure occurred in all patients. Coxa vara with shortening deformity was noted in 2 cases. Bone union was found in all the cases. The bone healing time was ranged from 4 to 10 months with an average of 6.2 months. The mean PPMS score at the final follow-up was 7.22±2.36. The Harris score was 79.46±11.02, 5 cases were classified as excellent, 9 as good and 2 as fair. CONCLUSIONS: Proximal femoral anatomic locking plate can be used in treating intertrochanteric fractures with compromised lateral wall, which has a satisfied medium term follow-up outcomes, especially for complex fractures patterns in which intramedullary nailing may be difficult, and should not emphasis on premature loading.

[Inversive LISS plate in treating intertrochanteric and subtrochanteric fractures combined with femoral shaft fractures].

OBJECTIVE: To study clinical effects of inversive LISS(less invasive stabilization system, LISS) plate for the treatment of intertrochanteric and subtrochanteric fractures combined with femoral shaft fractures. METHODS: From January 2012 to January 2015, 24 patients with intertrochanteric and subtrochanteric fractures combined with femoral shaft fractures were treated with inversive LISS plate, included 16 males and 8 females with an average age of 62.5 years old ranged from 35 to 81 years old. There were 8 cases of traffic accident injuries, 3 cases of falling from high place, and 13 cases of falls injuries. The time from injury to operation was ranged from 2 to 12 days with an average of 5.2 days. The operation time, intraoperative blood loss and the length of hospitalization were analyzed. The fracture union was assessed by follow-up radiographs and hip functional recovery by Harris hip scoring. RESULTS: All patients were followed up for 16.2 months (ranged, 18 to 36 months). The mean operative time was (68.22±48.36) min;the mean blood loss was (256.28±182.46) ml;the mean time of hospitalization was(14.8±5.2) days. There were no complications such as deep infection, deep vein thrombosis, pulmonary embolism and bone nonunion during the follow up period. The bone healing was ranged from 3 to 8 months with an average of 4.8 months. The mean Harris score was 76.49±12.28 at the final follow-up, 15 cases were classified as excellent, 6 as good and 3 as fair. CONCLUSIONS: Inversive LISS plate can be used in treating with intertrochanteric and subtrochanteric fractures combined with femoral shaft fractures, and should not emphasis on premature loading.

Scientific knowledge mapping-based visual analysis of research trend in major disaster medical rescue / 中华医学图书情报杂志

Objective To analyze the development trend of global and domestic major disaster medical rescue, pre-dict the development trend of key technologies in major disaster medical rescue, and put forward suggestions for the distribution of resources and technical training model in domestic major disaster medical rescue by investigating and comparing the researches in domestic major disaster medical rescue. Methods Data of disaster medical rescue were analyzed using the scientific knowledge mapping analysis tools ( TDA and VOSVIEWER) with the Web of Science Database-covered titles of papers on disaster medical rescue in 1995-2017 as the study objects. Results A total of 1333 titles of papers on disaster medical rescue were retrieved from the Web of Science Database, from which 89 high frequency co-occurrence key words in 7 major categories were selected. Conclusion The research on crush syndrome, posttraumatic stress syndrome, fracture, spinal cord injury, rehabilitation, casualty classification, and field hospital is advantageous over that on telemedicine, communication, pediatrics, personal identification and education in domestic major disaster medical rescue. Disaster rescue system should be established, research on disaster rescue concept, techniques and equipments should be deepened, and training model of emergency medical rescue should be expanded in our country.

[Comparison of anatomical locking plate and Gamma nail for the treatment of intertrochanteric fracture with external wall fractures].

OBJECTIVE: To compare clinical efficacy of anatomic locking plate and Gamma nail in treating unstable femoral intertrochanteric fractures with external wall fractures. METHODS: From June 2010 to June 2014,clinical data of 44 patients with intertroehanteric fractures associated with lateral wall fractures (type 31A2.2-3.3) followed more than 12 months,which treated with Gamma nail or anatomic locking plate,were retrospective analyzed. Sixteen patients were treated with anatomic locking plate, including 6 males and 10 females aged from 32 to 83 years old with an average of 56.5 years old. Twenty-eight patients were treated with Gamma nail including 17 males and 11 females aged from 26 to 87 years old with an average of 60.4 years old. Operative time, intraoperative fluoroscopy times, blood loss (intraoperative and hidden blood loss), hospital stays were observed and compared. PPMS and HHS scoring were used to evaluate postoperative clinical effect. RESULTS: All patients were followed up from 12 to 24 months with an average of 16.2 months. Operative time in Gamma nail was shorter than anatomic locking plate; while blood loss( intraoperative and hidden blood loss) and intraoperative fluoroscopy times in anatomic locking plate were less than that of in Gamma nail. There was no significant meaning in hospital stays between two groups. Postoperative full weight-bearing time in anatomic locking plate was prolonged than Gamma nail. At the final following-up, PPMS in Gamma nail was 7.50 ± 1.78 and 6.82 ± 1.38 in anatomic locking plate, and there was no obvious meaning between two groups (t = 2.341, P = 0.132); there was no significant differences in HHS score between Gamma nail (83.25 ± 11.18) and anatomic locking plate (86.14 ± 12.36) (t = 1.923, P = 0.243). The incidence of complications in Gamma nail was less than anatomic lock-ing plate (P = 0.005). CONCLUSION: Anatomic locking plate for intertrochanteric fractures with external wall fractures could avoid re-injury of external wall, especially for severe comminuted fractures, difficult for intramedullary nailing, and there was no significant meaning in hip joint function compared with Gamma nail, while postoperative incidence of complications was higher than Gamma nail, so early weight-bearing was not stress.

Hemostatic effect of topical hemocoagulase spray in digestive endoscopy.

AIM: To evaluate the hemostatic effect of topical hemocoagulase spray in digestive endoscopy. METHODS: Eighty-nine patients who developed oozing bleeding during endoscopic treatment from September 2014 to October 2014 at Center for Digestive Endoscopy, Tianjin Medical University General Hospital were randomly divided into either a study group (n = 39) or a control group (n = 50). The study group was given topical hemocoagulase spray intraoperatively, while the control group was given traditional 8% norepinephrine spray. Hemostatic efficacy was compared between the two groups. Bleeding site, wound cleanliness and perforation were recorded, and the rates of perforation and late bleeding were compared. RESULTS: Successful hemostasis was achieved in 39 (100%) patients of the study group and in 47 (94.0%) patients of the control group, and there was no significant difference in the rate of successful hemostasis between the two groups. Compared with the control group, after topical hemocoagulase spray in the study group, the surgical field was clearer, the bleeding site was more easily identified, and the wound was cleaner. There was no significant difference in the rate of perforation between the study and control groups (16.7% vs 35.0%, P = 0.477), but the rates of late bleeding (0% vs 15.8%, P = 0.048) and overall complications (P = 0.032) were significantly lower in the study group. CONCLUSION: Topical hemocoagulase spray has a definite hemostatic effect for oozing bleeding in digestive endoscopy, and this method is convenient, safe, and reliable. It is expected to become a new method for endoscopic hemostasis.

[DNA methylation of microRNA-34b/c and microRNA-124a in gastric cancer].

OBJECTIVE: To explore the effects of DNA methylation of microRNA (miRNA) gene on their expressions in patients with gastric carcinoma. METHODS: A total of 80 subjects were divided into gastric carcinoma group (n = 40) and control group (n = 40). The DNA methylation status of miRNA-34b/c and miRNA-124a gene promoters was detected by DNA methylation specific polymerase chain reaction (MSP) in gastric carcinoma tissues and normal mucosal tissues. RESULTS: The positive rate of DNA methylation of miRNA-34b/c gene promoter was 77.5% (31/40) and 5.0% (2/40) in gastric carcinoma and control groups respectively. There was statistically significant difference between two groups (P < 0.05). The positive rate of DNA methylation of miRNA-124a gene promoter was 60.0% (24/40) and 0 in these two groups respectively. There was statistically significant difference between two groups (P < 0.05). Also the hypermethylation positivity of gene promoter of miRNAs was correlated with the clinicopathological features of gastric carcinoma. CONCLUSION: The hypermethylation of miRNA-34b/c and miRNA-124a gene promoters may play a crucial role in the occurrence and development of gastric carcinoma.

The Governor's Focus on Servicemembers, Veterans, and Their Families.

The Governor's Focus on Servicemembers, Veterans, and Their Families is a coalition of federal, state, and local agencies and professional and consumer organizations. Its goal is to develop and maximize public and private services and supports for service members in active and reserve components of the armed forces, veterans, and their families.

[The predictive value of end-stage liver disease model for spontaneous bacterial peritonitis in cirrhotic patients with ascites].

OBJECTIVE: Spontaneous bacterial peritonitis (SBP) is a severe complication in cirrhotics with ascites. Early identification of high-risk patients is crucial for prognostic improvement. We aimed to investigate the predictive value of model for end-stage liver disease (MELD) score at admission in predicting incidence rate of SBP in cirrhotic patients with ascites, so as to evaluate its use in early diagnosis and prognosis of this complication. METHODS: A retrospective study enrolling 254 consecutive patients with cirrhosis and ascites between June 2003 and June 2006 was carried out. The data collected included the age, sex, etiology of liver disease, serum creatinine, total bilirubin, prothrombin time with international normalized ratio and ascitic fluid analysis of the patients. The patients were graded with MELD formula into 4 groups (MELD < or = 9, 10-19, 20-29, MELD > or = 30). The incidence rate of SBP was compared in the 4 groups according to the MELD score. The predictive accuracy in patients with and without SBP was evaluated with receiver operating characteristic (ROC) curve. RESULTS: SBP developed in 65 (26%) patients during hospitalization. The clinical characteristics were similar between the patients with and without SBP. The mean MELD score for patients with SBP was 23 and for those without was 14 (P < 0.01). Patients with 10-19 had an odds ratio of 1.44 (P > 0.05) for SBP, as compared with patients with MELD < or = 9. The frequency of spontaneous bacterial peritonitis was higher in the patients with MELD > or = 20 than those with MELD < or = 19. The incidence rate of SBP with MELD < or = 19, 20-29 and MELD > or = 30 were 12.5%, 52.38%, and 66.67% respectively. Patients with MELD > or = 30 had an odds ratio of 14 (95% CI 5.41-36.20) for SBP, as compared with patients with MELD < or = 19. Patients with 20-29 had an odds ratio of 7.7 (95% CI 4.17-14.20) for SBP, as compared with patients with MELD < or = 19. Area under curve (AUC) of MELD was 0.774 (95% CI 0.689-0.855). CONCLUSION: The cirrhotic patients with complicating ascites with higher MELD score have a greater risk of SBP. High MELD score might be an useful predictor of SBP in cirrhotic patients with ascites.

[The inhibitory effect of curcumin on the proliferation of HT-29 colonic cancer cell induced by deoxycholic acid].

OBJECTIVE: To assess the effect of curcumin on deoxycholic acid (DCA) induced cell proliferation in human HT-29 colon cancer cell line and to discuss its underlying anti-cancer mechanisms. METHODS: The effect of curcumin on cell proliferation was tested in vitro with MTT assay. RT-PCR was applied to measure cyclooxygenase-2 (COX-2) mRNA transcription. Cellular immunochemical stain was applied to label COX-2 protein expression. Radio immunoassay was applied to assess prostaglandin E(2) (PGE(2)) level. RESULTS: DCA increased cell proliferation, COX-2 mRNA expression and PGE(2) concentration of HT-29 cell line. Curcumin inhibited DCA-induced cell proliferation of HT-29 cell in a dose and time depended manner. Curcumin may inhibit DCA-induced COX-2 mRNA transcription at 6 hour with more than 5 micromol/L and at 12 hour with more than 0.5 micromol/L. However, Curcumin may decrease DCA-induced COX-2 expression and PGE(2) synthesis at 24 - 48 hour with more than 1 micromol/L and at 6-12 hour with more than 5 micromol/L. CONCLUSIONS: Curcumin may inhibit HT-29 cell proliferation, COX-2 mRNA transcription, COX-2 protein expression and PGE(2) synthesis induced by DCA in HT-29 cell line. These data provide new insights into the mechanism of its anti-cancer properties.

Safe babies: a qualitative analysis of the determinants of postpartum smoke-free and relapse states.

This qualitative study explores smoking cessation during pregnancy and the factors that contribute to remaining smoke-free and relapsing. Ninety-four women attending prenatal clinics in central North Carolina who had quit smoking before 30 weeks gestation were enrolled in an observational study that included a face-to-face interview at 4 months postpartum. Results were analyzed for common themes in the two groups: those who remained smoke-free and those who had relapsed. Fetal health motivated pregnant women to quit smoking, while stress, socializing with smokers, cravings, and easy access to cigarettes tempted women to smoke. Women who remained smoke-free postpartum overcame temptations by continuing to acknowledge the health benefits of not smoking and having a strong internal belief system, significant social support, negative experiences with renewed exposure to cigarettes, and concrete strategies for dealing with temptations. For women who relapsed postpartum, factors having the greatest influence on relapse included easy access to cigarettes, lack of social and financial support, insufficient resources for coping with the challenges of childrearing, physical addiction, reliance on cigarettes as a primary form of stress management, and feelings of regret, shame, or low self-esteem. Recommendations for relapse prevention include assessing women who quit during pregnancy for low or high risk of relapse and offering comprehensive interventions and case management for those at higher risk to address the physical, mental, behavioral, and social contexts leading to relapse.

Smoking cessation in pregnancy: a review of postpartum relapse prevention strategies.

OBJECTIVE: Review and examine existing research, current strategies, and directions for future research on smoking cessation relapse and relapse prevention in pregnancy and postpartum. METHODS: A MEDLINE/PubMed search in 2002 and 2003 for articles containing the key words "smoking," "pregnancy," "cessation," and "cessation relapse prevention" and references of retrieved papers yielded a review of more than 500 articles. Only 14 of these addressed program-based strategies to increase cessation among pregnant women through relapse prevention programs. CONCLUSION: Although there is much information on the rationale and strategies for smoking cessation for pregnant women, fewer studies exist on how to prevent relapse. Maintaining and accelerating progress in cessation during pregnancy and postpartum requires more research that focuses on relapse prevention and cessation. Programs should incorporate stresses particular to postpartum women, should be part of routine health care, and should involve the woman's social support network, including her partner, to maximize effectiveness.