Meta-analysis of differences in Constant-Murley scores for three mid-shaft clavicular fracture treatments.

There is no consensus on the optimal treatment for mid-shaft clavicular fracture. We conducted a meta-analysis to compare the effectiveness of non-operative treatment, plate fixation, and intramedullary pin fixation in terms of the Constant-Murley Score (CMS) for treatment of mid-shaft clavicular fracture. Comprehensive search of the Embase, Cochrane Library and PubMed was conducted to retrieve relevant randomized controlled trials (RCTs). A random-effect network meta-analysis was conducted within a Bayesian framework using Markov Chain Monte Carlo (MCMC) in OpenBUGS 3.2.2. Differences in CMS among the three treatments analyzed were evaluated with weighted mean difference (WMD) and surface under the cumulative ranking curves (SUCRA). Eleven studies met our inclusion criteria and were included in our network meta-analysis. Our results revealed that in terms of CMS followed-up for six months, the efficacies of plate fixation and intramedullary pin fixation were higher than non-operative treatment (plate fixation: WMD = 4.70, 95% CI = 1.21 ∼ 7.83; intramedullary pin fixation: WMD = 6.71, 95% CI = 3.20 ∼ 10.39), and intramedullary pin fixation had better efficacy than plate fixation, had better efficacy. However, no differences were found between the efficacies of the three treatments in pairwise comparisons with respect to CMS followed-up for six weeks, three months, 12 months and 24 months. In addition, the cluster analysis showed that intramedullary pin fixation had the best efficacy for patients with mid-shaft CF, followed by plate fixation and non-operative treatment. These analyses suggest intramedullary pin fixation may be the optimal therapeutic approach for mid-shaft clavicular fracture patients.

[Semicircular decompression for the treatment of old thoracolumbar fractures and intractable neuropathic pain].

OBJECTIVE: To investigate the clinical outcomes of semicircular decompression in treating old thoracolumbar fractures and intractable neuropathic pain. METHODS: From September 2009 to September 2013, 21 patients with old thoracolumbar fracture and intractable neuropathic pain were treated with semicircular decompression. Among initial surgery, posterior pedicle screw fixation was used in these patients, with or without laminectomy. All patients were male, range in age from 20 to 28 years old with an average of (25.00±2.38) years. Vertebral body residual bone block resulted in intra-spinal placeholder more than 50%. All patients were complete spinal cord injury (ASIA grade) or cauda equina injury. VAS scores was from 6 to 10 points with the mean of 7.14±0.91. In these patients, MRI, CT, X-rays were performed; denomination and dosage of analgesics were recorded; nerve function and pain status were respectively evaluated by ASIA grade and VAS score before and after operation. RESULTS: All patients were followed up from 8 to 32 months with an average of (17.29±6.02) months. All bone fragments of spinal canal were removed and spinal cord decompressions were achieved. At final follow-up, VAS scores were from 0 to 8 points with an average of (2.43±2.46) points, and were obviously reduced than peroperative data (P<0.05). Eleven cases of them stopped analgesic intake and 7 cases reduced using. Three patients' symptoms and VAS scores were not improved. CONCLUSION: Old thoracolumbar fractures and intractable neuropathic pain need receive imaging examination as soon as possible and consider semicircular decompression therapy if bone fragments were in vertebral canal and spinal canal stenosis existed. This therapy can effectively relieve pain and profit nerve functional recovery.

[Distribution characteristics of polycyclic aromatic hydrocarbons in runoff from the middle line source area of south-to-north water diversion project].

The distribution characteristics of polycyclic aromatic hydrocarbons in runoff from the middle line source area of south-to-north water diversion project were studied. Five groups of artificial runoff fields were established to collect runoff based on the different types of land-use, the contents of 16 USEPA priority PAHs in the runoff were determined using GC/MS method. The results showed that the average concentrations of PAHs of the aqueous phase in the collected runoff samples of different land-use types decreased in the order:cultivated land (26.53 ng x L(-1)) > oak forest (20.91 ng x L(-1)) > orchard (17.59 ng x L(-1)), and the average concentrations of PAHs of the particle phase were cultivated land (1 073.72 ng x g(-1)) > orchard (652.29 ng x g(-1)) > oak forest (385.46 ng x g(-1)). The high carcinogenic components Bap were detected in both run off of cultivated land and orchard with a detected rate of 30%. According to National Recommended Water Quality Standards of priority toxic pollutants (2006 USEPA), it was found that Chr exceed standard 40%, with a detected rate of 100%. It was also found that the runoff volume and the total PAHs content in runoff increase with the slope, and PAHs loss and slope were closely related in same land-use types. Based on the Molecular Markers Indicative Law, it can be concluded that the dominant source of PAHs in runoff of study area was combustion of coal, and a small amount came from vehicle exhaust emissions. There is a certain degree of ecological risk about runoff PAHs pollution in the study area, which is worth further attention.

[Distribution characteristics of organochlorine pesticides in surface water and sediments from the Mengjin wetland].

The surface water and sediments from the Mengjin wetland were collected. After seperated and concentrated by solid phase extraction and Soxhlet extraction, twenty kinds of organochlorine pesticides (OCPs) in the samples from the Mengjin wetland were analyzed by gas chromatography. In the surface water, 7 kinds of OCPs (incluing alpha-HCH, beta-HCH, gamma-HCH, delta-HCH, 4,4-DDT, heptachor and aldrin) were detected, with the detected ratio of 4.2% -62.5% and the content range of ND-12.21 ng/L. In the sediments, 4,4-DDE and 4,4-DDT were detected, with the detected ratio of 50%-75% and the content range of ND-64.58 ng/g. HCHs and DDTs in the surface water were both lower than the limited value defined by Environmental Quality Standards for Surface Water in China, while the surface sediments in the Mengjin wetland pose a bit high risk comparing with ERL and ERM value of risk evaluation. Distribution characteristics of OCPs components showed that HCHs usually had higher residue levels in surface water, while sediment was the fate of DDTs in the transfer process of materials from water to sediment. OCPs content in the surface water and sediments both decreased in the order of high water period > level water period > low water period. OCPs in the low water seasons were mainly the early residue, but OCPs in the high seasons had some new input in near term in the surface water and sediments. The results suggested that non-point source was one of the important sources of OCPs entering Mengjin wetland.