Objective To investigate the appl ication of anti-rotation screw after dynamic hi p screw (DHS) in treatment of intertrochanteric fracture. Methods Between April 2006 and January 2010, 22 cases of intertrochanteric fractures underwent DHS fixation operation with an anti-rotation screw, including 15 males and 7 females with an average ageof 66.3 years (range, 54-83 years). Fractures were caused by sl ipping in 16 cases, traffic accident in 5 cases, and fall ing from height in 1 case. All cases showed closed fractures, including 13 cases in the left and 9 cases in the right. Eighteen cases were simple intertrochanteric fracture, 4 cases were intertrochanteric fractures compl icated with Colles fractures. According to Evans classification standard, there were 14 cases of type I, 6 cases of type II, 1 case of type III, and 1 case of type IV. The time from wound to operation was 3-7 days (mean, 4.5 days). Results The operation time ranged from 51-95 minutes (mean, 72 minutes). The intraoperative blood loss was 150-350 mL (mean, 270 mL). The hospital ization days were 12-35 days (mean, 16.8 days). Primary heal ing was observed in all cases. All cases were followed up 6-17 months (mean, 14 months). Union of fracture was observed at 12-16 weeks (mean, 13.6 weeks); no fracture or internal fixation loosening occurred. According to HUANG Gongyi’s standard of efficacy assessment, the results were excellent in 19 cases and good in 3 cases. Conclusion Appl ication of an anti-rotation screw can help to improve the strength of the DHS for the internal fixation of intertrochanteric fracture, especially the anti-rotation abil ity, which does not increase the operation time obviously.
Objective To investigate the application of the dynamic contrast enhanced MRI (DCE-MRI ) combined with magnetic resonance spectroscopy (MRS) in the diagnosis of prostate cancer. Method A total of 60 patients with prostate cancer and 60 patients with benign prostatic hyperplasia diagnoses in Sichuan Cancer Hospital from January 2011 to January 2014 were included as prostate cancer group and proliferative group respectively. Sixty healthy individuals during the same period were included as the control group. We used Siemens Avanto 1.5 T high field superconducting MRI for DCE-MRI scan and MRS scan. After the MRS scan was finished, we used the workstation spectroscopy tab spectral analysis. Eventually we got the crest lines of prostate metabolites choline (Cho), creatine (Cr) and citrate (Cit). Then we calculated Cho/Cit, (Cho+Cr)/Cit and their average. Results Comparing the signal value in 21 seconds, 1 minute, 2 minutes of DCE-MRI, the differences among the three groups were statistically significant (P<0.05). Comparing the results of spectral analysis, the differences among the three groups were statistically significant (P<0.05). The sensitivity was 89.67%, the specificity was 95.45% and the accuracy was 94.34% when using DCE-MRI combined with MRS. Conclusion DCE-MRI combined with MRS greatly improves the sensitivity, specificity and accuracy of the diagnosis of prostate cancer; it has a great application value in the diagnosis of prostate cancer.
ObjectiveTo compare the clinical effects of early dynamic brace passive activity program and average delay activity program after the repair of extensor tendon. MethodsSeventy-eight patients undergoing repair of the extensor tendon during the period from December 2008 to October 2011 in our hospital were randomly divided into two groups.The treatment group had 36 patients who were treated with early dynamic brace passive activity program,and the other 42 patients belonged to the control group and they accepted delay activity program.TAM and FIM were used to evaluate their clinical effects six and eight weeks after surgery,respectively. ResultsThe results of TAM and FIM of the treatment group were significantly better than those of the control group (P<0.01). ConclusionThe early dynamic brace passive activity after extensor tendon injury repair can improve the clinical effect and is worth popularizing.
To investigate the effects of augmentation with bone cement on the biomechanics of the dynamic hip screw (DHS) fixation in the intertrochanteric fracture specimen that has a normal bone density.MethodsTwentyfour matched pairs of the embalmed male upper femora (48sides) were used to make the specimens of the intertrochanteric fracture of Type A2. All the specimens were fixed with DHS. The right femur specimen from each pair was fixed by augmentation with DHS (the augmentation group) and the left femur specimen was fixed with the conventional fixation (the control group). Thebiomechanical tests on the bending stiffness and the torsional stiffness were performed with the servohydraulic testing machine in the two groups.ResultsThe maximum load and the maximum torque were 3 852.160 2±143.603 1 N and 15.5±2.6 Nm in the augmentation group and 3 702.966 7±133.860 1 N and 14.7±3.4 Nm in the control group. There was no significant difference in the biomechanical effects between the two groups (P＞0.05). Conclusion The augmenting fixation with bone cement in the intertrochanteric fracture specimen with a normal bone density has no significant effect on the strength of the DHS augmentation or on the overall stability of the fractured bone.
Traditional Chinese medicine (TCM) has some unique advantages in the prevention and treatment of cancer. Due to different ideas and mechanism of between TCM and biomedicine in the prevention and treatment of cancer, the clinial effect evaluation approches of biomedicine could not be used as a beneficial method to scientifically evaluate the effects of TCM. From three angles, this article analyzes the key issues regardsing the evaluation methods of TCM as an adjuvant therapy of cancer. It draws lessons from the idea of quality-adjusted survival (QAS), proposes Two-in-One (TIO) method to evaluate the effects of TCM as adjuvant therapy of cancer, which reflects the combined value of the individual patient dynamic information and provides methodological support for the effect evaluation of TCM.
ObjectiveTo observe the dynamic changes of plasma Clara cell secretory protein (CC16) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and to explore its role in the occurrence and development of the disease and clinical significance.MethodsA total of 71 AECOPD patients were included in this study as observation group. All subjects completed the CAT questionnaire and were sampled 2 ml of venous blood on day 1 and day 7 after their admission. And the percentage of forced expiratory volume in the first second (FEV1%pred), percentage of forced vital capacity in the estimated value (FVC%pred), FEV1/FVC ratio, arterial partial pressure of carbon dioxide (PaCO2), white blood cell count (WBC), the proportion of neutrophils (NEUT%), C-reactive protein (CRP), procalcitonin (PCT) and the length of stay of subjects were recorded. Another 20 healthy adults were enrolled as the control group. Each subject of the control group was sampled 2 ml of venous blood. The plasma CC16 levels of the two groups were tested and compared, and analyzed its correlation with CAT score and length of stay.ResultsThe plasma CC16 level of AECOPD patients was significantly lower than that of the control group, lung function was significantly lower than that of the healthy control group, WBC and NEUT% were significantly higher than that of the healthy control group, and the difference was statistically significant (P<0.05). Compared with day 1 after admission, the plasma CC16 level, CAT score, PaCO2, WBC, NEUT%, CRP, PCT of AECOPD patients on day 7 were significantly decreased, with statistically significant differences (P<0.05). The plasma CC16 level of AECOPD patients was negatively correlated with their CAT score (r=–0.704, P<0.001), and also was negatively correlated with the length of stay (r=–0.351, P=0.003).ConclusionsCC16 is involved in the development and progression of AECOPD and closely related to the severity and prognosis of the disease. Its dynamic changes can predict the condition changes and evaluate the clinical treatment effect of patients with AECOPD. Combined with common clinical indicators, CC16 can shorten the length of stay of patients.
ObjectiveTo evaluate the accuracy of the new dynamic approach in the measurement of respiratory mechanics with different pressure support (PS) level during pressure support ventilation (PSV) via oral-nasal mask.MethodsThe Respironics V60 ventilator was connected to a ASL5000 lung simulator, which simulate lung mechanics in patients with chronic obstructive pulmonary disease ［system compliance (Crs)=50 mL/cm H2O, airway resistance (Raw)=20 cm H2O/(L·s), inspiratory time (TI)=1.6 s, breathing rate=15 beats per minute］. PSV were applied with different levels of PS ［positive end-expiratory pressure=5 cm H2O, PS=5/10/15/20/25 cm H2O) and back-up rate=10 beats per minute］. Measurements were conducted at system leaks with 25 – 28 L/min. The performance characteristics and patient-ventilator asynchrony were assessed, including flow, airway pressure, time and workload. Crs and Raw were calculated by using new dynamic approach.ResultsTidal volume (VT) was increased with increasing PS level ［(281.45±4.26)mL at PS 5 cm H2O vs. (456.81±1.91)mL at PS 10 cm H2O vs. (747.45±3.22)mL at PS 20 cm H2O, P<0.01］. Severe asynchronous was occurred frequently when PS is at 25 cm H2O. Inspiration cycling criterion (CC) was up-regulated accompanied by increasing PS level ［(15.62±3.11)% at 5 cm H2O, vs. (24.50±0.77)% at 20 cm H2O, P<0.01］. Premature cycling was always existed during PSV when PS < 20 cm H2O, which could be eliminated as PS level increasing. Delay cycling was found when PS was at 20 cm H2O, and cycling delay time was (33.60±15.91)ms (P<0.01). The measurement of Crs was (46.19±1.57)mL/cm H2O with PS at 10 cm H2O, which was closer to the preset values of simulated lung. The underestimate of Crs was observed during high level PS support. The calculation of inspiratory and expiratory resistance was approximate to 20 cm H2O/(L·s) when PS level was exceeded 15 cm H2O.ConclusionsThe new dynamic approach can continuously assess the respiratory mechanics during non-invasive ventilation, which is no need to interrupt the patient's spontaneous breathing. Higher inspiratory flow during PSV is beneficial for Raw measurement, whereas the accuracy of Crs was influenced by the value of actual VT.
Objective From the viewpoint of health economics, to analyse the cost-utility of Coflex interspinous dynamic reconstruction and 360° fusion in the treatment of single level lumbar degenerative disease, so as to provide references to doctors and patients for making the best solution. Methods From October 2008 to November 2010, a prospective non-randomized controlled study was carried out on the patients diagnosed as L4-L5 degenerative lumbar spinal disorders, of whom Group A were treated by posterior decompression combined with Coflex interspinous dynamic reconstruction and Group B accepted lumbar 360° fusion treatment. The SF-36 questionnaire was used to survey the life quality of patients and to calculate the quality-adjusted life year (QALY); meanwhile, the costs of the treatment were collected to compare the cost-utility ratio between the two groups. Results A total of 60 patients were included, among whom 29 patients including 20 males and 9 females were in Group A, and the other 31 patients including 16 males and 15 females were in Group B; and the mean time of follow-up was 16.4 months (12-23 months). The average age of Group A and Group B was 45.1 years (21-67 years) and 56.2 years (32-86 years), respectively; the medical costs were 51 509.9±2 422.9 yuan and 57 409.7±9 072.9 yuan, respectively; the life quality compared with that of pre-operation improved by 42.60% and 42.82%, respectively; the cost-utility ratios were 69165.6±4716.0 yuan/QALY and 77 976.7±12 757.4 yuan/QALY, respectively. For each increase of one QALY, Group A could save 12.74% of the cost compared with Group B. Conclusion Coflex interspinous dynamic reconstruction has the equal short-term effects to lumbar 360° fusion in the treatment of L4-L5 degenerative lumbar spinal disorders, but it has lower costs than the latter, and is more in line with the requirements of health economics.
Objective To elucidate the new development, structural features and appl ication of the lumbar interspinous process non-fusion techniques. Methods With the review of the development course and important research works in the field of the lumbar inter-spinous process non-fusion techniques, the regularity summary, science induction, and prospect were carried out. Results The lumbar inter-spinous process non-fusion technique was a part of non-fusion insertof spinal division posterior surface. According to the design, it could be divided into two major categories: dynamic and static systems. The dynamic system included Coflex and device for intervertebral assisted motion; the static system included X-STOP, ExtenSure and Wall is. The lumbar inter-spinous process non-fusion technique was a new technique of spinal division, it could reserve the integrated function of intervertebral disc and zygapophysial joint, maintain or recover the segmental movement to a normal level, and have no adverse effect on the neighboring segments. A lot of basic and cl inical researches indicated that lumbar inter-spinous process insert had extensive appl ication to curatio retrogression lumbar spinal stenosis, discogenic low back pain, articular process syndrome, lumbar intervertebral disc protrusion and lumbar instabil ity and so on. Conclusion With the matures of lumbar inter-spinous process non-fusion techniques and the increased study of various types of internal fixation devices, it will greatly facil itate the development of treatment of lumbar degenerative disease. But long-term follow-up is needed to investigating the long-term efficacy and perfect operation indication.
Objective To assess the changes of cardiac autonomic nerves’s function in patients underwent bronchofiberscopy by observing the dynamic electrocardiogram ( DCG) and heart rate variability ( HRV) , and investigate the effect of different preoperative medications on heart function.Methods Eighty patients underwent bronchofiberscopy were randomly divided into three groups according to different anaesthesia. Group A ( n =30) were local anaesthetized by nebulized lidocaine, group B ( n = 30) received atropine 1 mg injection intramuscularly and nebulized lidocaine, group C ( n = 20) were anaesthetized bypropofol intravenously. The DCG and HRV of three groups were mornitored at pre-inductive point( T0 ) , post inductive point ( T1 ) , point during the operation ( T2 ) , and point after operation ( T3 ) .Results The incidences of ST-T change, tachycardia, and bearing premature in group A and B were increased. The incidence of tachycardia in group C was also increased, but lower than group A and B while the ST-T change and bearing premature were milder ( P lt;0. 05) . Episodes of bradycardia occurred 3 times in group A andnone in group B and C ( P lt;0. 01) . The low-frequency ( LF) , high-frequency ( HF) , total power ( TP) in group A and B were raised, but the LF was highly raised, and the LF/HF and HRV significantly decreased.The LF/HF and HRV decreased lightly in group C ( P gt; 0. 05) . Conclusions Bronchofiberscopy examination can decrease HRV and induce arrhythmia and ST-T change, but also excite vagus nerve. Atropine can inhibit the excitability of vagus nerve and have no influence on HRV. The propofol may obviously decrease the sympathetic nervous activation, balance sympathetic and vagus nerves, which is beneficial to the stability of hemodynamics.