To compare the effectiveness between open reduction combined with internal fixation and artificial radial head replacement in treating Mason type-III comminuted fracture of radial head, to provide the evidence for available treatment methods. Methods Between January 2004 and June 2008, 65 cases of Mason type-III comminuted fractures were treated with open reduction, AO mini plate and screw system or a combination of Kirschner treatment (internal fixation group, n=35) and with artificial radial head replacement (replacement group, n=30). In internal fixation group, there were 21 males and 14 females with an age range of 21 to 35 years (mean, 30.7 years); the causes of injury were traffic accidentin 12 cases, fall ing from height in 8 cases, and a fall in 15 cases; the locations were left side in 23 cases and right side in 12 cases; and the time between injury and surgery was 1-7 days (mean, 3 days). In replacement group, there were 19 males and 11 females with an age range of 23 to 67 years (mean, 32.5 years); the causes of injury were traffic accident in 7 cases, fall ing from height in 8 cases, and a fall in 15 cases; the locations were left side in 17 cases and right side in 13 cases; and the time between injury and surgery was 1-6 days (mean, 1.5 days). There was no significant difference in gender, age, disease cause, disease duration, or other general information between 2 groups (P gt; 0.05), so that 2 series of patients had comparabil ity. Results Incisions healed primarily in 2 groups. All patients were followed up 1 to 4 years with an average of 2.5 years. There were significant differences in elbow flexion angle, extension angle, and forearm rotation angle between 2 groups (P lt; 0.05), but no significant difference in elbow pronation or supination weakness (P gt; 0.05). In internal fixation group, primary union occurred in 29 cases, delayed union in 2 cases, nonunion with ectopic ossification in 2 cases, and internal fixation failure in 2 cases. In replacement group, elbow flexion angle lost beyond 30o in 1 case after 1 year, elbow stiffness occurred in 1 case because prosthesis was too long. According to Broberg and Morrey elbow scores system, the scores were 69.51 ± 10.23 in internal fixation group and 81.55 ± 12.06 in replacement group, showing significant difference (P lt; 0.05). The results were excellent in 15 cases, good in 5 cases, fair in 11 cases, and poor in 4 cases with an excellent and good rate of 57.1% in internal fixation group; the results were excellent in17 cases, good in 5 cases, fair in 6 cases, and poor in 2 cases with an excellent and good rate of 73.3%. Conclusion Artificial radial head replacement can achieve better joint function compared with open reduction combined with internal fixation in treating Mason type-III comminuted fractures of radial head.
Objective To evaluate the safety and effect of early therapeutic endoscopic retrograde cholangiopancreatography (ERCP) and interventional treatment for acute biliary pancreatitis. Methods Eighty-seven hospitalized patients with acute biliary pancreatitis were divided into endoscopic therapy group and conservative therapy group according to the treatment methods. ERCP examination and treatment were used in the endoscopic therapy group, medical conservative treatments were used in the conservative therapy group. The efficacy such as blood amylase recovery time, abdominal pain relief time, blood white blood cell recovery time, liver function recovery time, hospital stay, and complications were observed. Results Blood amylase recovery time, abdominal pain relief time, blood white blood cell recovery time, liver function recovery time, and hospital stay in the endoscopic therapy group were significantly shorter than those in the conservative therapy group (Plt;0.05). There were no ERCP related severe complications or aggrevated symptoms. Conclusion Early endoscopic therapy is a safe and effective method for acute biliary pancreatitis and can prevent further progression to severe status.
ObjectiveTo investigate the feasibility and safety of the double cavity casing negative pressure drainage by inside and outside of the intestine in the primary resection and anastomosis of left colon cancer combined with acute obstruction. MethodsEighty-one cases of left colon cancer combined with acute obstruction who underwent surgeries in our hospital from January 2009 to December 2012 were collected prospectively, and were divided into one-stage surgery group (n=41) and control group (n=40). Cases of one-stage surgery group received double cavity casing negative pressure drainage by inside and outside of the intestine in the primary resection and anastomosis, and cases of control group underwent two-stage surgeries. Comparison of operation time, blood loss, time of anal exhaust after operation, hospital stay, hospital expense, and incidence of complication between the 2 groups was performed. ResultsThere were no significant difference in the operation time[(166±19) minutes vs. (173±23) minutes], blood loss[(253±42) mL vs. (273±50) mL], and time of anal exhaust after operation[(3.24±0.73) days vs. (3.50±0.95) days]beeween one-stage surgery group and control group, but hospital stay[(15.1±2.3) days vs. (23.1±4.1) days]and hospital expense[(3.70±0.68) ×105 yuan vs. (5.77±0.95) ×105 yuan]of one-stage surgery group were lower than those of control group (P<0.05). In addition, there were no significant difference in the incidences of wound infection[7.3% (3/41) vs. 10.0% (4/40)], intraabdominal infection[4.9% (2/41) vs. 10.0% (4/10)], pulmonary infection[12.2% (5/41) vs. 15.0% (6/40)], and anastomotic leakage[2.4% (1/41) vs. 5.0% (2/40)]beeween one-stage surgery group and control group (P>0.05). All of the cases were followed up for 1-36 months, and the median time were 22 months. There were no significant difference in the mortality[0 (0/41) vs. 2.5% (1/40)], recurrence rate[2.4% (1/41) vs. 5.0% (2/40)], and metastasis rate[7.3% (3/41) vs. 10.0% (4/40)]beeween one-stage surgery group and control group too (P>0.05). ConclusionIn the case of negative pressure drainage of double cavity casing, underwent decompression of the small bowel, and irrigation of colon, the primary resection and anastomosis of left colon cancer combined with acute obstruction was safe and feasible.
Objective To evaluate the results of operative treatment of acetabular fractures and to investigate its influence factors. Methods The cl inical data were analyzed retrospectively from 82 patients with acetabular fractures treated between September 2004 and June 2009. Of 82 patients, 65 were male and 17 were female, aged 26-72 years (mean, 38 years).Fractures were caused by traffic accident in 62 cases, by crush in 13 cases, and by fall ing from height in 7 cases. The time from injury to admission was 30 minutes to 12 days (median, 7.6 hours) in 70 cases, 12 cases were transferred because poor result after 34-67 days of conservative treatment. According to Judet classification, there were 24 cases of posterior wall fracture, 3 cases of posterior column fracture, 1 case of anterior wall fracture, 2 cases of anterior column fracture, 6 cases of transverse fracture, 16 cases of transverse and posterior wall fracture, 4 cases of posterior column and posterior wall fracture, 5 cases of T-type fracture, 3 cases of anterior and posterior hemitransverse fracture, and 18 cases of complete both-column fracture; 24 cases combined with dislocation of the hip. During operation, Kocher-Langenbeck approach was used in 49 cases, anterior il ioinguinal approach in 19 cases, and the combination of anterior and posterior approaches in 14 cases. Reconstructive plate (74 cases) and hollow lag screw (8 cases) internal fixation were used. The function of the hip was evaluated according to the modified Merled’Aubigne- Postel hip score system postoperatively. According to fracture type, age, lower extremity fracture before operation, qual ity of reduction, timing of surgery, hi p dislocation and time of reduction, operative approach, deep vein thrombosis (DVT), and heterotopic ossification (HO), the patients were divided into the groups and the results were compared. Results Accordancewith the Matta X-ray evaluation criteria, anatomic reduction was achieved in 21 cases, good reduction in 37 cases, fair reduction in 16 cases, and poor reduction in 8 cases, and the excellent and good rate was 71%. All the cases were followed up 12-52 months mean, 34 months). Iatrogenic sciatic nerve injury occurred in 8 cases, infection in 3 cases, HO in 16 cases, DVT in 3 cases, hip posttraumatic arthritis in 12 cases, and avascular necrosis of the femoral head in 9 cases. X-ray examination showed that 80 cases achieved fracture union at 10-24 weeks after operation (mean, 14 weeks) and 2 cases had fracture delayed union at 10 months and 12 months after operation. According to the modified Merled’Aubigne-Postel hip score system, the function of the hip was rated as excellent in 26 cases, good in 32, fair in 20, and poor in 4 at 6 months after operation; the excellent and good rate was 71%. The affecting factors of cl inical results of acetabular fractures were fracture type, age, lower extremity fracture before operation, qual ity of reduction, timing of surgery, hip dislocation and time of reduction (P lt; 0.05). However the operative approach, DVT, and HO were not affecting factor of the acetabular fractures (P gt; 0.05). Conclusion Operative treatment of acetabular fractures has a satisfying therapeutic effect. Fracture type, age, lower extremity fracture before operation, qual ity of reduction, timing of surgery, hip dislocation, and time of reduction are risk factors affecting postoperative results.
Objective To compare the clinical effect of tissue selecting therapy stapler (TST) and procedure for prolapse and hemorrhoids (PPH) in treatment of hemorrhoid in Ⅲ-Ⅳ degree. Methods Clinical data of 80 cases of hemorrhoid in Ⅲ-Ⅳ degree who treated in The First Affiliated Hospital of Harbin Medical University from May 2015 to July 2015 were retrospectively collected. All the 80 cases were divided into TST group (n=40) and PPH group (n=40) according to the surgical types. The comparison of the clinical effect of 2 groups was performed. Results The operative time, hospital stay, intraoperative blood loss, anal fall bilge feeling score, postoperative pain score at 3 time points, and the incidence of anal secretions of TST group were lower or shorter than those corresponding indexes of PPH group (P<0.05). But there was no significant difference in cure rate, the incidence of urinary retention, the incidence of anal stenosis, the incidence of intractable pain, and satisfaction situation between the 2 groups (P>0.05). All of the cases were followed up for 3 months, during the follow-up period, no one suffered from rectal vaginal fistula, fecal incontinence, and recurrence. Conclusion TST and PPH both have satisfactory effect in treatment of hemorrhoid in Ⅲ-Ⅳ degree, but TST has advan- tages of less blood loss, shorter operative time, rapid postoperative recovery, and less pain.
Objective To describe the design and application of an emergency response mobile phone-based information system for infectious disease reporting. Methods Software engineering and business modeling were used to design and develope the emergency response mobile phone-based information system for infectious disease reporting. Results Seven days after the initiation of the reporting system, the reporting rate in the earthquake zone reached the level of the same period in 2007, using the mobile phone-based information system. Surveillance of the weekly report on morbidity in the earthquake zone after the initiation of the mobile phone reporting system showed the same trend as the previous three years. Conclusion The emergency response mobile phone-based information system for infectious disease reporting was an effective solution to transmit urgently needed reports and manage communicable disease surveillance information. This assured the consistency of disease surveillance and facilitated sensitive, accurate, and timely disease surveillance. It is an important backup for the internet-based direct reporting system for communicable disease.
Objective To evaluate the effectiveness of terazosin, tamsulosin and finasteride for benign prostatic hyperplasia (BPH). Methods We searched the related original studies all over the world, and only included randomized controlled trials (RCT) and quasi-randomized controlled trials (CCT). MEDLINE (1966 to Dec. 2004), EMBASE (1984 to Dec. 2004), The Cochrane Library (Issue 4, 2004) and four Chinese databases were electronically searched and 10 related journals were handsearched. The studies included in the references of eligible studies were additionally searched. Two reviewers independently screened the studies for eligibility, evaluated the quality and extracted the data from the eligible studies, with confirmation by cross-checking. Divergences of opinion were consulted by a third party. Meta-analysis was performed by using RevMan 4.2 software. Results Twelve original studies involving 2 471 participants met inclusion criteria. Compared with terazosin, tamsulosin could improve international prostatic symptom score, with WMD 0.75, 95% confidence interval (CI) 0.03 to 1.46, P=0.04. There was no statistical difference between terazosin and tamsulosin in improving the average rate of urine flow (WMD 0.23, 95%CI -0.39 to 0.85, P=0.46), the residual urine volume (WMD 0.82, 95%CI -2.92 to 4.57, P=0.67) and in diminishing the volume of prostate (WMD 2.20, 95%CI -3.99 to 8.39, P=0.49). There was no statistical difference between finasteride and tamsulosin in improving the international prostatic symptom score (WMD 0.65, 95%CI -0.45 to 1.75, P=0.25) or the max rate of urine flow (WMD 0.39, 95%CI -0.72 to 1.51, P=0.49). Only two studies compared finasteride with terazosin and had different conclusions. Only one study compared finasteride or terazosin with a combination of these drugs suggested that the combination had higher effective power than finasteride alone but no difference with terazosin alone. Conclusions Although the effectiveness in some aspects is higher in the tamsulosin group, there is not enough evidence to show which one is the best among these three drugs. The combination of finasteride and terazosin does not show more effectiveness than terazosin alone. This review suggests that tamsulosin alone should be used for the treatment of BPH and the combination needs to be identified by better evidence. It is important to improve the quality of original studies.
Objective To study the efficacy and safety of combined anti-tuberculosis regimen containing bedaquiline in the treatment of multidrug-resistant tuberculosis (MDR-TB). Methods A total of 69 MDR-TB patients treated by joint regimen combined bedaquiline with other anti-tuberculosis drugs between March 2018 and August 2019 in Public Health Clinical Center of Chengdu were taken as the trial group, and 60 MDR-TB patients received treatment without bedaquiline between June 2016 and December 2017 in the same hospital were taken as the control group. The efficacy and safety of the two groups were compared. Results The 69 patients in the trial group included 44 males and 25 females, aged from 21 to 63 years, with an average of (34.6±11.0) years; 58 patients (84.1%) completed the 24-week treatment with bedaquiline, while 11 patients did not complete the treatment, including 3 deaths (4.3%), 1 loss of follow-up (1.4%), 1 withdrawal from the study (1.4%), and 6 discontinuation due to adverse events (8.7%). Among the 54 patients with positive results of tuberculosis on baseline sputum culture, 49 transformed to negative results within 24 weeks of treatment (the negative conversion rate was 90.7%), and the median negative conversion time was 13.0 weeks. The 60 patients in the control group included 45 males and 15 females, aged from 16 to 66 years, with an average of (35.5±13.2) years. Among the 53 patients with positive results of tuberculosis on baseline sputum culture, 30 transformed to negative results within 24 weeks of treatment (the negative conversion rate was 56.6%), and the median negative conversion time was 12.0 weeks. The negative conversion rate of sputum bacteria in the trial group was significantly higher than that in the control group (χ2=16.133, P<0.001). The most common adverse reactions in the trial group were liver function abnormalities (42 cases, 60.9%), prolonged QTc interval (37 cases, 53.6%), electrolyte disturbances (20 cases, 29.0%), and blood system damage (20 cases, 29.0%). In the 37 patients who experienced prolonged QTc interval, there were 8 patients with QTc intervals≥500 ms and 29 patients with QTc intervals ≥450 ms and <500 ms, with a median occurrence time of 16.0 weeks, among whom 25 patients experienced prolonged QTc interval in 4-48 weeks after the withdrawal of bedaquiline. Conclusion The negative conversion rate of tuberculosis sputum culture of patients with MDR-TB treated by bedaquiline combined with other anti- tuberculosis drugs is high, but electrocardiogram should be closely monitored during and after the treatment in order to guard against the potential cardiac toxic effects of bedaquiline.
Objective To assess the necessity and safety of ureteral stenting after ureteroscopic lithotripsy in treatment of middle and distal ureteral calculi. Methods We electronically searched MEDLINE, EMbase, Cochrane Library, CBM, VIP and CNKI to collect randomized controlled trials (RCTs) involving men with or without ureteral stenting after ureteroscopic lithotripsy from 2000 to March 2010. The quality of included trials was assessed. Data were extracted and analyzed with RevMan5.0 software. Results Six RCTs involving 543 patients were identified. The results of meta-analysis showed that: a) There was no statistical difference between two groups in stone clearance rate (RR=0.45, 95% CI 0.98 to 1.01, P=0.15), dysuria rate (RR=1.35, 95% CI 0.99 to 1.84, P=0.06), and hematuria rate (RR=2.12, 95% CI 1.00 to 4.49, P=0.05); b) There was statistical difference between two groups in frequent micturition rate (RR=2.17, 95% CI 1.13 to 4.17, P=0.02), the mean visual analog score 3 days postoperatively (WMD=0.94, 95% CI 0.47 to 1.42, P=0.000?1), and the operation time (WMD=3.57, 95% CI 1.40 to 5.72, P=0.001). Without postoperative ureteral stenting can shorten the operation time, decrease the irritation signs of bladder, and can improve quality of postoperative life without influence on stone clearance. Couclusions The routine ureteral stenting after ureteroscopic lithotripsy may be not necessary in order to keep patients from unsafety. More reasonable randomized double blind controlled trails with large sample are required to provide proofs with high quality because the methodology quality of included studies is lower.
Objective To evaluate the operative procedure and the cl inical effectiveness of open reduction and internal fixation in the treatment of posterior malleolus fractures. Methods Between June 2005 and December 2008, 46 patients with posterior malleolus fractures were treated with open reduction and internal fixation and followed up. There were 29 males and 17 females with an average age of 47.7 years (range, 19-76 years). Fractures were caused by sprain in 17 cases, by fallingin 15 cases, by traffic accident in 12 cases, and by other reasons in 2 cases. The locations were left ankle in 25 cases and right ankle in 21 cases. There were 6 simple posterior malleolus fractures, 13 lateral and posterior malleolus fractures, and 22 trimalleolar fractures, and 5 lateral and posterior malleolus fractures accompanying by injury of deltoid l igament of ankle. According to Lauge- Hansen classification system, 13 cases and 9 cases were rated as supination-external rotation type III and type IV respectively, and 18 cases as pronation-external rotation type IV. According to Naoki’s classification of posterior malleolus fractures, there were 29 cases of posterolateral-obl ique type, 11 cases of medial-extension type, and 6 cases of small-shell type. Seven patients underwent emergency operation and 39 patients underwent selective operation. Results Two patients developed superficial infection, which was cured after dressing change, and the other incisions healed by first intention. Forty-six patients were followed up 37 months on average (range, 18-63 months). All fractures healed after 3 to 6 months (mean, 4.3 months). One patient developed lateral suralcutaneous nerve injury, and 9 patients had mild weight-bearing pain or discomfort. The results of American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score were excellent in 17 cases, good in 21 cases, and fair in 8 cases with an excellent and good rate of 83%. The mean visual analogue scale (VAS) score was 1.9 (range, 0-5). Conclusion The anatomic reduction and internal fixation can achieve the satisfactory results in the treatment of posterior malleolus fractures. The best treatment and fixation methods should be chosen based on different types of posterior malleolus fractures.