Modified pedicle screw-rod versus anterior subcutaneous internal pelvic fixation for unstable anterior pelvic ring fracture: a retrospective study and finite element analysis.

OBJECTIVES: This study compared the stability and clinical outcomes of modified pedicle screw-rod fixation (MPSRF) and anterior subcutaneous internal pelvic fixation (INFIX) for the treatment of anterior pelvic ring fractures using the Tornetta and Matta grading system and finite element analyses (FEA). METHODS: In a retrospective review of a consecutive patient series, 63 patients with Orthopaedic Trauma Association (OTA)/Arbeitsgemeinschaft für Osteosynthesefragen (AO) type B or C pelvic ring fractures were treated by MPRSF (n = 30) or INFIX (n = 33). The main outcome measures were the Majeed score, incidence of complications, and adverse outcomes, and fixation stability as evaluated by finite element analysis. RESULTS: Sixty-three patients were included in the study, with an average age of 34.4 and 36.2 in modified group and conventional group, respectively. Two groups did not differ in terms of the injury severity score, OTA classification, cause of injury, and time to pelvic surgery. However, the MPSRF group had a rate of higher satisfactory results according to the Tornetta and Matta grading system than the conventional group (73.33% vs 63.63%) as well as a higher Majeed score (81.5 ± 10.4 vs 76.3 ± 11.2), and these differences were statistically significant at 6 months post-surgery. FEA showed that MPSRF was stiffer and more stable than INFIX and had a lower risk of implant failure. CONCLUSIONS: Both MPSRF and INFIX provide acceptable biomechanical stability for the treatment of unstable anterior pelvic ring fractures. However, MPSRF provides better fixation stability and a lower risk of implant failure, and can thus lead to better clinical outcomes. Therefore, MPSRF should be more widely applied to anterior pelvic ring fractures.

A new method for assessing variability of 24 h blood pressure and its first application in 1526 elderly men.

1. Blood pressure variability (BPV) includes physiological and random variations in blood pressure (BP). Commonly used approaches, such as standard deviation (SD) and weighted standard deviation (wSD) methods, do not efficiently assess random variation in BP. In the present study, we propose a novel method to assess individual BP variations, extracting random variation in BP by eliminating physiological variation mathematically. This novel assessment method furthers our understanding of the relationship between BP variation and lacunar infarction (LACI). 2. In the present study, we analysed ambulatory blood pressure monitoring recordings taken from 1526 men aged 60-98 years of age. Individual curves were created using a mathematical method and the related BP variation calculated, namely the SD for individual BP variations. In addition, correlations between LACI and BP variations as determined by the classical SD method, wSD and our novel assessment method (SD') were evaluated. 3. The results demonstrated that 24 h variations in systolic BP (SBP) were closely associated with LACI when the SD and wSD methods were used (P < 0.05), but the most significant correlations were observed when the SD' method was used (P < 0.01). Furthermore, using SD' yielded the lowest value of the parameter P among the three different methods used to analyse BPV. Using the SD' method, a significant correlation was found between variations in SBP and the incidence of LACI (P < 0.05). It was found that the incidence of LACI increased by 2% with each 1 mmHg increase in SBP variation. 4. In conclusion, our novel assessment method enables mathematical removal of interference from physiological BP variation and the results show a better correlation with LACI. Thus, our novel method may be considered a simple index of 24 h BP variation that is superior to conventional SD and wSD methods.

Efficacy and safety of benidipine therapy of essential hypertension in elderly Chinese patients.

BACKGROUND: Benidipine (CAS 105979-17-7) is a dihydropyridine calcium channel blocker used in the treatment of hypertension and angina pectoris. OBJECTIVE: To examine the efficacy and safety of therapy with benidipine in elderly hypertensive patients. METHODS: Chinese patients >60 years of age with mild to moderate essential hypertension were enrolled. The patients were prescribed benidipine at the dose of 8 mg once daily for 12 weeks. Detailed laboratory examinations and 24-h ambulatory blood pressure monitoring were performed before and after the treatment. RESULTS: One hundred and sixty-four of the 180 patients enrolled completed the 12-week active treatment phase. Sitting systolic blood pressure (SBP) and diastolic blood pressure (DBP) reductions at the end of treatment were 21.50 +/- 12.83 and 10.60 +/- 8.04 mmHg, respectively; the proportion of patients showing a good treatment response was 95.1% for SBP and 96.9% for DBP. Benidipine significantly reduced the mean 24-h ambulatory blood pressure (p < 0.001 vs. baseline) exhibiting smooth, sustained effects and high trough-to-peak ratios (T/P ratio) (0.87 for SBP and 0.72 for DBP). Moreover, benidIpine significantly reduced the systolic morning blood pressure surge and urinary albumin, and it was well tolerated. No serious adverse events were noted. CONCLUSION: Benidipine was welltolerated and effective in elderly Chinese patients with essential hypertension.