Middle-term follow-up results of Pipkin type IV femoral head fracture patients treated by reconstruction plate and bioabsorbable screws.

PURPOSE: To investigate the mid-term curative effects of the treatment of Pipkin type IV femoral head fractures using a reconstruction plate and bioabsorbable screws and provide the evidence for clinical practice. METHODS: From February 2010 to September 2014, 21 patients with Pipkin type IV femoral head fractures were treated surgically. There were 13 males and 8 females with an average age of 41.1 years (range, 20-65 years). The causes of the fractures included traffic accidents (13 cases), falls from a height (four cases), heavy lifting injuries (three cases), and sport injury (one case). All patients were followed up with radiography and three-dimensional reconstruction computed tomography and other checks and any complications were actively managed. Closed reduction of fracture-dislocation of the hip was attempted under general anesthesia using the Kocher-Langenbeck approach. Femoral head fractures were treated with internal fixation or excision based on the size of the fracture fragments, whereas acetabular fractures were fixed with a reconstruction plate and screws following anatomic reduction. RESULTS: The incisions healed by primary intention in all patients after surgery, without any infection, deep venous thrombosis, or other complications. All 21 patients were followed up for 36-76 months, with an average follow-up duration of 49 months. Postoperative imaging data showed that all dislocations and fractures were anatomically reduced, and bony union of the fractures was achieved. Heterotopic ossification was found in four patients, post-traumatic osteoarthritis in three, and avascular necrosis of the femoral head in two. At the final follow-up, the assessment of hip joint function according to the Thompson-Epstein scoring scale was excellent in 10 cases, good in six cases, fair in three cases, and poor in two cases. The rate of excellent and good functional outcomes was 76.1%. CONCLUSION: The mid-term curative effects of a reconstruction plate and bioabsorbable screws in the treatment of Pipkin type IV femoral head fractures is significant, and such the treatment can significantly improve the patient's joint function and quality of life.

Early and mid-term results of transarticular external fixation in the treatment of supination-external rotation type IV equivalent ankle fractures.

PURPOSE: To investigate the early and mid-term results of open reduction and internal fixation (ORIF) with transarticular external fixation (TEF) but no deltoid ligament repair (DLR) in the treatment of supination-external rotation type IV equivalent (SER IV E) ankle fractures (AO/OTA classification 44-B 3.1) and provide evidence for clinical practice. METHODS: This study cohort consisted of 22 patients with SER IV E ankle fractures that underwent ORIF with TEF but no DLR between December 2011 and December 2014. There were 13 males and 9 females, mean age 38.9 years (range, 17-73 years). Eight cases involved the left side and 14 the right side. The causes of fractures included road traffic accidents (11 cases), falling from height (6 cases) and sports injuries (5 cases). The mean period of hospitalization was 9.8 days (range, 6-14 days). For all the patients, MRI and three-dimensional CT were done before surgery and X-rays done preoperatively and during follow-ups. The external frame was kept for 8-10 weeks. The preoperative American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was 56.86 ± 4.400, the Medical Outcomes Short Form 36-item (SF-36) questionnaire score was 57.41 ± 4.102 and the visual analog score (VAS) was 5.50 ± 1.058. Patients' main complaints about inconvenience of daily life were also recorded. RESULTS: All the 22 patients were followed up for 24-63 months (mean, 33.6 months). None of them developed nonunion during the follow-up; pin site infection was observed in one patient and posttraumatic osteoarthritis in another. At the final follow-up, the average AOFAS score, SF-36 score and VAS score were respectively 90.59 ± 5.096, 79.59 ± 5.394 and 1.82 ± 1.181, which were significantly improved compared with the preoperative data (t = 26.221, p < 0.001; t = 11.910, p < 0.001; t = 11.571, p < 0.001). The therapeutic effect was excellent in 13 cases, good in 7 cases and fair in 2 cases, with a good-excellent rate of 90.9%. Patients' main complaints were inconvenience of clothing (17 cases) and extremity cleaning (5 cases). CONCLUSION: In the treatment of SER IV E ankle fractures, ORIF with TEF but no DLR can achieve satisfactory outcome, but long-term effect should be confirmed by large sample randomized controlled trials.

Effect of titanium preoxidation on wrought pure titanium to ceramic bond strength.

STATEMENT OF PROBLEM: The creation of high bond strength between machined computer-manufactured pure titanium and porcelain remains a problem. However, machined titanium does not form the thick titanium oxide film found in cast titanium. PURPOSE: The purpose of this study was to investigate the effects of different preoxidation treatments on the bond strength of a machined pure titanium ceramic system. MATERIAL AND METHODS: Specimens of commercially pure titanium (25 × 3 × 0.5 mm) were divided equally into 6 groups (n=8), which received different preoxidation treatments (3 hour natural oxidation; 600°C, 650°C, 700°C, 750°C, and 800°C for 3 minutes). Bond strengths were evaluated by using a 3-point bend test. The results were analyzed by using 1-way ANOVA and the least significant difference test. Twelve additional specimens of commercially pure titanium (15 × 3 × 0.5 mm) were cut for interface observation and divided equally into 6 groups that received the preoxidation treatments described previously. Scanning electron microscopy and energy dispersive spectrum were used to observe microscopic features of the interface between Ti and ceramic. RESULTS: The bond strength values of the 6 groups ranged from 23.72 ±2.53 MPa to 36.99 ±3.92 MPa, with significant differences (P<.05). The specimen that received 750°C preoxidation had the highest bond strength. The main interface elements of the 6 groups were O, Si, Ti, Sn, Al, Na, and K. Ti showed a sigmoidal diffusion curve in each group, and Si showed a sigmoidal diffusion curve in most groups. Sn was enriched in each group's interface. CONCLUSIONS: Preoxidation under vacuum before porcelain firing can effectively improve the bond strength of machined pure titanium-porcelain systems.

Tolerability, pharmacokinetics and pharmacodynamics of CMAB001, an anti-CD11a antibody, in Chinese healthy volunteers and psoriatic patients.

AIM: To evaluate the pharmacokinetics (PK), pharmacodynamics (PD) and primary tolerability of an anti-CD11a monoclonal antibody (CMAB001) in Chinese healthy volunteers and psoriatic patients. METHODS: Two open-label studies were conducted. One was a parallel-group, single-center, dose-escalation test, including 24 healthy adult volunteers from 18 to 45 years in age. All subjects randomly received a single subcutaneous injection dose of 0.5, 1.0 or 2.0 mg/kg. The other was a multiple-dose study: 10 adult psoriatic patients were administered weekly subcutaneous injections of 1.0 mg/kg for 7 weeks. RESULTS: CMAB001 was well tolerated in the single- and multiple-dose studies. Slow absorption was observed in both studies. In the single-dose study, the concentration of CMAB001 reached its highest level 2 d later after the injection, and the C(max) increased in an approximate dose-proportionate manner, while the area under curve (AUC) showed much greater than dose-proportionate increase. In the multiple-dose study, the steady-state serum concentration level was attained following the 4th injection. CONCLUSION: CMAB001 exhibited a nonlinear pharmacokinetic profile over the dose range from 0.5 to 2.0 mg/kg, and was well tolerated in healthy volunteers and psoriatic patients.

[Experience of He's three-clear method by stages for herpes zoster on the head and face].

The clinical experience of He's three-clear method by stages for herpes zoster on the head and face is summarized. The strong-clear method (blood-letting therapy) combined with mild-clear method (acupuncture with filiform needle) are applied for the acute pain period and subacute pain period of herpes zoster on the head and face. For acute pain period, the bleeding volume should be large (more than 10 mL), and treatment is given once every other day; for the subacute pain period, the bleeding volume should be 5-10 mL, and treatment is given 2-3 times a week. In the chronic pain period, the fire needle of the warm-clear method combined with mild-clear method (acupuncture with filiform needle) are applied for the syndrome of qi-stagnation and blood-stasis, while the warm acupuncture of the warm-clear method combined with mild-clear method (acupuncture with filiform needle) ware applied for the syndrome of qi-deficiency yin-injury blood-stasis.

[Moxibustion on plaque psoriasis of blood stasis: a randomized controlled trial].

OBJECTIVE: To observe the short-term and long-term effects of moxibustion on plaque psoriasis of blood stasis, and to compare the curative effect between moxibustion and calcipotriol ointment. METHODS: A total of 80 patients with plaque psoriasis of blood stasis were randomly divided into an observation group (40 cases, 2 cases dropped off) and a control group (40 cases, 4 cases dropped off). Both groups were given routine medical vaseline topical emollient basic treatment. In the observation group, moxibustion was applied to ashi point (target skin lesions), Zusanli (ST 36), Xuehai (SP 10) and Qihai (CV 6) for 30 min each time, 3 times a week. The control group was treated with calcipotriol ointment (0.25 g each time, once in the morning and evening) on the target skin lesions. Both groups were treated for 8 weeks. The psoriasis area and severity index (PASI) score before and after treatment, main clinical symptoms of TCM score and dermatology life quality index (DLQI) score before and after treatment and 3 and 6 moths follow-up were observed in the two groups; the clinical efficacy after treatment was evaluated and the recurrence rates of the two groups were followed up for 3 and 6 months after treatment. RESULTS: After treatment, the PASI scores in the both groups were lower than before treatment (P<0.01). After treatment and 3 and 6 months follow-up, the main clinical symptoms of TCM scores and DLQI scores of the two groups were lower than those before treatment (P<0.05), and at 3 and 6 months follow-up, those in the observation group were lower than the control group (P<0.01). There was no statistically significant difference between the observation group and the control group in overall effective rate and target skin lesion effective rate (P>0.05). At 3 and 6 months follow-up, the overall recurrence rate and target skin lesion recurrence rate in the observation group were lower than those in the control group (P<0.05). CONCLUSION: Both moxibustion and calcipotriol ointment have good short-term effects on plaque psoriasis of blood stasis. Moxibustion has more advantages in reducing the recurrence rate of psoriasis, improving the main clinical symptoms of TCM and quality of life.

Lentiviral vector-mediated doxycycline-inducible iASPP gene targeted RNA interference in hepatocellular carcinoma.

BACKGROUND AND OBJECTIVE: iASPP, an inhibitory member of the apoptosis-stimulating proteins of p53 (ASPP) family, has been found to be up-regulated in various human tumor types. This study was to construct an efficient doxycycline-regulated, lentiviral vector-mediated knockdown system for iASPP that will allow for inducible down-regulation of iASPP gene expression and preliminary functional analysis. METHODS: A pair of complementary oligos with hairpin structures targeting the iASPP gene and a negative control were synthesized, then ligated with pLVTHM vector and sequenced. The fragment containing the shRNA cassette was cloned to pLVCT-tTR-KRAB plasmid. The recombinant vectors were co-transfected with viral packaging mix into 293T cells, and viral supernatant was harvested to determine the titer. After treatment with or without doxycycline, HepG2 cells infected with virus were harvested and the expression of iASPP was detected by reverse transcription-polymerase chain reaction (RT-PCR) and Western blot analysis. Its effects on tumor growth were characterized using MTS assay, soft agar colony formation, and flow cytometry analysis. RESULTS: The lentiviral vector expressing shRNA that targets to the oncogene iASPP was constructed successfully. HepG2 infected with the lentivirus expressing shRNA against iASPP inhibited the expression of iASPP in the presence of doxycycline, which resulted in the repression of tumor cell proliferation and anchorage-independent growth potential. CONCLUSIONS: The lentiviral vector-mediated tet-on system demonstrates efficient and inducible knockdown of iASPP in hepatocellular carcinoma cells. iASPP gene may be involved in tumorigenesis and progression of human tumors.

Pharmacokinetics of CTLA4Ig fusion protein in healthy volunteers and patients with rheumatoid arthritis.

AIM: To evaluate single-dose and multiple-dose pharmacokinetics of cytotoxic T-lymphocyte-associated antigen 4 fusion protein (CTLA4Ig) in healthy volunteers and patients with rheumatoid arthritis (RA). METHODS: The clinical trials included two phase I open studies: study 1 was an open-label dose-escalation study in 27 healthy volunteers and study 2 was a single-group, open-label study in patients with rheumatoid arthritis. In study 2, 9 patients were arranged to receive 10 mg/kg of CTLA4Ig at 0, 2, 4, 8, 12, and 16 weeks. The concentration-time data obtained by a validated ELISA method were subjected to non-compartmental pharmacokinetic analysis by DAS 2.1 software. RESULTS: In study 1, serum CTLA4Ig concentrations climbed rapidly to the peak and declined slowly with a t(1/2) of 15.1+/-2.6 d, 14.2+/-2.3 d, and 11.8+/-1.2 d after a single infusion of 1, 10, and 20 mg/kg, respectively. C(max) and AUC(0-infinity) increased proportionally with the dose. In study 2, the steady-state condition for CTLA4Ig following multiple doses of 10 mg/kg appeared to be attained at the fourth dose (d 56), with peak and trough concentrations of 239.8+/-45.3 mg/L and 20.5+/-7.9 mg/L, respectively. After multiple infusions, serum concentrations dropped slowly and the terminal half-life was 12.6+/-4.7 d. CONCLUSION: Intravenous infusion of CTLA4Ig was well tolerated in healthy volunteers and patients with rheumatoid arthritis. CTLA4Ig exhibited linear pharmacokinetics over the dose range of 1 to 20 mg/kg in healthy volunteers. The pharmacokinetics in RA patients appeared to be similar to that in healthy volunteers. No system accumulation appeared upon repeated infusions of 10 mg/kg every 4 weeks.

Pharmacokinetic and pharmacodynamic study of LFA3Ig fusion protein in healthy volunteers and patients with psoriasis.

AIM: To evaluate the pharmacokinetics (PK) and pharmacodynamics of the LFA3Ig fusion protein (LFA3IgFP) in healthy volunteers and patients with chronic plaque psoriasis. METHODS: The clinical trials included 2 phase I open studies. Study 1 was an open-label dose escalation study in 24 healthy volunteers, and study 2 was a single-group, open-label study in 12 patients with chronic plaque psoriasis. The serum drug concentrations were measured, and the concentration-time data were analyzed by compartmental analysis using the Practical Pharmacokinetic Program. RESULTS: In study 1, after intramuscular (im) administration at a dosage of 5, 15, and 25 mg, the concentration-time curves of LFA3IgFP fitted well to a 1 compartment open model. Areas under the concentration-time curves increased linearly with dose. Clearance rates (Cls/ F) and elimination half-lives (T1/2ke) had no significant difference between different dose groups. A transient, slight decline of CD(4+) and CD(8+) T-cell subsets was observed after administration. In study 2, after im administration at a dosage of 15 mg weekly for 8 weeks, the concentration-time curve was best fitted to a 1 compartment open model, with a T(1/2ke ) of 307.9+/-32.7 h. The steady state was attained after the fifth administration. CONCLUSION: The PK behaviors of LFA3IgFP in healthy volunteers and patients with chronic plaque psoriasis complied with linear kinetics within the examined dose range. A significant accumulation was observed after repeated administration at a dose of 15 mg weekly for 8 weeks.

[Stage-based treatment of gouty arthritis by combination therapy of traditional Chinese and Western medicines: a randomized controlled trial].

OBJECTIVE: To evaluate the clinical therapeutic effect of the combination therapy of traditional Chinese and Western medicines in treating gouty arthritis based on the stage of disease, and to explore a safe, effective and reasonable therapeutic regimen for prevention and treatment of gouty arthritis. METHODS: One hundred and sixty-six cases of gouty arthritis were divided into three groups randomly, 58 cases in traditional Chinese drug (TCD)-treated group, 56 cases in Western medicine (WM)-treated group and 52 cases in TCD plus WM-treated group. They were all treated for 12 weeks. In the acute stage, patients in TCD-treated group were treated with Huzhang Gout Granule and Jinhuang Ointment, and patients in WM-treated group were treated with diclofenac sodium dual release enteric-coated capsules. In the intermission, patients in TCD-treated group were given Yinlian Gout Granule, and patients in WM-treated group were given benzbromarone or allopurinol. Patients in TCD plus WM-treated group were given both TCD and WM. Clinical symptom score and blood uric acid (BUA) level were measured. The effect initiating time, relapse rate, efficacy rate and the incidence rate of adverse effects were also studied. RESULTS: There were no significant differences in the efficacy rate and effect initiating time among the three groups in the acute stage. The clinical symptom score and BUA level were obviously reduced in three groups. In the intermission, BUA level in the WM-treated group and TCD plus WM-treated group were obviously reduced. Although there was a drop tendency in the BUA level in TCD-treated group, there was no statistical difference. The relapse rates in TCD-, WM- and TCD plus WM-treated groups were 12.07%, 26.79% and 9.62%, respectively. There was statistical difference in relapse rates among the three groups (P<0.05). The relapse rate was decreased in TCD plus WM-treated group as compared with those in TCD-treated and WM-treated groups. The average clinical symptom scores during recurrence in the three groups were (10.00+/-3.61), (12.38+/-1.85) and (10.75+/-1.89), respectively. The incidence of adverse effects in TCD-treated group (3.45%) was lower than the other two groups (21.43% and 15.38%). CONCLUSION: The combination therapy of traditional Chinese and Western medicines based on the stage of disease can control the symptoms of gouty arthritis in the acute stage, improve joint function, and can control the BUA level during the intermission, prevent recurrence and relieve the adverse effects.

Effect of pretreatments on the metal-ceramic bonding strength of a Pd-Ag alloy.

OBJECTIVES: The purpose of this study was to evaluate the efficacy of surface treatments on the bonding properties between a metal and ceramic. METHODS: Sixty metal specimens were divided equally into four groups of 15 samples each. These groups received different treatments (Gr1: 250µm Al2O3+preoxidation; Gr2: 250µm Al2O3+degassing; Gr3: 120µm Al2O3+preoxidation; Gr4: 120µm Al2O3+degassing). Bond strengths were evaluated using a three-point bending test. The results were analyzed using 2-way ANOVA and Tukey's test. Scanning electron microscopy and energy dispersive spectroscopy were used to observe the microscopic features, elemental compositions and distributions, and diffusion in the specimens. Mechanical profiler was used to measure the roughness of metal surface. RESULTS: The bond strengths of the four groups ranged from 45.00±3.63MPa to 51.61±5.91MPa, with significant differences (P<.05). The specimen that received the pretreatment of 250µm Al2O3 air-particle abrasion+degassing had the highest bond strength. Heating under different oxygen partial pressures caused the final Pd-Ag alloys to have varying degrees of internal oxidation and different quantities of metallic nodules. None of the elements in either the ceramic or the Pd-Ag alloy layer diffused into the other layer. CONCLUSIONS: The metal-ceramic specimen subjected to air-particle abrasion with 250µm Al2O3 and degassed before porcelain firing had significantly higher bond strength than specimens treated differently.

[Effect of different heat treatment on the bonding strength of porcelain and Co-Cr alloy].

PURPOSE: To investigate and compare the effect of different heat treatment on the metal- ceramic bonding strength and the interfacial microstructure of the Co-Cr alloy. METHODS: Thirty specimens were made according to ISO 9693,and then divided into 3 groups (n=10) through the measurements .Group A(degassed 60s):degassed and then maintained 60s in 980 degrees centigrade Group B(degassed 60s and preoxidation 60s): degassed and maintained 60s in 980 degrees centigrade, then were maintained continuously for 60s in 980 degrees centigrade after re-gassed,Group C(degassed 120s): degassed and maintained 120s in 980 degrees centigrade. The bonding strengths of the three groups were evaluated through three point bending test. Six specimens divided into 3 group were made in the same method to observe the metal-ceramic interface through scanning electronic microscope(SEM) and energy dispersive spectrum(EDS).The bonding strength data were analyzed using ANOVA and Bonferroni's test by SPSS13.0 software package. RESULTS: The mean value of bonding strength was (39.03±2.70)MPa for group A, (34.43±2.36)MPa for group B, (31.65±1.49)MPa for group C, respectively. There were significant difference between every two groups (P<0.05). SEM demonstrated that the width of interfacial transition layer was 12.3-16.4µm in group A, 15.2-21.8µm in group B and 26.3-32.2µm in group C. CONCLUSIONS: Higher metal-ceramic bonding strength for Co-Cr alloy will be formed under the situation of degassed,and maintained 60s in 980 degrees centigrade ; while extending degassed time, prolonging the heat maintained time and preoxidation after degassing will reduce metal-ceramic bonding strength.

[Survey on the situation of antenatal care in different regions of China, in 1971 - 2003].

OBJECTIVE: To comprehensively understand the situation of antenatal care in the last thirty years and to identify the existing problems and challenges. METHODS: PPS method was used to select those women under study and face to face interview was carried out at the house. RESULTS: The quality and coverage rate of antenatal care as well as the rate of hospital delivery had been continuously increasing over time and the coverage rate of antenatal checkup had increased from 38.7% in 1970s to 95.9%, while the institutional delivery rose from 20.1% to 87.4% in the last three years. However, problems and challenges were found refering to the of delay first antenatal care, inadequate timing and with incomplete contents. Only 71.7% of the pregnant women had received first checkup during the first three months. 64.1% of the women received 5 times or more of the checkups while only 29.1% of the women had received all the 7 basic checkup items. Rate of hospital delivery was unsatisfactory that most (79.5%) of the women had the delivery not in the hospitals when under the assistance of midwife/village doctors. Indicators showed that the worst was in the western regions. CONCLUSION: Great progress had been made in the field of antenatal care in last thirty yeats in China. The coverage rate of antenatal checkup and institutional delivery had been improved. But the quality of antenatal care should be further improved, especially in the western regions.