Clinical efficacy of anterior radius head fracture combined with lateral ligament complex injury / 中华骨科杂志

Objective:To investigate the operation efficacy of anterior radius head fracture combined with lateral ligament complex injury.Methods:The patients with radial head fracture admitted from September 2017 to August 2021 were retrospectively analyzed, 51 males and 54 females, average age of 38.84±13.63 years (range of 16-70 years). Based on the radial head fractures of Mason classification of type II, the cases involving the anterior radius head fracture were divided into three subtypes according to the number of fracture blocks and the type of displacement: type A (53 cases): one part of the anterior radius head collapse fracture; type B (50 cases): two or more parts of the anterior radial head collapse fracture; type C (2 cases): anterior radius head dissociated and displaced fracture. All fractures were treated with open reduction and internal fixation. Among them, the lateral ligament complex of type B were elongated due to the injury but the continuity existed. Therefore, the lateral ligament complex in 21 cases were not repaired in the early period (unrepaired group); in recent years, 29 cases repaired the lateral ligament complex (repair group). The postoperative efficacy was evaluated by elbow range of motion, table-top relocation test, Mayo score, and Broberg Morrey score. the patients were evaluated at final follow-up, except table-top relocation test was recorded according to the actual completion time.Results:All operations were successfully completed. The mean follow-up was 14.08±1.52 months (range of 12-18 months). Type A: the flexion and extension range was 115.70°±6.35°; the completion time of the table-top relocation test was 75.68±11.90 days; the Mayo score was 93.72±2.40 point, and the Broberg Morrey score was 92.89±2.28 point. Type B: lateral ligament repair group (repaired group) 29 cases and unrepaired lateral ligament group (unrepaired group) 21 cases. The flexion and extension range of elbow in repaired group was 112.1°±4.4°, which was better than that in unrepaired group 105.8°±3.7° ( t=5.31, P<0.001). The completion time of table-top relocation test was 77.72±6.51 days in repaired group and 104.29±18.45 days in unrepaired group ( t=6.32, P<0.001). The Mayo score of the repaired group was 90.21±5.88 points and that of the unrepaired group was 87.14±5.26 points ( t=1.90, P=0.063), and there was no significant difference between the two groups. Broberg Morrey score of 90.93±6.43 points in the repaired group was better than 86.95±6.37 points in the unrepaired group ( t=2.17, P=0.035). Type C for 2 patients, the flexion and extension range of elbow were 107°and 106°; the completion time of table-top relocation test were 82 days and 98 days; the Mayo scores were 91 point and 87 point; Broberg Morrey scores were 93 point and 85 point. There was a patient developed myositis ossificans in unrepair group of tybe B. Conclusion:The elbow joint is stable when one part of the anterior radius head collapse fracture; there is a degree of instability in the elbow when two or more parts of the anterior radial head collapse fractures suggest to repair the lateral ligament complex. The elbow joint is extremely unstable when anterior radius head dissociated and displaced fractures, the lateral ligament complex should be repaired in time.

Drug resistance characteristics of pathogenic bacteria in neonatal bloodstream infections from a hospital in Chuzhou, Anhui, 2017-2021 / 中国热带医学

@#Abstract： Objective　To investigate the distribution and antimicrobial resistance profile of the bacterial strains isolated from blood cultures in neonatal septicemia children of Neonatology Department, the First People's Hospital of Chuzhou during Jan. 2017-Dec. 2021, in order to guide clinical rational drug use. Methods　The distribution and the results of antimicrobial susceptibility tests and characteristics of the pathogenic bacteria isolated from blood culture samples in neonatal septicemia children in the First Hospital of Chuzhou from Jan. 2017 to Dec. 2021 were retrospectively analyzed. The results were analyzed with WHONET 5.6 software, according to the Clinical and Laboratory Standards Institute (CLSI) 2021 breakpoints. 　Results　A total of 189 strains were isolated from the 4 538 sample of blood cultures, the positive rate was 4.2%, including 59(31.2%) Gram-negative bacterial strains, 130 (68.8%) Gram-positive bacterial strains. The most frequently isolates were coagulase-negative staphylococci（64.0%), Serratia liquefaciens (15.9%), Escherichia coli (3.2%), Acinetobacter lwoffii (2.6%) and Delftia acidovorans (2.6%). The prevalence of methicillin-resistant isolates was 81.8%(99/121) in coagulase-negative Staphylococci and 25.0%（1/4） in Staphylococcus aureus. No staphylococcal strains were found resistant to vancomycin, quinupristin-dalfopristin or linezolid. The sensitivity of the antibacterial drug monitored by Serratia liquefaciens was 100.0%.Conclusions　Gram-positive bacterial are the main pathogen of neonatal septicemia, and is highly resistant to the common antibacterial drugs. The clinical should choose antibacterial agents reasonably according to drug sensitivity.

Diagnosis and treatment strategy of radial head fracture / 中华骨科杂志

Radial head fracture is a common disease in upper limb trauma. The most common cause of injury is longitudinal violence along the forearm, often associated with injuries, such as ulnar coronoid process fracture, elbow ligamentous injury, forearm interosseous membrane injury, distal radioulnar joint injury and so on. The treatment strategy of radial head fractures should be determined according to the specific fracture type of the patient. The vast majority of Mason I fractures can usually be treated conservatively, while Mason II and III fractures often require surgical treatment. The surgical treatment usually includes radial head excision, open reduction and internal fixation, and radial head prosthetic replacement. For simple comminted radial head fractures without longitudinal instability of the elbow or forearm, radial head resection can be used. However, if there is longitudinal instability of the elbow or forearm, radial head resection is contraindicated and internal fixation or radial head replacement is recommended. In view of the gradual standardization of the treatment of radial head fracture, this article will review the epidemiological investigation, anatomy and biomechanics, injury mechanism, clinical diagnosis and treatment of radial head fracture, so as to provide ideas for clinical selection of the best treatment scheme suitable for individual patients.

Short-term clinical outcome of dual plate for proximal humerus fracture with calcar comminution / 中华骨科杂志

Objective:To investigate the efficacy of dual plate fixation in the treatment of proximal humeral fracture with comminuted calcar.Methods:From July 2018 to April 2020, 25 patients (7 males and 18 females) were treated operatively for proximal humeral fractures with calcar comminution using anterior plate and lateral Philos plate. The data of patients who were followed up for more than 12 months was retrospectively analyzed. The mean age was 58.3 years (range 33-79 years). There were 13 right sides (all principal sides) and 12 left sides (all non-principal sides). The causes of injuries included: falling on flat ground (12 cases), traffic accidents (11 cases) and falling from height (2 cases). According to Neer classification, there were 7 cases of two-part fractures, 16 cases of three-part fractures and 2 cases of four-part fractures. A number of parameters including patient demographics, mechanism of injury, operative time, time to union, the range of shoulder motion, visual analogue scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley shoulder joint score, neck-shaft angle and the complications were recorded.Results:All of 25 patients were operated and followed up for 24.7 months (range 14 to 36 months). The operation time was 124.3 min (75-185 min), and the blood loss was 178.4 ml (100-350 ml). All patients had healed fractures at the last follow-up, and the neck-shaft angle was 132.88°±8.11° immediately after surgery, and 132.68°±8.36° at the last follow-up. All 25 patients healed completely in 4.7 months (range 3-5 months). Range of shoulder joint motion were forward flexion 161.20°±13.01° (range 140°-180°), external rotation 37.60°±7.65° (range 20°-45°), and internal rotation T 4-L 4 levels. VAS score was 0.36±0.81 points (range 0-3 points), while ASES score was 87.32±8.78 points (range 57.7-100 points) and Constant-Murley score was 89.40±8.37 points (range 60 to 100 points). Overall satisfaction score (Constant-Murley score) was excellent in 23 cases, and good in 2 cases. No obvious complications occurred. Conclusion:The combination of anterior plate and lateral Philos plate in the treatment of proximal humerus fractures with comminuted calcar can achieve stable fixation and satisfactory postoperative results.

Clinical application of combined infratemporal fossa approaches for internal carotid artery in petrous bone reconstruction for large lateral skull base tumors / 中华耳鼻咽喉头颈外科杂志

Objective: By summarizing the technical points and therapeutic outcomes of combing infratemporal fossa approach (IFA) and internal carotid artery (ICA) reconstruction for the colossal skull base tumor invading ICA in petrous bone, the clinical application value was discussed. Methods: Five patients (2 males, 3 females,aging from 27 to 55 years old) who received surgeries between July 2015 and May 2017 for lateral skull base pathology involved petrous ICA using technique combined IFA and pre-reconstruction, were reviewed. Results: Among the five patients, three were paraganglioma of head and neck, one was carotid aneurysms, and one was recurrent adenoid cystic carcinoma (ACC). The median tumor size in the largest cross-section was 60 mm × 51 mm (range, 28 mm × 22 mm-72 mm × 58 mm). Complete excision was achieved with IFA and ICA reconstruction. The median blood loss volume was 1 000 ml (range, 600-2 500 ml). Four cases showed no new long-term neurologic sequelae, while one showed hemiplegia due to graft vessel occlusion. Except for the one with ACC having facial nerve cut, others achieved good facial nerve function of HB grade Ⅰ to Ⅱ during 3 to 12 months, follow-up. No tumor recurrence was observed over the median duration of follow-up for above 36 months (range, 36-58 months). Conclusion: For lesions involved superior part of ICA, which is unable to separate from ICA, IFA and ICA reconstruction can achieve complete excision.

Early efficacy evaluation of the treatment of complex proximal humeral fractures in the elderly with reverse shoulder arthroplasty / 中华骨科杂志

Objective@#To evaluate the short-term efficacy of one-stage reverse shoulder arthroplasty in the treatment of complex proximal humeral fractures in the elderly.@*Methods@#Data of 43 elderly patients with complex proximal humeral fractures who were treated by reverse shoulder arthroplasty from July 2017 to January 2019 were retrospectively analyzed. There were 12 males and 31 females with an average age of 72 years (range, 66-78 years). All fractures were fresh and close which caused by trauma. The average time from injury to operation was 8.0 days (range, 6-11 days). According to Neer classification, 21 cases (48.8%, 21/43) were three-part fractures, 22 cases (51.2%, 22/43) four-part fractures. Visual analogue scale (VAS), Neer shoulder replacement evaluation system and Constant-Murley score were used to evaluate the postoperative results.@*Results@#All operations were successfully completed. The average operation time was 141.3 minutes (range, 120-170 minutes. The mean blood loss was 407 ml (range, 250-700 ml) and intraoperative blood transfusion was 446.5 ml (range, 400-800 ml). All patients were followed up for 10.9 months (range, 6 to 16 months). All patients were discharged within 7 days after operation, and no wounds related complications occurred. The bigger and lesser tuberosities of all patients healed completely within 8 weeks. At the latest follow-up, no loosening or dislocation of prosthesis occurred, and the forward elevation was 133.0° (range, 100°-165°); external rotation was 29.5° (range, 20°-35°); internal rotation was 46.7° (range, 30°-60°). VAS score was 0.8 (range, 0-3). The Neer score was 87 (range, 73-98), with 20 cases (46.5%, 20/43) excellent, 16 cases (37.2%, 16/43) good, and 7 cases (16.3%, 7/43) fair. Constant-Murley score was 88.7 (range, 70-98). A 71-year-old patient had symptoms of axillary nerve injury after operation and recovered completely 6 weeks after the operation, which did not affect the functional rehabilitation exercise or the stability of the prosthesis. During the follow-up, no other complications such as infection, acromial stress fracture and scapular notching were found in all patients.@*Conclusion@#The short-term effect of one-stage reverse shoulder arthroplasty for the treatment of complex proximal humeral fractures in the elderly is satisfactory.

Early efficacy evaluation of the treatment of complex proximal humeral fractures in the elderly with reverse shoulder arthroplasty / 中华骨科杂志

Objective To evaluate the short-term efficacy of one-stage reverse shoulder arthroplasty in the treatment of complex proximal humeral fractures in the elderly.Methods Data of 43 elderly patients with complex proximal humeral fractures who were treated by reverse shoulder arthroplasty from July 2017 to January 2019 were retrospectively analyzed.There were 12 males and 31 females with an average age of 72 years (range,66-78 years).All fractures were fresh and close which caused by trauma.The average time from injury to operation was 8.0 days (range,6-11 days).According to Neer classification,21 cases (48.8％,21/43) were three-part fractures,22 cases (51.2％,22/43) four-part fractures.Visual analogue scale (VAS),Neer shoulder replacement evaluation system and Constant-Murley score were used to evaluate the postoperative results.Results All operations were successfully completed.The average operation time was 141.3 minutes (range,120-170 minutes.The mean blood loss was 407 ml (range,250-700 ml) and intraoperative blood transfusion was 446.5 ml (range,400-800 ml).All patients were followed up for 10.9 months (range,6 to 16 months).All patients were discharged within 7 days after operation,and no wounds related complications occurred.The bigger and lesser tuberosities of all patients healed completely within 8 weeks.At the latest followup,no loosening or dislocation of prosthesis occurred,and the forward elevation was 133.0° (range,100°-165°);external rotation was 29.5° (range,20°-35°);internal rotation was 46.7° (range,30°-60°).VAS score was 0.8 (range,0-3).The Neer score was 87 (range,73-98),with 20 cases (46.5％,20/43) excellent,16 cases (37.2％,16/43) good,and 7 cases (16.3％,7/43) fair.Constant-Murley score was 88.7 (range,70-98).A 71-year-old patient had symptoms of axillary nerve injury after operation and recovered completely 6 weeks after the operation,which did not affect the functional rehabilitation exercise or the stability of the prosthesis.During the follow-up,no other complications such as infection,acromial stress fracture and scapular notching were found in all patients.Conclusion The short-term effect of one-stage reverse shoulder arthroplasty for the treatment of complex proximal humeral fractures in the elderly is satisfactory.

How job stress influences job performance among Chinese healthcare workers: a cross-sectional study

OBJECTIVES@#Public service motivation refers to the idea of commitment to the public service, pursuit of the public interest, and the desire to perform work that is worthwhile to society. This study investigates how challenge stress and hindrance stress influence job performance among healthcare workers in Chinese public hospitals. It has also examined the mediating effect of public service motivation.@*METHODS@#Data of 1594 healthcare workers were obtained from typical public hospitals in eastern, central, and western China. To test our hypotheses, we used descriptive statistical analysis, correlation analysis, structural equation modeling, and subgroup analysis to investigate the sample.@*RESULTS@#Challenge stress and hindrance stress were strongly correlated among healthcare workers in Chinese public hospitals (β = 0.59; p < 0.001). Challenge stress was significantly positively associated with public service motivation (β = 0.14; p < 0.001) and job performance (β = 0.13; p < 0.001). Hindrance stress was significantly negatively associated with public service motivation (β = - 0.27; p < 0.001) and job performance (β = - 0.08; p < 0.05). Public service motivation was directly positively associated with job performance (β = 0.58; p < 0.001), and it indirectly mediated the association between job stress and job performance.@*CONCLUSIONS@#This study provides important empirical evidence on the effects of job stress and public service motivation on job performance among healthcare workers in Chinese public hospitals. Job performance may be raised by limiting hindrance stress, which provides moderate challenge stress and increases public service motivation.

Predictive Score Model for Delayed Graft Function Based on Hypothermic Machine Perfusion Variables in Kidney Transplantation / 中华医学杂志(英文版)

Background@#Hypothermic machine perfusion (HMP) is being used more often in cardiac death kidney transplantation; however, the significance of assessing organ quality and predicting delayed graft function (DGF) by HMP parameters is still controversial. Therefore, we used a readily available HMP variable to design a scoring model that can identify the highest risk of DGF and provide the guidance and advice for organ allocation and DCD kidney assessment.@*Methods@#From September 1, 2012 to August 31, 2016, 366 qualified kidneys were randomly assigned to the development and validation cohorts in a 2:1 distribution. The HMP variables of the development cohort served as candidate univariate predictors for DGF. The independent predictors of DGF were identified by multivariate logistic regression analysis with a P < 0.05. According to the odds ratios (ORs) value, each HMP variable was assigned a weighted integer, and the sum of the integers indicated the total risk score for each kidney. The validation cohort was used to verify the accuracy and reliability of the scoring model.@*Results@#HMP duration (OR = 1.165, 95% confidence interval [CI]: 1.008-1.360, P = 0.043), resistance (OR = 2.190, 95% CI: 1.032-10.20, P < 0.001), and flow rate (OR = 0.931, 95% CI: 0.894-0.967, P = 0.011) were the independent predictors of identified DGF. The HMP predictive score ranged from 0 to 14, and there was a clear increase in the incidence of DGF, from the low predictive score group to the very high predictive score group. We formed four increasingly serious risk categories (scores 0-3, 4-7, 8-11, and 12-14) according to the frequency associated with the different risk scores of DGF. The HMP predictive score indicates good discriminative power with a c-statistic of 0.706 in the validation cohort, and it had significantly better prediction value for DGF compared to both terminal flow (P = 0.012) and resistance (P = 0.006).@*Conclusion@#The HMP predictive score is a good noninvasive tool for assessing the quality of DCD kidneys, and it is potentially useful for physicians in making optimal decisions about the organs donated.

SECTRA 3D real-time reconstruction of virtual simulation technology in the anatomy teaching of otolaryngology / 基础医学与临床

Objective To explore SECTRA 3D real-time reconstruction of virtual simulation technology in the anat-omy teaching of otolaryngology. Methods Eighty medical students who have received traditional class teaching of otolaryngology anatomy joined the SECTRA 3D real-time reconstruction class to study the major anatomic knowledge of otolaryngology. Questionnaires and exams were provided for them before and after the SECTRA 3D real-time re-construction class. Results The test scores were 79.19±10.39 before 3D class and 87.69±10.25 after 3D class. After teaching, the scores improved significantly.Conclusions Application of SECTRA real-time reconstruction of 3D virtual simulation technology in otolaryngology anatomy teaching, can help medical students to master the ana-tomical knowledge better than the traditional class teaching and can stimulate their interests to learn otolaryngology anatomy.

Laryngeal endoscopic cricopharyngeal myotomy for cricopharyngeal achalasia post stroke / 中华耳鼻咽喉头颈外科杂志

Objective@#To explore the safety and validity of endoscopic cricopharyngeal myotomy in patients with cricopharyngeal achalasia.@*Methods@#A total of 19 patients with cricopharyngeal achalasia suffered from sustained dysphagia were enrolled in this study. The patients were divided into transcervical cricopharyngeal myotomy(CPM) group and endoscopic CPM (ECPM) group. Swallowing function and complications were evaluated.SPSS7.0 software was used to analyze the data.@*Results@#The swallowing function improved significantly in seven patients in ECPM group, and 9 patients improved in CPM group.The video fluoroscopic swallowing study(VFSS)-swallowing score, VFSS-aspiration score and drinking test score were (3.1±1.1), (3.4±0.8) and (2.0±0.6)in post-ECPM, (3.4±1.4), (3.0±0.9) and (2.2±0.6)in post-CPM. No statistical difference was found in validity between CPM group and ECPM group(t=-0.435, t=1.086, t=-0.607, P>0.05). No statistical difference was observed on the occurrence of complication between two groups. Only one patient had subcutaneous emphysema after operation in ECPM.@*Conclusions@#New surgical instruments and endoscopic surgical technique were safe and effective for cricopharyngeal achalasia. Because these instruments are cheaper, laryngeal endoscopic cricopharyngeal myotomy is easier to be popularized more easily than microscopic laser assistted CPM.

Curative effect of simple volar or dorsal plating in the treatment of intra-articular distal radius fracture / 中华创伤杂志

Objective To compare the clinical effect of simple volar or dorsal plate fixation of intra-articular distal radius fracture.Methods This retrospective study included 42 patients with closed intra-articular distal radius fracture treated surgically using the dorsal or volar plate.Out of the 15 patients in dorsal plating group 5 were males and 10 females at age of (55 ± 7)years (range, 48-62 years), 13 were injured from falls and 2 traffic accidents, 10 were classified as AO type C3 and 5 AO type C2.Out of the 27 patients in volar plating group 8 were males and 19 females at age of (56 ± 6)years (range, 50-62 years), 24 were injured from falls and 3 traffic accidents, 17 were classified as AO type C3 and 10 AO type C2.Between-group differences were compared with respect to wrist range of motion, postoperative radiographic parameters, postoperative complications, disabilities of the ann, shoulder and hand (DASH) score and Gartland-Werley score.Results All the patients were followed up for 11-25 months.There were no significant differences in the wrist range of motion and radiographic parameters between the two groups (P ＞ 0.05).Volar plating group resulted in a significantly better Gartland-Werley score compared to dorsal plating group [1 vs 4 points, P ＜ 0.05], but no significant difference was noted in DASH score (P ＞ 0.05).Four patients (27％) in dorsal plating group developed tendon adhesions and tenolysis was in demand, but one patients (4％) in volar plating group was complicated by median nerve symptoms (P ＜ 0.05).Conclusions Although the DASH score of the two methods was similar, volar plating yields better results in Gartland-Werley score and complication incidence.Thus the volar plating is recommended for intra-articular distal radius fracture.

Surgical management of refractory dysphagia and aspiration / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the methods and results of surgical management for refractory dysphagia and aspiration.</p><p><b>METHODS</b>The clinical data of 24 refractory dysphagia and aspiration patients who accepted surgical management were retrospectively analysed.</p><p><b>RESULTS</b>Twenty-four refractory dysphagia and aspiration patients accepted 26 operations between 2001 and 2014. Of the 26 operations, 17 were cricopharyngeal myectomy (CPM), 6 were scarectomy, 3 were laryngeal-tracheal separation. No severe complications occurred. Assessments of dysphagia were completed in 18 operations before and after operation. Aspiration scores of videofluoroscopic swallowing study (VFSS) were 4.50 [4.00;7.00] vs 2.00 [1.00; 3.25], P = 0.000; swallow dysfunction scroes of VFSS were 5.00 [4.00; 12.00] vs 1.00 [1.50; 10.00], P = 0.001; aspiration scores of fibroptic endoscopic evaluation of swallowing (FEES) were 4.00 [5.00; 7.00] vs 2.00 [1.75; 3.00], P = 0.000. But the surgical results for post radiotherapy dysphagia were not successful (n = 5): aspiration scores of VFSS were 7.00 [6.50; 8.00] vs 6.00 [2.00; 7.50], P = 0.109;swallow dysfunction scroes of VFSS were 12.00 [10.50; 12.00] vs 12.00 [7.50; 12.00], P = 0.180;aspiration scores of FEES were 7.00 [6.50; 8.00] vs 6.00 [2.00; 7.50], P = 0.109.</p><p><b>CONCLUSION</b>Surgical management was effective for refractory dysphagia and aspiration, but the surgical indication selection should be strict.</p>

Research progress of differential diagnosis between hypoplastic myelodysplastic syndromes and aplastic anemia / 白血病·淋巴瘤

Hypoplastic myelodysplastic syndromes (hypo-MDS) is one special type of MDS which is similar to the clinical and laboratory manifestation of aplastic anemia.This it is difficult to differentiate hypoMDS with aplastic anemia.The differential diagnosis includes peripheral blood parameters, bone marrow cell morphology, bone marrow biopsy, hematopoietic progenitor cell culture, cell genetics, molecular biology and cell phenotype analysis, etc.This review will discuss the differential diagnosis between hypo-MDS and aplastic anemia.

Changes of CD34(+) and CD71(+)CD45(-) cell levels in bone marrow of MDS and AA patients / 中国实验血液学杂志

This study was aimed to investigate the changes of CD34(+) and CD71(+)CD45(-) cell levels in MDS and AA patients. A total of 25 cases MDS and 43 cases of AA (18 cases SAA and 25 cases of NSAA) from January 2010 to October 2013 in the Department of Hematology, affiliated hospital of Hebei United University were enrolled in this study. The complete blood count, bone marrow smears, bone marrow biopsy, karyotype analysis and bone marrow blood cell immune genotyping (mainly the proportion of CD34(+) cells, CD71(+)CD45(-) cells in nucleated cells) were carried out for all patients; the changes of CD34(+) and CD71(+)CD45(-) cell levels in patients with MDS and AA (SAA NSAA) were compared; the differences of white blood cell count, platelet count and hemoglobin concentration in patients with count of CD71(+)CD45(-) ≥ 15% or <15% were analyzed. The results showed that the count of CD34(+) in MDS group was higher than that in AA (NSAA and SAA) group (P < 0.05). The count of CD71(+)CD45(-) cells in MDS group was higher than that in SAA (P < 0.05), there was no significant difference between NSAA group and MDS group. In MDS group with CD71(+)CD45(-) ≥ 15%, the platelet count was significantly higher than that in NSAA group (P < 0.05); and there was no statistical difference for leukocyte, platelet count and hemoglobin level between MDS and NSAA group with CD71(+)CD45(-) <15% (P > 0.05). It is concluded that the count of CD34(+) cells in MDS patients is significantly higher than that in AA and SAA patients. The count of CD71(+)CD45(-) cells in MDS group is significantly higher than that of SAA group. The platelet count in MDS patients with CD71(+)CD45(-) cells ≥ 15% is significantly higher than that of the NSAA group.

Preliminary research on clinical value of localization of upper airway obstruction with nasopharyngeal airway combined with polysomnography / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical value of localization of upper airway obstructive site with the method of combination of nasopharyngeal airway and polysomnography (PSG).</p><p><b>METHODS</b>Forty-seven patients diagnosed as obstructive sleep apnea hypopnea syndrome (OSAHS) by PSG were enrolled. Each patient was examined by Somte PSG for the first night, underwent repeated PSG examination with the nasopharyngeal airway in place for the second night and received airway continuous pressure measurements (ApneaGraph) examination for the third night. The standard of treatment success was defined as apnea-hypopnea index (AHI) less than 20/h and a reduction of 50% or more. The patients were divided into success group and failure group. The PSG indices and ApneaGraph data of the two groups were compared. Correlations between AHI with nasopharyngeal airway in place by PSG and lower AHI and constituent ratio of lower obstruction by ApneaGraph were calculated. SPSS 17.0 software was used to analyze the data.</p><p><b>RESULTS</b>Forty-two patients completal three-night examination. With the nasopharyngeal airway in place, AHI, the lowest oxyhemoglobin saturation (LSaO2), average oxyhemoglobin saturation, percent of sleep time with oxyhemoglobin saturation <0.90 (SaO2 < 0.90T%) were improved obviously (P < 0.001). Twenty-nine patients (69.0%) achieved treatment success. There were statistical differences (t = 2.670, P = 0.011; Z = -3.252, P = 0.001 and t = -4.556, P < 0.001) of LSaO2 by PSG, lower AHI and constituent ratio of lower obstruction by ApneaGraph compared success group with failure group. The correlations between AHI with nasopharyngeal airway in place by PSG and lower AHI and constituent ratio of lower obstruction by ApneaGraph were 0.616 (P < 0.001) and 0.526 (P < 0.001).</p><p><b>CONCLUSION</b>The method of combination of nasopharyngeal airway with PSG is a reliable method of localization of upper airway obstructive site and can be used as a simple means to find out if there's any retroglossal obstruction.</p>

The clinical significance of synchronous monitoring with micro-movement sensitive mattress sleep monitoring system and apnea graph / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the relevance and clinical value of synchronous monitoring with Apnea Graph (AG) and micro movement sensitive mattress sleep monitoring system (MSMSMS) for the patient with obstructive sleep apnea-hypopnea syndrome before surgery.@*METHOD@#One hundred and fifteen patients diagnosed as OSAHS by PSG were synchronous examined by two methods: MSMSMS and AG with continuous upper airway pressure recording at night in Peking Union Medical College Hospital. The apnoeic and oxygen desaturation events during sleep determined by the two methods were compared. The correlation between MSMSMS and AG were analyzed.@*RESULT@#According to the OSAHS severity grading: the mild, moderate and severe were 6, 16, 93 for AG and 8, 26, 81 for MSMSMS respectively, and the hypoxemia severity grading:the mild, moderate, severe were 14, 70, 27 for AG and 6, 72, 37 for MSMSMS respectively. There were no statistically difference in the severity grading of OSAHS and hypoxemia during sleep determined by AG and MSMSMS. According to the parameters of the two methods, the AHI are (51.5 +/- 21.2) times/h (x +/- s, similarly hereinafter) and (48.1 +/- 24.2) times/h, r = 0.947; the LSaO2 are 0.736 +/- 0.110 and 0.710 +/- 0.108, r = 0.935; the correlation coefficient (r) of apnea index and obstructive apnea and hypopnea index were 0.856 and 0.841, P < 0.01 respectively, the data monitored by the two methods is positively correlated.@*CONCLUSION@#There is no significant difference in determining the severity of OS AHS between the AG and MSMSMS. The two methods had good correlation in respiratory disturbance index and oxygen decline index, and revealed well-prospects of preoperative assessment in patients with OSAHS.

Treatment of trimalleolar factures through posterolateral transmalleolar approach / 中华创伤杂志

Objective To evaluate the outcome of posterolateral approach to the fibula for trimalleolar fractures,especially the fracture in posterior malleolus.Methods Thirty-two patients with trimalleolar fractures treated via posterolateral transmalleolar approach from July 2006 to July 2011 were analyzed retrospectively.All underwent open reduction and internal fixation,including 22 Lauge-Hansen grade Ⅳ supination-external rotation ankle fractures and 10 Lauge-Hansen grade Ⅳ pronation-extemal rotation ankle fractures.Results All fractures had bone union after the follow-up of average 15.5 months (range,12-18 months).Average American Orthopedic Foot & Ankle Society (AOFAS) score was 90.75points,suggesting an excellent result.Kellgren grading system for posttraumatic arthritis severity was grade 0 in eight patients,grade Ⅰ in 18,grade Ⅱ in five,and grade Ⅲ in one,which turned out to be satisfactory.Conclusions Posterolateral approach to the fibula for trimalleolar fractures allows direct reduction and fixation of posterior malleolus fragment in treatment of trimalleolar factures and the clinical outcome is satisfactory.Moreover,the approach deserves clinical practice.

Arthrolysis for posttraumatic elbow stiffness with heterotopic ossification / 中华创伤杂志

Objective To discuss methods and clinical efficacy of patients treated with arthrolysis for posttraumatic elbow stiffness with heterotopic ossification.Methods The study involved 16 patients with posttraumatic elbow stiffness combined with heterotopic ossification treated by arthrolysis between June 2007 and June 2011.There were 11 males and 5 females,at average age of 29.6 years (range,18-53 years).Time from injury to surgery averaged 10.7 months (range,8-14 months).Other than medial approach for only one patient,the rest adopted medial to lateral approaches to have a complete clearance of periarticular heterotopic ossification tissue and hyperplastic tissue as well as partial resection of articular capsules and ligaments.Besides,seven patients were fixed using hinged external fixators.After surgery,three weeks of oral celecoxib was given for the patients.Rehabilitation was started immediately after operation.Range of motion (ROM) of the elbow and Mayo elbow pcrformance score (MEPS) were used to determine clinical results.Results All patients were followed up for 8-17 months (mean 13.4 months).ROM of the elbow (extension lag,flexion,pronation and supination)showed an improvement from (45.2-3.5)° to (27.2 ±8.4)°,(68.1-11.8)° to (106.8 ± 16.4)°,(55.8 ± 8.2) ° to (80.5 ± 3.3) °,and (53.7 ± 6.3) ° to (83.1 ± 5.3) ° respectively (P ＜ 0.01).MEPS increased from (46.8 ±7.0) points to (83.2 ±9.4) points after operation (P ＜0.01).According to MEPS criterion,the results were excellent in seven patients,good in five and fair in four.Conclusion With respect to posttraumatic elbow stiffness with heterotopic ossification,satisfactory therapeutic results can be achieved by thorough preoperative evaluation,strict control of surgical indications,appropriate selection of intraoperative techniques and early systematic rehabilitation.