ObjectiveTo summarize the related research results of open wedge high tibial osteotomy (OWHTO) complicated with lateral hinge fracture. MethodsTo review the relevant literature of OWHTO at home and abroad in recent years and summarize and analyse the clinical experience. ResultsThe lateral hinge rupture may occur during the OWHTO, which may lead to the loss of correction angle after operation, delayed healing or non-union of osteotomy and so on. The lateral hinge plays an important role in the stability of the osteotomy. During the operation, the " safe zone” internal osteotomy can be used to protect the bone. Once the lateral hinge breaks, the TomoFix plate can be used to obtain the sufficient stability. For patients with lateral hinge rupture, functional exercise and full weight loading time should be guided by hinge breakage classification. ConclusionThe intact lateral hinge is beneficial to the healing and rehabilitation of OWHTO. The lateral hinge should be paid enough attention by clinicians.
Objective To explore a new method for the pre-degeneration of peripheral nerve in vitro for obtaining many effective Schwann cells so as to provide a large number of seed cells for the research and application of tissue engineered nerves. Methods The bone marrow derived cells (BMDCs) from transgenic green fluorescent protein C57BL/6 mouse and the sciatic nerve segments from the C57BL/6 mouse were co-cultured to prepare the pre-degeneration of sciatic nerve in vitro (experimental group, group A), and only sciatic nerve was cultured (control group, group B). At 7 days after culture, whether BMDCs can permeate into the sciatic nerve in vitro for pre-degeneration was observed by gross and immunohistofluorescence staining. And then Schwann cells were obtained from the sciatic nerves by enzymic digestion and cultured. The cell number was counted, and then the purity of primary Schwann cells was determined using immunohistofluorescence staining and flow cytometer analysis. Results At 7 days after pre-degeneration, gross observation showed that enlargement was observed at nerve stumps, and neuroma-like structure formed; the group A was more obvious than group B. Immunohistofluorescence staining showed many BMDCs permeated into the nerve segments, with positive F4/80 staining in group A. After culture, the yield of Schwann cells was (5.59 ± 0.19) × 104 /mg in group A and (3.20 ± 0.21) × 104/mg in group B, showing significant difference (t=2.14, P=0.03). At 48 hours after inoculation, the cells had blue bipolar or tripolar cell nuclei with small size and red soma by immunohistofluorescence staining; fibroblasts were flat polygonal with clear nucleus and nucleolus, showing negative p75NTR staining; and there were few of fibroblasts in group A. The purity of Schwann cells was 88.4% ± 5.8% in group A and 76.1% ± 3.7% in group B, showing significant difference (t=2.38, P=0.04). And the flow cytometer analysis showed that the purity was 89.6% in group A and 74.9% in group B. Conclusion BMDCs can promote the pre-degeneration of peripheral nerve in vitro, and it is a new method to effectively obtain Schwann cells for tissue engineered nerve.
Objectives Based on the Global Minimum Essential Requirement in Medical Education (GMER), we tried to use the theories and methods of “competency” as a reference to introduce the concept of “competency” into medical education in China and to investigate the skills that medical graduates need for their prospective clinical work. Methods According to a literature search and expert interviews, the Glossary of Medical Graduates’ Competencies was built to define the competencies needed by medical graduates. Students’ attitudes toward those competencies were surveyed by questionnaires. Factor analysis and Analytic Hierarchy Process (AHP) were used to analyze the data and to build the Medical Graduates’ Competency Model. Results The competencies of medical graduates could be divided into six groups. The weighting of each competency group and specific competence was different. Conclusion The Medical Graduate Competency Model can be used to evaluate medical graduates’ capacities. It has significant reference value for medical education, in terms of the evaluation of medical graduates and the reform of teaching methods.
The meta-analysis of rare binary data is a difficulty in the field of medical research, and its methodology remains immature. The traditional meta-analysis technique is based on the normal-normal model of fixed effects analysis or random-effects analysis, however there are methodological problems in this method. Stijnen proposed an exact within-study likelihood models (EWLM) meta-analysis technique based on the generalized linear mixed model (GLMM), including the binomial-normal model (BN) and Hypergeometric-normal model (HNM), which can be used to achieve random effects meta-analysis of rare binary data. This paper introduces the model in detail and its implementation in SAS software with examples to provide relevant SAS code.
ObjectiveTo explore the nature of micromovement and the biomechanical staging of fracture healing.MethodsThrough literature review and theoretical analysis, the difference in micromovement research was taken as the breakthrough point to try to provide a new understanding of the role of micromovement and the mechanical working mode in the process of fracture healing.ResultsThe process of fracture healing is the process of callus generation and connection. The micromovement is the key to start the growth of callus, and the total amount of callus should be matched with the size of the fracture space. The strain at the fracture end is the key to determine the callus connection. The strain that can be tolerated by different tissues in the fracture healing process will limit the micromovement. According to this, the fracture healing process can be divided into the initiation period, perfusion period, contradiction period, connection period, and physiological period, i.e., the biomechanical staging of fracture healing.ConclusionBiomechanical staging of fracture healing incorporates important mechanical parameters affecting fracture healing and introduces the concepts of time and space, which helps to understand the role of biomechanics, and its significance needs further clinical test and exploration.
Longitudinal data had intrinsic correlation problems at different time points, and traditional meta-analysis techniques cannot resolve this problem. Regression coefficients based on multi-level models can fully consider the correlations of longitudinal data at various time points. This paper uses SAS software to perform multi-level regression coefficient model meta-analysis and provides programming code which is simple and easy to operate.
Despite the rapid development of meta-analysis technology, there were currently no consolidation technology for longitudinal data. The meta-analysis model based on the generalized linear mixed-effects model can fully encapsulate the correlation between various time points and accurately estimate the final combined effect, which is an ideal model for longitudinal-data meta-analysis. Through example data, this paper used SAS software to realize longitudinal-data meta-analysis and provided programming codes.
ObjectiveTo evaluate the feasibility and effectiveness of percutaneous screwdriver rod-assisted closed reduction in the treatment of valgus-impacted femoral neck fractures. MethodsBetween January 2021 and May 2022, 12 patients with the valgus-impacted femoral neck fractures were treated with percutaneous screwdriver rod-assisted closed reduction and femoral neck system (FNS) internal fixation. There were 6 males and 6 females with a median age of 52.5 years (range, 21-63 years). The fractures were caused by traffic accident in 2 cases, falling in 9 cases, and falling from height place in 1 case. All were unilateral closed femoral neck fractures, including 7 on the left side and 5 on the right side. The time from injury to operation was 1-11 days, with an average of 5.5 days. The fracture healing time and postoperative complications were recorded. The quality of fracture reduction was evaluated by Garden index. At last follow-up, Harris score was used to evaluate the hip joint function, also the shortening of femoral neck was measured. ResultsAll the operations were successfully completed. After operation, the incision fat liquefaction occurred in 1 case, which healed after enhanced dressing change, and the other patients’ incisions healed by first intention. All patients were followed up 6-18 months, with an average of 11.7 months. The X-ray film reexamination showed that the quality of fracture reduction was grade Ⅰ in 10 cases and grade Ⅱ in 2 cases according to the Garden index. All fractures reached bony union, and the healing time was 3-6 months, with an average of 4.8 months. At last follow-up, the femoral neck was shortened by 1-4 mm, with an average of 2.1 mm. No internal fixation failure or osteonecrosis of the femoral head occurred during follow-up. At last follow-up, the hip Harris score was 85-96, with an average of 92.4; 10 cases were rated as excellent and 2 were good. Conclusion The percutaneous screwdriver rod-assisted closed reduction can effectively reduce the valgus-impacted femoral neck fracture. It has the advantages of simple operation, effective, and less impact on blood supply.
Objective To observe the influence on adjacent lumbar bone density after strengthening of T12, L1 segment vertebral osteoporotic compression fracture by percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) in postmenopausal female. Methods Between January 2008 and June 2011, 59 patients with T12, L1 segment thoracolumbar osteoporotic compression fracture were treated with PVP in 29 cases (PVP group) and PKP in 30 cases (PKP group), who were in accordance with the inclusion and exclusion criteria. No significant difference was found in gender, duration of menopause, disease druation, causes of injury, fractured vertebral body, and vertebral fracture classification between 2 groups (P gt; 0.05). The kyphosis Cobb angle of surgical area was measured at preoperation, 1 week after operation, and last follow-up; the lower three lumbar spine bone mineral density (BMD) of the surgical area, the femoral neck BMD, and body mass index (BMI) of patients were measured at perioperative period and last follow-up to find out the statement of anti-osteoporosis; FRAX online tools were used to evaluate the probability of major osteoporotic fracture and hip fracture of the next 10 years. Results The average follow-up was 25.5 months (range, 12-48 months) in 2 groups. There was significant difference in kyphosis Cobb angle of T12, L1 between preoperation and last follow-up in 2 groups (P lt; 0.05); the Cobb angle of PKP group was significantly less than that of PVP group at 1 week after operation and last follow-up (P lt; 0.05). No significant difference was found in BMI between 2 groups, and between perioperative period and last follow-up in the same group (P gt; 0.05). The lower three lumbar spine BMD of the surgical area and its T value at last follow-up was improved significantly when compared with BMD at perioperative period (P lt; 0.05); there was no significant difference in the lower three lumbar spine BMD and its T value between 2 groups at perioperative period (P gt; 0.05), but significant difference was found between two groups at last follow-up (P lt; 0.05). Difference was not significant in the femoral neck BMD and its T value between 2 groups, and between perioperative period and last follow-up in the same group (P gt; 0.05). The probability of major osteoporotic fracture and hip fracture of the next 10 years was not significantly different between 2 groups and between perioperative period and last follow-up in the same group (P gt; 0.05). Conclusion The increased BMD of adjacent lumbar spine can improve the strength of the vertebral body and reduce the incidence of adjacent vertebral fracture in patients with T12, L1 segment vertebral osteoporotic compression fracture after PVP/PKP, and PKP is superior to PVP increasing BMD of adjacent lumbar spine.
ObjectivesTo compare the efficacy and safety of weekly nedaplatin compared with weekly cisplatin as postoperative concurrent chemoradiotherapy scheme for cervical cancer patients.MethodsThis trial was performed in the Department of Radiation Oncology in the Second Affiliated Hospital of Fujian Medical University from June 2016 to January 2017. A total of 200 patients with stage ⅠB1-ⅡB cervical cancer were randomly assigned to the nedaplatin group and the cisplatin group after signing informed content. The dose of nedaplatin or cisplatin ranged 35 to 40 mg/m2, once a week for 5 weeks. Intensity-modulated radiation therapy or three-dimensional conformal radiation therapy were used for patients. The progression-free survival, overall survival and adverse reactions were compared between two groups. Statistical analysis was performed by SPSS 24.0 software.ResultsA total of 105 patients were enrolled in the nedaplatin group, and 95 patients were in cisplatin group. The three-year progression-free survival rate was 80.5% vs. 79.5% in the nedaplatin group and the cisplatin group, respectively; and no statistical significant difference was found (χ2=0.198, P=0.656) between two groups. The 3-year overall survival rates were 72.5% and 69.9% for the nedaplatin group and the cisplatin group, respectively, and there was no significant difference between the two groups (χ2=0.261, P=0.609). The incidence of grade 3/4 nausea and vomiting in the nedaplatin group was 6.67%, which was significantly lower than that of 15.79% in the cisplatin group, and statistical significant difference was found (χ2=2.555, P=0.011); however, the incidence of grade 3/4 thrombocytopenia in the nedaplatin group was 9.52%, which was significantly higher than that in the cisplatin group (3.15%); and the difference was statistically significant (χ2=1.985, P=0.047). There was no difference in the incidence of adverse reactions such as anemia, neutropenia, and radiological proctitis in both groups.ConclusionsNedaplatin-based concurrent chemoradiotherapy has similar efficacy compared to cisplatin-based concurrent chemoradiotherapy, and it could significantly reduce the digestive tract reaction, which can be used as an alternative to cisplatin.