ObjectiveTo summarize the procedures of the shoulder arthroplasty and the evolution of the shoulder prosthesis, and to discuss the indications and contraindications of the several common shoulder arthroplastis. MethodsThe related literature on shoulder arthroplasty was extensively reviewed, summarized, and analyzed. ResultsAt present, shoulder arthroplasties can be classified into shoulder hemiarthroplasty, total shoulder arthroplasty, resurfacing shoulder arthroplasty, stemless shoulder arthroplasty, and reserve shoulder arthroplasty, etc. Each type of the prosthesis has several special indications and contraindications. Mostly, the shoulder arthroplasties achieved the satisfied results, such as pain-relief and restoration of the elevation and adduction of shoulder. The survival rate of the most shoulder prostheses may reach 10 years or more. ConclusionMost shoulder arthroplasties are effective and satisfied to treat the shoulder traumas and diseases in pain-free and functional restoration of shoulders.
ObjectiveTo investigate the development and clinical application of the reverse total shoulder arthroplasty. MethodsThe relative publications on reverse total shoulder arthroplasties were extensively reviewed and analyzed. ResultsReverse total shoulder arthroplasty has extensive indications, especially for pseudoparalysis caused by irrepairable rotator cuff tears with forward or upper shift of the humeral head and intact function of deltoid. The clinical research results indicate that the short-term results are satisfactory, but there are some special complications, such as scapular nothching, instability and limities of internal and external rotation. While performing this kind of operation, the selection of the approach, the determination of the prosthetic rotation center should be considered well, and the bone graft should be paid attention to when the bony defect of the glenoid and proximal humerus exists. ConclusionThe using time of the reverse total shoulder arthroplasty is short, so the long-term results should be observed. The development of computer assisted technique is hopeful to be improve the results of the reverse total shoulder arthroplasty.
【Abstract】 Objective To investigate the qual itative rotation al ignment of components in total knee arthroplastyand the accuracy and the effectiveness of Bone Morphing computer assisted system when qual itatively practicing. MethodsFrom November 2002 to June 2003, 21 patients with three compartments osteoarthritis(21 knees) were treated by primarytotal knee arthroplasty after the conservative medical treatment failed, with the assistance of a “Bone Morphing” CeravisionSystem, implanted posterior stabil ized total knee prosthesis. Twenty-one patients included 5 males (5 knees) and 16 females (16knees) with an average age of 72.4 years (64-79 years) . The locations were left knee in 10 cases and right knee in 11 cases. Thepatients suffered from knee pain and l imitation of movement from 2 to 10 years. There were 14 genu varum and 7 genu valgumpreoperatively. The relative preoperative, intraoperative and postoperative data from cl inical check-up, the X-ray films and theintraoperative components rotational al ignment real-time records in CD Rom were analyzed. Results All operative incisionshealed up by first intension. Twenty-one patients were followed up 12-16 months(mean 13.3 months). For the achievement ofproper lower l imb al ignment and normal frontal laxity of knee, rotational al ignment of femoral components was from internalrotation (IR)1° to external rotation (ER) 5°, tibial components from IR 0° to ER 5°. In patients with genu varum, the rotationalal ignment of the femoral components was ER 1°- ER 5°, of tibial components ER 2°- ER 5°. In patients with genu valgum, the rotationalal ignment of femoral components was IR 1°- ER 4°, of tibial components IR 0°-ER 4°. After 3 months of operation, themean flexion angle measured as range of motion (ROM) was 115°(105-130°), the frontal laxsity measured as 0.2-0.5 cm (mean0.27 cm) of internal laxity and 1.0-2.5 cm (mean 1.7 cm) for external laxity, there were no knee pain, paterllar instabil ity or dislocationand abnormal knee frontal laxity. Conclusion Using Bone Morphing computer-assisted system can optimise theindividual components rotation al ignment accurately.
Pressure-support ventilation (PSV) is a form of important ventilation mode. Patient-ventilator synchrony of pressure support ventilation can be divided into inspiration-triggered and expiration-triggered ones. Whether the ventilator can track the patient's inspiration and expiration very well or not is an important evaluating item of the performance of the ventilator. The ventilator should response to the patient's inspiration effort on time and deliver the air flow to the patient under various conditions, such as different patient's lung types and inspiration effort, etc. Similarly, the ventilator should be able to response to the patient's expiration action, and to decrease the patient lung's internal pressure rapidly. Using the Active Servo Lung (ASL5000) respiratory simulation system, we evaluated the spontaneous breathing of PSV mode on E5, Servo i and Evital XL. The following parameters, the delay time before flow to the patient starts once the trigger variable signaling the start of inspiration, the lowest inspiratory airway pressure generated prior to the initiation of PSV, etc. were measured.
ObjectiveTo systematically review the efficacy and safety of tripterygium wilfordii Hook F (TwHF) in treatment of IgA nephropathy. MethodsThe Cochrane Library (Issue 4, 2014), PubMed, EMbase, CBM, CNKI, VIP and WanFang Data were searched up to April 28th, 2004 to collect randomized controlled trials (RCTs) about the efficacy and safety of TwHF in treatment of IgA nephropathy. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality of included studies. Metaanalysis was then conducted using RevMan 5.2 software. ResultsA total of 10 RCTs involving 521 patients were finally included. The results of meta-analysis showed that:a) compared with MMF group, TwHF group had better outcomes in complete remission (CR) (OR=2.01, 95%CI 1.04 to 3.87, P=0.04), total remission (TR) (OR=3.17, 95%CI 1.22 to 8.23, P=0.02), 24-hour urinary protein content (MD=2.61, 95%CI 1.34 to 3.88, P<0.000 1), and level of serum albumin (MD=-6.42, 95%CI -9.13 to -3.71, P<0.000 01); and b) compared with ACEI (ARB) group, TwHF group had better outcomes in complete remission (CR) (OR=4.25, 95%CI 2.63 to 6.86, P<0.000 01), total remission (TR) (OR=4.15, 95%CI 2.33 to 7.40, P<0.000 01), 24-hour urinary protein content (MD=1.15, 95%CI 0.63 to 1.66, P<0.000 1), and level of serum albumin (MD=-5.18, 95%CI -8.96 to -1.41, P=0.007), all with significant differences. ConclusionTwHF has favourable therapeutic efficacy and safety in treatment of IgA nephropathy. Due to limited quantity and quality of the included studies, the above conclusion should be verified by further conducting more high quality, large-scale, multicentre RCTs.
ObjectiveTo explore the teaching effects of case-based learning (CBL) as an educational strategy in digestive diseases module teaching. MethodsSixty-three oral and dental medical senior students were randomly divided into two groups during February to June 2012. Among them, 31 students were enrolled in the CBL group accepting CBL teaching method based on certain cases, while the other 32 students were designated into the control group receiving traditional teaching method. Their scores in practice skill examination, analytical ability of medical records, module test scores and behavior observation results were compared. Questionnaire survey was performed for students in the CBL group. ResultsThere were no significant difference in scores of clinical practice skill examination and behavior observation results between the two groups (P>0.05). Students in the CBL group did significantly better in case analysis and module test scores (P<0.05). Questionnaire survey revealed that CBL method could significantly improve the learning interest, cultivate the ability to combine theory and practice, strengthen analytical skills and promote problem-solving abilities. The students were generally satisfied with the CBL teaching method. ConclusionCBL method has an obvious advantage in digestive diseases teaching.
This paper is to explore changes of intestinal mucosal barrier, intestinal flora, and bacterial translocation in rats with severe acute pancreatitis (SAP). Twenty four male SD rats were randomly divided into the control group (n=10) and the experimental group (n=14). The model of severe acute pancreatitis of rats was induced by the method of injecting adversely 5% sodium taurocholate into the common biliary-pancreatic duct. All of the rats were killed after 24 hours and the level of the serum amylase and the plasma endotoxin was determined after that. The pathological changes of pancreas and small intestine were observed through hematoxylin-eosin staining (HE staining) and the abdominal viscera bacterial translocation rates were tested. With the method of real-time polymerase chain reaction (RT-PCR) the quantity of the intestinal flora was analyzed. In the control group, the level of Escherichia coli, Lactobacillus and Bifidobacterium were 2.08±1.29, 11.04±7.55 and 12.21±4.95, respectively. On the contrast, the level of Escherichia coli in the cecum contents was much higher (9.72±3.58, P < 0.01), while the Lactobacillus number was decreased significantly (0.67±0.34, P < 0.01), and the Bifidobacterium number was also decreased (4.59±3.42, P < 0.05) in the experimental group, so the ratio of Bifidobacterium/Escherichia coli was reversed. Besides, in the experimental group, the plasma endotoxin positive rates and the bacterial translocation rates were much higher (P < 0.01 or P < 0.05) and the pathology scores of pancreas and small intestines were also significantly higher (P < 0.01) than those in the control group. These results indicated that in severe acute pancreatitis rats, the intestinal mucosal barrier was severely damaged and the dysbacteriosis occurs in the intestinal canal. And these might relate to the occurrence and development of multiple organ infection.
Objective To investigate the feasibility and safety of uniportal video-assisted thoracic surgery (VATS) for primary lung cancer. Methods We retrospectively analyzed the clinical data of 95 primary lung cancer patients in our hospital between January 2014 and January 2015. The patients were divided into an observation group (45 patients) and a control group (50 patients). Standard thoracoscopy lobectomy was used in the control group. Uniportal thoracoscopy lobectomy was used in the trial group. The parameters of the two groups were observed. Results The surgeries of the two groups were successfully completed. There was no statistical difference in operative time, intraoperative transit rate, blood loss, number of lymph node dissection, thoracic drainage and pathology Ⅰ, Ⅱ period (P>0.05). Postoperative drainage tube time, postoperative hospital stay, postoperative pain in the observation group were better than those in the control group (P<0.05). But postoperative drainage time in the observation group was longer than that in the control group (P<0.05). Also, the total hospital costs, especially on the use of expensive consumables, during surgery in the observation group was higher. And there was a higher risk of delayed incision healing or airway injury (P<0.05) in the observation group. One death in the control group during perioperative period occurred. Conclusion Uniportal VATS operation applied in radical operation for lung cancer is safe and feasible. It accelerates postoperative turnover, reduces postoperative pain. But there is a higher risk for airway injury or delayed wound healing, and an increase in use of medical consumptive stuff.