【Abstract】 Objective To investigate corresponding relation between structure change of the femoral head with“crescent sign” and stress exerted on the avascular necrosis of femoral head, to explore the mechanism of the “crescent sign” formation. Methods From March 1998 to April 2003, the femoral heads of 18 hips in 16 cases having osteonecrosis and “crescent sign” in X-ray film before total hi p arthroplasty, were collected. General and coronal section plane morphology of the femoral heads were observed. The princi ple of effective stress and stress concentration theory were used to explain the phenomena and structure changes in osteonecrosis of the femoral head. Results Cancellous bone existed as a threedimensional,interconnected network of trabeculae rods and plates, with 50%-90% of porosity and 20-30 mmHg bone marrow pressure. According to the definition of porous media, bones especially cancellous bone was a kind of sol id and l iquid two phases porous media. Cross-sectional structure changes in the junction between subchondral plate and cancellous were the place where stress concentrated. The principle of effective stress and stress concentration theory could explain the phenomena and their relationship that occurred in avascular necrosis of the femoral head. Conclusion The “crescent sign” starts in an area of very focal resorption in the subchondral plate laterally and peripherally. The focal resorption in the subchondral plate breaks the continuity of subchondral plate and causes stress concentration in the resorption region. The concentrated stress accumulates in the junction between subchondral plate and unrepaired necrotic cancellous bone brings on the fracture right below the subchondral plate. The focal resorption of the subchondral plate also provides a pathway for the pore water in the unrepaired necrotic bone skeleton to outflow, therefore cause effective stress increase and unrepaired necrotic bone skeleton be compacted by increased effective stress appl ied on unrepaired necrotic cancellous bone skeleton, and results in the volume decrease of unrepaired necrotic cancellous bone and the formation of cavum below the subchondral plate. The cavum shows “crescent sign” in the X-ray film.
Objective To evaluate the performance on the project of health system recovery using World Bank loan for ‘5.12’ Wenchuan earthquake after three years of these projects have been finished. Methods From March to December 2016, we formulated evaluation frameworks and indicators, used statistical reports and surveys to collect data of the 60 post-earthquake recovery projects using World Bank loan in Chengdu, Deyang and some other cities. Data of pre-earthquake (2007) and post-earthquake (2015) were compared. The evaluation indicators included institutional size, institutional environment, institutional services and social benefits. A descriptive analysis was performed using SPSS 22.0 software. Results Compared with the year of 2007, in 2015, the building and utilized for business purpose areas of loan benefited hospitals increased 4.49 and 3.58 times, respectively. The budgeted and actual beds count increased 43% and 55%, respectively. All inside structure and processes of hospitals were optimized, and green areas, parking slots and waiting areas increased greatly. Headcount of budgeted and actual increased 15.09% and 70.31%, respectively. Qualifications of healthcare technicians were improved in country level hospitals as well; there were more undergraduates and more senior competent personnel. In maternal and child health care hospitals and township hospitals, more diploma holders and personnel who had passed the middle level professional appraisals were observed. Numbers of hospital treatments, hospitalizations counts, numbers of surgeries performed increased 2.0, 2.1, and 2.0 times, respectively. Accuracy of diagnosis on hospitalized counts increased 3.12%. Utilizations of bed counts increased from 63.87% to 66.53%. The average duration of hospitalizations decreased from 7.36 days to 7.10 days. Numbers of clinical and surgery types increased 928 and 285, respectively. Both customer and staff satisfactory score reached 4.5 points in 2015. Conclusion The completed projects of health system recovery using World Bank loan for ‘5.12’ Wenchuan earthquake is running well, and meet the expectations.
Objective To explore the application of peer education in TB prevention at middle schools in Kai County of Chongqing and compare it with traditional education, and to provide theory support for further policy making. Methods Four complete middle schools were randomly selected as the control group, the peer education group, the traditional education group and the combined group of peer education and traditional education, respectively. Effect evaluation was performed one month later (instant evaluation) and six months later (long-term evaluation), respectively, after the intervention period. Results The instant and long-term evaluation showed that the knowledge, attitude and practice scores of the three intervention groups were higher than the scores before intervention or those of the control group (Plt;0.01). Besides, the behavior score of the peer education group had no significant difference between instant and longterm evaluation. All scores in the instant evaluation were higher than those of long-term evaluation both in the peer education group and the traditional education group (Plt;0.01). For the knowledge, attitude and practice scores, there was no significant difference between instant and long-term evaluation in the combined group of peer education and traditional education. Conclusion Compared with the peer education group and the traditional education group, the combined group achieves an enduring effect. There is obvious instant effect in the traditional education group, and peer education has a long-term influence on students’ behavior.
Objective To evaluate the safety and effect of early therapeutic endoscopic retrograde cholangiopancreatography (ERCP) and interventional treatment for acute biliary pancreatitis. Methods Eighty-seven hospitalized patients with acute biliary pancreatitis were divided into endoscopic therapy group and conservative therapy group according to the treatment methods. ERCP examination and treatment were used in the endoscopic therapy group, medical conservative treatments were used in the conservative therapy group. The efficacy such as blood amylase recovery time, abdominal pain relief time, blood white blood cell recovery time, liver function recovery time, hospital stay, and complications were observed. Results Blood amylase recovery time, abdominal pain relief time, blood white blood cell recovery time, liver function recovery time, and hospital stay in the endoscopic therapy group were significantly shorter than those in the conservative therapy group (Plt;0.05). There were no ERCP related severe complications or aggrevated symptoms. Conclusion Early endoscopic therapy is a safe and effective method for acute biliary pancreatitis and can prevent further progression to severe status.
ObjectiveTo explore the effect of quality control circle (QCC) on the management of hospital medication. MethodsAccording to the existing problems between December 2013 and January 2014, we put forward a series of continuous improvement plans, strengthened the nurses training, and intensified the supervision methods from February to May 2014. ResultsAfter the implementation of QCC, the incidence of leakage from drugs significantly decreased from 15.8% to 0.0%; the nurse-related drug management knowledge rate increased from 64.1% to 92.3%. Withdrawal process execution rate increased from 71.8% to 100.0%, and the difference was statistically significant (P<0.05) from February to May 2014. ConclusionQCC activity improves the hospital medication management, increases the nurses' sense of responsibility, and ensures the medical security of hospitalized patients.
Meibomian gland dysfunction (MGD) is a common ocular surface disease, and the pathogenesis of MGD is closely related to the alteration of meibomian gland morphology and (or) function. At present, the treatment strategy for MGD consists of physical therapy, artificial lubricants, topical and systemic antibiotics and anti-inflammatory agents, topical steroids and Ω-3 dietary supplementation. Recently, the thermal pulsation system (LipiFlow) has been used clinically, which allows heat to be applied to the palpebral surfaces of the upper and lower eyelids directly over the meibomian glands, while simultaneously applying pulsatile pressure to the outer eyelid surfaces. Due to its specific design, the cornea and eyeball can successfully avoid the potential damage from overheating and improper expression, which will greatly improve the safety during the clinical application and patients’ compliance. Studies have showed that the effectiveness of LipiFlow when treating MGD is at least as well as twice-daily lid warming and massage for 3 months, which displays a broad application prospect. At present, the application of LipiFlow in China has not been fully developed, and only some hospitals have experimental applications. This paper summarizes the research progress of LipiFlow treatment in MGD.
Objective To evaluate the effectiveness of Medicated γ-IUD compared with other IUDs for contraception. Methods CBMdisc （1986 -2005）, VIP （1989 -2005） , CNKI （1994-2005） , The Cochrane Library （Issue 4, 2005 ） and 10 related journals were searched for randomized controlled trials （R.CTs） and quasi-randomized controlled trials （quasi-RCTs） on the comparison between γ-IUD and other IUDs. The quality of included trials was critically appraised. RevMan 4.2.8 software was used for statistical analysis. Results Ten published studies with 8 381 participants were included. The results of meta-analysis were expressed with Peto OR （ cumulative pregnancy rate, cumulative expulsion rate, cumulative rate of removing for medical reasons） or OIL （ cumulative continuation rate ） and 95% CI. Compared with MSSR-165, Medicated γ-25,200 resulted in lower pregnancy rate at 1, 2, 3 years of follow-up [ with the OR （95% CI） 0. 31 （0.15,0.64） , 0. 31 （0. 17,0.54） , 0. 31 （0.19,0. 51） , respectively], lower cumulative expulsion rate in5 year follow-up [0.26 （0.17,0.40）, 0.28 （0.20,0.41）, 0.30 （0.21,0.42）, 0.29 （0.19,0.44）, 0.32 （0.21, 0. 48 ）, respectively], lower cumulative rate of removing for medical reasons.after 4 year follow-up [0.57 （0.36,0. 92 ） ], and higher rate of cunmlative continuation in 5 years of follow-up 13.35 （ 2.29,4.89 ） , 2.76 （ 2.06,3, 69 ） , 2.41 （1.89,3.08）, 2.22 （1.69,2.91）, 1.99 （1.55,2.55）, respectively]. Compared with TCu220, Medicated γ-25,200 resulted in lower cumulative pregnancy rate after follow-up 2, 3 years [ 0.46 （0.25 ,0.87 ） ; 0.48 （0.27,0. 85 ） ], lower cumulative expulsion rate after 1 year follow-up [ 0. 58 （0.35,0.97） ] , lower cumulative rate of being removed for medical reasons in5 year follow-up [0.37 （0.23,0.59）, 0.38 （0.26,0.56）, 0.45 （0.32,0.64）, 0.47 （0.30,0.73）, 0.58 （0.39,0.87）, respectively ] and higher rate of cumulative continuation in 5 years of follow-up [ 2. 15 （ 1.61,2.87 ）, 2.02 （ 1.56,2.63）, 1.72 （ 1.34,2.20）, 1.44 （ 1.08,1.91 ）, 1, 39 （ 1.07,1.80）, respectively]. Compared with Uterus-Cu, Medicated γ-25,200 resulted in higher rate of cumulative continuation after follow-up 1 year [ 0.51 （0.34, 0.77） ]. Compared with MLCu375, Medicated γ-25,200 resulted in lower cumulative rate of being removed for medical reasons and higher rate of cumulative continuation after follow-up for 3 years [ 0. 22 （0.09,0.52） , 2.84 （ 1.64,4. 94 ）]. Compared with TCu380A, Medicated γ-25, 200 resulted in lower cumulative rate of being removed for medical reasons and higher rate of cumulative continuation in follow-up for 2 years [ 0.36 （ 0.18,0.73 ）, 0.29 （ 0. 12,0.70 ） ; 3.06 （ 1.72,5.44）, 3.61 （1.75,7.47） ]. Conclusions Available evidence shows that Medicated γ-IUD has better or equal effectiveness when compared with other IUDs. However, more RCTs with high quality and longer follow up period are needed to confirm the conclusion.
ObjectiveTo compare the effectiveness between the method of simple posterior debridement combined with bone grafting and fusion and internal fixation and the method of one-stage anterior radical debridement combined with bone grafting and fusion and posterior internal fixation in the treatment of thoracolumbar brucella spondylitis so as to provide the reference for the clinical treatment. MethodsA retrospective analysis was made on the clinical data of 148 cases of thoracolumbar brucella spondylitis between January 2002 and January 2012. Simple posterior debridement combined with bone grafting and fusion and internal fixation was used in 78 cases (group A), and one-stage anterior radical debridement combined with bone grafting and fusion and posterior internal fixation in 70 cases (group B). There was no significant difference in gender, age, disease duration, involved vertebral segments, erythrocyte sedimentation rate (ESR), visual analogue scale (VAS) score, neural function grade of America Spinal Injury Association (ASIA), and kyphosis Cobb angle before operation between 2 groups (P > 0.05). The peri operation period indexes (hospitalization time, operation time, and intraoperative blood loss) and the clinical effectiveness indexes (VAS score, ASIA grade, Cobb angle, and ESR) were compared; the bone fusion and the internal fixation were observed. ResultsIncision infection and paravertebral and/or psoas abscess occurred in 2 and 3 cases of group A respectively. All incisions healed by first intention and 2 cases had pneumothorax in group B. The operation time and the hospitalization time of group A were significantly shorter than those of group B (P < 0.05), and the intraoperative blood lossof group A was significantly lower than that of group B (P < 0.05). All of the cases in 2 groups were followed up 14-38 months, 25 months on average. The VAS, ESR, and Cobb angle were significantly decreased at each time point after operation when compared with preoperative ones in 2 groups (P < 0.05), but no significant difference was found between 2 groups (P > 0.05). The neurological function was significantly improved at 3 months after operation; there were 1 case of ASIA grade C, 14 cases of grade D, and 63 cases of grade E in group A, and there were 1 case of grade C, 11 cases of grade D, and 58 cases of grade E in group B; and difference was not significant (Z=0.168, P=0.682). The grafting bone fusion was observed in both groups. The fusion time was (8.7±0.3) months in group A and (8.6±0.4) months in group B, showing no significant difference (t=0.591, P=0.601) was found. At last follow-up, no loosening or fracture of internal fixation was found. ConclusionBased on regular medicine therapy, the effectiveness of the two methods is satisfactory in the treatment of thoracolumbar brucella spondylitis as long as the operation indications should be controlled strictly.
ObjectiveTo evaluate the effectiveness of locking compress plate (LCP) for the treatment of aseptic diaphyseal humeral nonunions. MethodsBetween January 2006 and January 2012, 23 patients with aseptic diaphyseal humeral nonuninons were treated with LCP and autologous iliac crest bone graft, and the clinical data were retrospectively analyzed. There were 15 males and 8 females with the average age of 42.5 years (range, 28-60 years). The fracture located at left side in 11 cases and right side in 12 cases. The mechanism of the injury was traffic accident in 15 patients, and falling from height in 8 patients. Fracture was treated by internal fixation in 20 cases and external fixation in 3 cases. And 6 patients had open fractures and other 17 had close fractures. Based on the Weber-Cech classification, 6 cases were rated as atrophic nonunions, and 17 cases as hypertrophic nonuninons. Shoulder function was evaluated by Constant-Murley score and elbow function was evaluated by Mayo score. ResultsAfter operation, 2 patients had transient radial nerve symptoms of numbness and 1 patient had superficial infection. Primary healing of incision was obtained in the other patients. All patients were followed up 22.22 months on average (range, 16-30 months). Normal range of motion of the shoulder was found in 11 cases; and limited movements of abduction, elevation, and posterior extension were observed in 12 cases. And osseous union was observed clinically and radiographically in all patients. The average union time was 16.95 weeks (range, 12-24 weeks). The average Constant-Murley score was 81.87 (range, 50-98); and shoulder function was excellent in 14 cases, good in 6, and fair in 3. And the average Mayo score was 87.78 (range, 70-96); and the result was excellent in 14 cases, good in 7, and fair in 2. ConclusionAseptic diaphyseal humeral nonunions can be successfully treated with LCP, coupled with the use of autologous iliac crest bone graft.