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Objective:To characterize the geriatric osteoporotic pelvic fractures using 3-D computed tomography (CT) fracture mapping.Methods:Retrospectively analyzed were the 79 elderly patients with pelvic fracture who had been admitted to Department of Orthopaedics, The 7th Medical Center of PLA General Hospital between January 2017 and December 2021. There were 24 men and 55 women, aged from 60 to 98 years (average, 74.3 years). The CT scan data of the pelvis from all patients were imported into the software (Mimics Medical 18.0, Geomagic Studio 2014, Rhinoceros 6.0, and Matlab) to create a 3-D pelvic fracture model. The fracture pieces were imported into a standard pelvic template to obtain the morphology of the fracture lines after fitting. A map of fracture line distribution frequency and a fracture heat map were created by fitting the fracture lines of all patients into a common pelvic template.Results:Of the 79 elderly patients with pelvic fracture, 69 (87.3%) had fractures of both the anterior and the posterior rings. The fracture map and heat map of geriatric pelvic fractures showed the following: the fracture lines of the anterior ring were concentrated in the junction of the cancellous bone and cortical bone of the superior and inferior pubic rami; the fracture lines of the posterior ring were concentrated in the middle and posterior 1/3 of the ilium and in the sacral wing; the fracture frequencies incurred by the pubic bone, sacrum, and ilium were from the highest to the lowest.Conclusions:Fracture mapping can visually characterize the distribution of fracture lines of the geriatric pelvic fractures. Simultaneous fractures of the anterior and posterior rings of the pelvis are the most typical kind of pelvic fractures in the elderly. The junction of the cancellous and cortical bones of the superior and inferior pubic rami and the area surrounding the sacroiliac joint are the most frequent locations for the fractures.
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Objective:To evaluate clinical outcomes and complications of minimal invasive surgery for the treatment of elderly patients with fragility fracture of pelvis.Methods:Elderly patients with fragile pelvic fractures undergoing minimally invasive surgery and being followed up were retrospectively analyzed from January 2015 to December 2019.Based on the classification of pelvic fragile fractures(FFP), open reduction and internal fixation with pelvic anterior ring instability internal fixator(INFIX)plus posterior ring sacroiliac screw, or open reduction and internal fixation with iliac fossa approach, were performed for elderly patients with fragile pelvic fractures.The general data of all patients(age, sex, mechanism of injury)were recorded.Time from injury to operation, VAS(visual analogue scale)before and after operation, blood loss during operation, complications during hospitalization, time to ambulation, mortality, and Koval walking index at 2 year follow-up were recorded to evaluate clinical outcomes and complications of minimal invasive surgery for the treatment of fragility fracture of pelvis.Results:Thirty-two patients were followed up, including 11 males and 21 females, aged 65-88 years(76.9±5.5)years.The mechanism of injury was fall on the ground as a percentage of 59.4%(19/32), fall in the sitting position as a percentage of 25.0%(8/32), and 15.63%(5/32)had unknown history of trauma.The time from injury to operation was 3-36 days(9.6±3.3)days.There were 50.0%(16/32)type Ⅱ, 31.3%(10/32)type Ⅲ and 18.8%(6/32)type Ⅳ cases according to FFP classification.The mean blood loss during operation was(65.9±35.2)ml(range, 20-200 ml). The preoperative VAS score was 5-9 scores, with an average of(6.41±1.07)scores.The postoperative VAS score was 1-4(1.71±0.63). Average time from injury to operation was(9.6±3.3)days(range, 3~36). The incidence of complications during operation was 9.4%(3/32), including 1 case of gastrointestinal bleeding, 1 case of lower extremity deep vein thrombosis, and 1 case of superficial wound infection.Ambulation was at 4 weeks post-operation in 56.3%(18/32)cases, at 6 weeks post-operation in 31.3%(10/32)cases and at 8 weeks post-operation in 12.5%(4/32)cases.6.25%(2/32)patients died within 2 year follow-up.Koval walking index of the rest 30 patients included grade 1 in 46.9%(15/32)cases, grade 2 in 18.8%(6/32)cases, grade 3 in 6.3%(2/32)cases, grade 4 in 18.8%(6/32)cases and grade 6 in 3.1%(1/32)case(1 year after surgery, hemiplegia after cerebral infarction).Conclusions:Minimal invasive surgery achieves significant pain relief and early mobilization in patients with fragility fracture of pelvis.
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Objective:To determine the factors related to postoperative 1-year and 5-year mortalities in elderly patients with hip fracture plus chronic obstructive pulmonary disease (COPD).Methods:A retrospective study was conducted of the elderly patients with hip fracture who had sought medical attention at Department of Orthopaedics, The 7th Medical Center of PLA General Hospital from January 2012 to December 2016.Of them, 103 were complicated with COPD, and another 103 without COPD were selected as controls who were matched in age, gender and fracture site. The 2 groups were compared in terms of postoperative 30-day, 1-year and 5-year mortalities; the risk factors were explored for postoperative 1-year and 5-year mortalities in patients with hip fracture plus COPD.Results:The postoperative 30-day, 1-year and 5-year mortalities in the COPD group were 7.8%(8/103), 29.1%(30/103) and 48.5%(50/103), significantly higher than those in the control group except for the 30-day value [1.9%(2/103), 13.6%(14/103) and 31.1%(32/103)] ( P<0.05). Advanced age ( P=0.003), cardiovascular disease ( P=0.006), respiratory disease ( P=0.009), acute exacerbation of COPD (AECOPD) ( P<0.01), American Society of anesthesiologists (ASA) grades Ⅲ+Ⅳ ( P=0.001), delayed surgery (>48 h) ( P=0.015), pre-injury activities of daily living (ADL) score ( P=0.002) and mobility ( P=0.010) were related to an increased risk for 1-year mortality after operation. Advanced age ( OR=1.106, 95% CI: 1.016 to 1.210, P=0.021), AECOPD ( OR=5.053, 95% CI: 1.520 to 16.800, P=0.008), and ASA grades Ⅲ+Ⅳ ( OR=1.657, 95% CI: 1.072 to 3.912, P=0.040) were the risk factors for 5-year mortality in patients with COPD; pre-injury ADL ( OR=0.974, 95% CI: 0.987 to 0.967, P=0.043) was negatively correlated with 5-year mortality. Conclusions:COPD can significantly increase the short-term and long-term mortalities in elderly patients with hip fracture.Cardiovascular disease, AECOPD and ASA grades Ⅲ+Ⅳ are factors related to postoperative 1-year mortality in patients with hip fracture plus COPD. Advanced age, AECOPD and ASA grades Ⅲ+Ⅳ and delayed surgery (>48 h) are risk factors for postoperative 5-year mortality in patients with hip fracture plus COPD. ADL score before injury is negatively correlated with postoperative 1-year and 5-year mortalities.
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Objective:To investigate the clinical effect of minimally invasive plate osteosynthesis (MIPO) through anterolateral approach in treatment of middle-distal humeral shaft fracture.Methods:A retrospective case series study was conducted to analyze the clinical data of 21 patients with middle-distal humeral shaft fracture admitted to 7th Medical Center of Chinese PLA General Hospital from August 2015 to March 2018, including 12 males and 9 females, aged 18-68 years [(31.3±3.6)years]. All were closed fracture. According to AO classification, the fracture were classified as type A in 6 patients, type B in 10 and type C in 5. All patients were treated with anterolateral minimally invasive plate fixation. The operation time, intraoperative blood loss and hospital stay were recorded. The fracture healing was observed after operation. The visual analogue scale (VAS), University of California at Los Angeles (UCLA) shoulder rating scale, and Mayo elbow performance score (MEPS) were used to evaluate the effectiveness before operation and at 2 weeks, 3 months and 12 months after operation.Results:All patients were followed up for 12-26 months [(18.2±2.4)months]. The operation time was 50-82 minutes [(68.2±19.4)minutes], with intraoperative blood loss of 40-95 ml [(60.2±21.3)ml]. The hospital stay was 6-16 days [(6.8±1.2)days]. There was no iatrogenic vascular or nerve injury during operation. The patients with radial nerve injury before operation were all adventitia contusion. The nerve function returned to normal within 3 months after operation. All fractures were healed within 5-10 months [(5.3±1.2)months]. At 2 weeks, 3 months and 12 months after operation, the VAS [(3.6±0.8)points, (2.1±0.4)points, (1.8±0.3)points] was lower than that before operation [(8.3±1.6)points] ( P<0.05); UCLA shoulder rating scale [(31.2±1.5)points, (33.6±0.8)points, (34.6±0.5)points] was higher than that before operation [(28.4±2.3)points] ( P<0.05); and MEPS [(80.2±3.4)points, (93.4±2.2)points, (96.4±3.5)points] was higher than that before operation [(60.5±4.5)points] ( P<0.05). At the last follow-up, the UCLA shoulder rating scale and MEPS showed excellent results. Conclusion:For middle and lower humeral shaft fracture especially for the fracture line relatively distal to the shaft, MIPO technique through anterolateral approach can attain satisfactory results in terms of pain, range of motion of shoulder and elbow joint, and joint function.
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Studies on chronic myeloid leukemia (CML) have served as a paradigm for cancer research and therapy. These studies involve the identification of the first cancer-associated chromosomal abnormality and the subsequent development of tyrosine kinase inhibitors (TKIs) that inhibit BCR-ABL kinase activity in CML. It becomes clear that leukemia stem cells (LSCs) in CML which are resistant to TKIs, and eradication of LSCs appears to be extremely difficult. Therefore, one of the major issues in current CML biology is to understand the biology of LSCs and to investigate why LSCs are insensitive to TKI monotherapy for developing curative therapeutic strategies. Studies from our group and others have revealed that CML LSCs form a hierarchy similar to that seen in normal hematopoiesis, in which a rare stem cell population with limitless self-renewal potential gives rise to progenies that lack such potential. LSCs also possess biological features that are different from those of normal hematopoietic stem cells (HSCs) and are critical for their malignant characteristics. In this review, we summarize the latest progress in CML field, and attempt to understand the molecular mechanisms of survival regulation of LSCs.
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Animals , Humans , DNA-Binding Proteins , Genetics , Metabolism , Fusion Proteins, bcr-abl , Metabolism , Hypoxia-Inducible Factor 1 , Metabolism , Leukemia, Myelogenous, Chronic, BCR-ABL Positive , Drug Therapy , Metabolism , Pathology , Lipid Metabolism , Neoplastic Stem Cells , Metabolism , Protein Kinase Inhibitors , Pharmacology , Therapeutic Uses , Proto-Oncogene Proteins c-bcl-6 , src-Family Kinases , MetabolismABSTRACT
Objective To explore the influential factors of treatment of the intra-articular calcaneal fractures treated with calcaneal titanic alloy plate.Methods The treatment of intra-articularcalcaneal fractures with calcaneal titanic alloy plate was reviewed.Thefalling height, weight, complication, Sanders evaluation method,mechanism of injured, the change degree of B(o)hler and Gissane angle were recorded and compared.One-way ANOVA, Chi-Square Tests and logistic test were applied to evaluate the relationship of these factors.Results According to AOFAS scale system, the average recovery score was 86.35, excellent rate was 91.6%.Binary logistic stepwise regression showed that the correlation between weight and resu1ts of treatment was statistically significant( P ＜0.01 ).The correlation between the period before operation and the recovery score was statistically significant( P ＜0.01).Sanders evaluation method was statistically significant ( P ＜0.05).The correlation between preoperative B(o)hler'sngle and Gissane's angle and the postoperative functional recovery score was statistically significant ( P ＜ 0.05) .Conclusions Calcaneal titanic alloy plate used in treatment of intra-articular calcaneal fracturcs was a good method.The weight, the period before operation, level of trauma and the B(o)hler's angle and Gissane's angle influenced the treatment effect.
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Chronic myeloid leukemia (CML) is a myeloproliferative disease characterized by the overproduction of granulocytes, which leads to high white blood cell counts and splenomegaly in patients. Based on clinical symptoms and laboratory findings, CML is classified into three clinical phases, often starting with a chronic phase, progressing to an accelerated phase and ultimately ending in a terminal phase called blast crisis. Blast crisis phase of CML is clinically similar to an acute leukemia; in particular, B-cell acute lymphoblastic leukemia (B-ALL) is a severe form of acute leukemia in blast crisis, and there is no effective therapy for it yet. CML is induced by the BCR-ABL oncogene, whose gene product is a BCR-ABL tyrosine kinase. Currently, inhibition of BCR-ABL kinase activity by its kinase inhibitor such as imatinib mesylate (Gleevec) is a major therapeutic strategy for CML. However, the inability of BCR-ABL kinase inhibitors to completely kill leukemia stem cells (LSCs) indicates that these kinase inhibitors are unlikely to cure CML. In addition, drug resistance due to the development of BCRABL mutations occurs before and during treatment of CML with kinase inhibitors. A critical issue to resolve this problem is to fully understand the biology of LSCs, and to identify key genes that play significant roles in survival and self-renewal of LSCs. In this review, we will focus on LSCs in CML by summarizing and discussing available experimental results, including the original studies from our own laboratory.
Subject(s)
Animals , Humans , Male , Mice , 5-Lipoxygenase-Activating Proteins , Metabolism , Benzamides , Disease Models, Animal , Fusion Proteins, bcr-abl , Chemistry , Metabolism , Imatinib Mesylate , Leukemia, Myelogenous, Chronic, BCR-ABL Positive , Drug Therapy , Genetics , Pathology , Neoplastic Stem Cells , Pathology , PTEN Phosphohydrolase , Metabolism , Philadelphia Chromosome , Piperazines , Therapeutic Uses , Point Mutation , Protein Structure, Tertiary , Protein-Tyrosine Kinases , Chemistry , Metabolism , Pyrimidines , Therapeutic UsesABSTRACT
[Objective]To introduce an operative treatment of complex talar body fracture and discuss the therapeutic effect in the near future.[Method]From March 1999 to January 2003,8 patients of complex talar body fracture in our department were treated.There were 5 males and 3 females with an average age of 28.9 years from 19 years to 46 years.The injuries were caused by fall in 3 cases,traffic accident in 3 cases,crash in 1 case,and on left 5 cases,right 3 cases.Two cases were combined with malleolus fracture and 1 case with open fracture and dislocation.All patients were treated with operation through approach of internal or external malleolus osteotomy and useing Absorbable screw for fixation.[Result]All the patients were followed up 1 to 3 years,average 1.3 year.By the assessment of clinical effects dependingon the complaints,functions and radiological results of the ankle and subtalar joint,4 patients were rated as being excellent,2 patients good,1 fair and 1 poor,the total rate of being excellent and good was 75%.No postoperative avascular necrosis of the talar was seen on radiographies.[Conclusion]Operation through approach of internal or external malleolus osteotomy and Absorbable scrow for fixation is a good method for treatment of complex talar body fracture.
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Objective To reconstruct on the basis of histological study the computerized 3D ima ges of the fascicular groups of ulnar nerve,which can be used to guide the microsurg ical repair of injuries of brachial plexus and ulnar nerve and to provide morpholog ical evidence for the functional rec overy of intrinsic muscles of hand after root avulsion of brachial plexus.Methods The successive AchE-staining histo logical cross-sections were made.T he photos of the sections were transformed into digital information and sto red in the computer.Different functional fas-cicular groups were distinguished a nd marked on each section.The topographic database was analyzed by image pro-cessing software,with the support o f OpenGL three dimensional graphic l ibrary.3D images of the fascicular g roups of ulnar nerve were reconstructed usin g the contour-based surface constru ction method in the program written w ith VC language.Results The 3D images of the individual external surface of the reconstructive fa scicular groups were displayed and the human-computer in teraction was realized by performin g the arbitrary rotation and the rand om cross-section.By selecting the int erested object,the spatial structu re of any fascicular group could be di splayed in the same space simultaneously.Compare d with the result of microanatomy,th e 3D shape could truly reflect the str ucture,adjacent relationship and arrangem ent of fascicular groups in the ulnar nerve trunk.Conclusions Since the re-constructive 3D images can truly reflect the arrangement and distribution of the functional fascicular grou ps,they will have positive effects on understanding the internal structure of ulnar nerve,designing operative procedur e and adjusting operative method for surgeons.[
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Objective To observe and study the distribution and histological feature of the fascicular groups to deltoid muscle in axillary nerve at the level of quadrilateral zone. Methods 12 adult human cadavers (24 upper limbs)embalmed by formalin were used,, and microsurgical longitudinal contradissection of the axillary nerves by tracing their terminal branches were processed. At the level of quadrilateral zone,distrabution of the fscicular groups to deltoid muscle in the never trunk were recorded and their diameters were measured;Another 6 upper extremities (3 right and 3 left) of fresh-frozen human cadavers were obtained.Axillary nerves and their fascicular groups were exposured, and the segments at the level of qusdrilateral zone gotten, then histological cross section was done, acetycholinesterase (ACHE) stained with the method of Karnovsky Roots and myelin stained with the method of Loyezs. Defferent never fibres were distinguished under microscope and the fiber number was counted with IAS . Results At the level of quadrilateral zone,fasciculars were divided into two groups.The fascicular group of anterior branch to deltoid muscle was in the lateral of the nerve trunk . Its cross sectional area was (2.449?1.327)mm2 ,occupied 55.4%?9.3%of the axillary nerve trunk ;Its most fibers were motor fibers;The number of fibers is (2112?631), occupied 45.6 %?1.1%of all fibers of axillary nerve . Conclusions In the treatment of root avulsion of brachial plexus injury, selective suture donor nerve with the lateral fascicular group should be processed to repair the function of shoulder abduction,fibers loss would be reduced and rate of functional restoration improved .
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Objective To observe the arrangement and distribution of the fascicular groups in the ulnar nerve trunk to the intrinsic muscles so as to provide anatomical evidence for selective repair in the clinic.Methods 12 cadaveric upper extremities recently embalmed with formalin were obtained. The ulnar nerve and its branches were exposed. Microanatomy and longitudinal contradissection of each functional fascicular group were performed by tracing their terminal branches, and the arrangement and distribution were observed and recorded. The fascicular groups to the intrinsic muscles of hand in the nerve trunk were observed to see how they crossed and mixed with other fascicular groups. The diameter of the nerve trunk and the fascicles to the intrinsic muscles were measured, and the area and the distribution range of the fascicles calculated. Results The shape and the diameter of the ulnar nerve trunk varied at different positions. The fibers of functional fascicular groups had the definite differentiation at distal while interfused and diffused at proximal. The fascicular groups to the intrinsic muscles of hand were the largest and their fibers relatively concentrated (the distribution range occupied 40% ～ 80% of the ulnar nerve), and had the definite localization at the forearm and distal to the 3/8 segment of upper arm. Conclusion Since the fascicles to the intrinsic muscles of the hand are the most important in the ulnar nerve, selective repair by using epineural and perineural techniques at the forearm and upper arm will reduce the loss of nerve fibers and will contribute to the functional recovery.
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OBJECTIVE:To probe into the effects of ?-1bIFN on the development process from the hepatitis gravis to postnecrotic cirrhosis.METHODS:The change of serum liver fibrosis markers and hepatic function were observed in treatment group and control group before and after treatment.RESULTS:(1)In treatment group,all the serum liver fibrosis markers were decreased after treatment and were significantly different from those in control group(P0.05).(2)After treatment,the levels of serum albumin,globulin and count of platelet reverted to normal in treatment group and the levels were significantly different from those in control group(P