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To investigate the clinical efficacy of using the posterior tibial artery and peroneal artery perforator flaps to repair the heel wounds. Methods From January, 2011 to May, 2018, heel soft tissue de-fect caused by trauma in 18 cases were treated by posterior tibial artery and peroneal artery perforator flaps respec-tively. The posterior tibial artery perforator flap was used in 11 cases, and the peroneal artery perforator flap was used in 7 cases. The area of flaps ranged from 5.0 cm×3.0 cm to 11.0 cm×9.0 cm. The length of the vascular pedicle was from 10.0 cm to 16.0 cm.After operation, the patients were followed-up regularly.The time of wound healing, appear-ance and texture of the flap, and function of ankle joint were observed. Results After the operation, 13 flaps sur-vived uneventfully. The wound achieved primary healing. Partial necrosis occurred in the distal of posterior tibial artery perforator flap in 2 cases, and repaired by skin graft 1 or 2 months later.Marginal necrosis occurred in posterior tibial artery perforator flap in 2 cases and in peroneal artery perforator flap in 1 case. And scar healing occurred in these 3 cases finally.All the 18 patients were followed-up for 3 to 60 months, with an average of 10 months. Fracture healing time was from 3-6 months, with an average of 4 months. Flap was soft with satisfied appearance in 16 cases. Obvious scar formation occurred in 2 cases. There was no obvious scar contracture in donor sites. There was no obvi-ous limitation of the flexion and extension function of the ankle joint in 18 cases. According to the American Or-thopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, there was excellent in 16 cases, and good in 2 cases. Conclusion As for the characteristics of the heel wound, it is a simple and practical method to use leg perforator flap to repair.The flap is based on a long vascular pedicle.And the clinical effect is satisfied.
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Objective To promote the Institutional Review Board(IRB) construction and development via paying more attention to the detail management and providing better protection of subjects' rights and interests in ethical review of clinical trials and scientific research projects.Methods Assessment criteria were established according to the domestic and international laws and regulations on the management of ethical and scientific research project.Ethical site visit was performed on the 37 clinical trials/scientific research projects approved by IRB during the year 2012-2015.Results Clinical trials/scientific research projects were divided into tree types:the registered clinical trials,the post-marketing clinical trials and the researcher initiated scientific research project.All the types met with the following assessment criteria:satisfy the requirement of equipment,facilities and qualifications of drug preservation required for conducting clinical research;subjects were given compensation according to the protocol;informed consent were obtained.Among them,the registered clinical trials meet more criteria than other research types.Regarding to the standard of informed consent implementation,all types met with the following assessment criteria:all the subjects enrolled signed informed consent forms,informed consent forms are well documented;investigators and subjects/ the guardian signed the forms.However,during the site visit,some other criteria were also neglected more or less.Particularly,only few project recorded the consent process and time spots singed the forms.Conclusions Investigators should pay more attention to the activities and behaviors taken place during the research implementation process.Researchers and management staffs should pay attention to ethical detail management to guarantee better protection of subjects' rights and interests.
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Objective To investigate the clinical effect of placement of distal tibiofibular screw which is parallel to tibial in treating ankle fracture with tibiofibular syndesmosis separation.Methods Data of 59 cases with ankle fracture combined with tibiofibular syndesmosis separation from May 2014 to December 2015 were retrospectively analyzed.According to the direction of distal tibiofibular syndesmosis screw,59 cases were divided into two groups.There were 27 cases (18 males and 9 females) in Group A (parallel nailing group),with an average age of 42.00± 11.35 years.According to Lauge-Hansen classification,6 cases were supination extension-rotation Ⅲ and 9 were supination extension-rotation Ⅳ°,3 pronation extension-rotation Ⅲ and 7 pronation extension-rotation Ⅳ,2 pronation abduction ⅢL In group B (traditional nailing group),there were 32 cases (20 males and 12 females),with an average age of 44.00±13.34 years.According to Lauge-Hansen classification,5 cases were supination extension-rotation Ⅲ° and 12 supination extension-rotation Ⅳ°,4 pronation extension-rotation Ⅲ° and 8 pronation extension-rotation Ⅳ°,3 pronation abduction Ⅲ°.Two groups were compared of the flexion and extension angle of ankle joint after operation and function of ankle joint according to Baird-Jackson score.Results All the patients were followed up for 18 months.The fracture healing time of parallel nailing group was 2.5 to 5 months with an average of 3.4 months.While the fracture healing time of traditional nailing group was 2.5 to 6 months with the average of 3.8 months.The excellent rate of planting nail for group A was 100％ (24 cases for excellent and 3 for good),and for group B was 53.13％ (5 cases for excellent and 12 for good).There was significant difference between two groups (x2=16.97,P=0.0001).The excellent rate of group A was better than that in group B.6 weeks after operation,the flexion and extension angle of ankle joint was 25.00°±6.33° in group A and 17.00°±4.46° in group B with significant difference between two groups (t=5.82,P=0.0002).12 weeks after operation,the flexion and extension angle of ankle joint was 31.00°±7.75° in group A and 19.00°±5.58° in group B,with significant difference between two groups (t=7.54,P=0.0008).The flexion and extension angle of group A was better than that in group B for early postoperative period.6 months after operation,according to BairdJackson score,the excellent rate of ankle function of group A was 44.44％ (2 cases for excellent and 10 for good),and group B was 12.50％ (4 cases for good),with significant difference between two groups (x2=7.56,P=0.007).12 months after operation,the excellent rate of group A was 77.78％ (6 cases for excellent and 15 for good),group B was 34.38％ (2 cases for excellent and 9 for good),with significant difference between two groups (x2=11.11,P=0.001).18 months after operation,the excellent rate of ankle function of group A was 88.89％ (17 cases for excellent and 7 for good),and group B was 78.13％ (10 cases for excellent and 15 for good),with no significant differences (x2=0.56,P=0.23).One year after operation,the ankle function of group A was better than that in group B,while 18 months after operation,there was no statistical differences between the two groups.The data of 18 months after operation were further studied,using the method of stratified analysis,and the rate of excellent of group A was 59.26％ (16/27),while group B was 34.38％ (11/32),with significant difference between two groups (x2=3.65,P=0.049).The ankle function of group A was better than that of group B 18 months after operation.Conclusion Compared with the traditional method,this kind of method could accurately locate the distal tibiofibular syndesmosis screw.About early and mid-term postoperative period,it is superior to the traditional method for ankle function.
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With the widely development of psychiatric clinical researches,the ethical issue has been concerned gradually.Although the ethical review has strict rules on informed consent,there are many problems and challenges on informed consent implementation because of the special mental illness population.According to the relevant laws and regulations,combined with the characteristics of clinical psychiatric researches,this paper discussed the protection of subjects' fights and interests during the implementation of informed consent in psychiatric clinical researches,from the following aspects:providing a quiet,comfortable,and relatively independent environment for the participants to ensure informed consent,guaranteeing full informed consent time,choosing qualified researchers for informed consent,ensuring the effective process of informed consent,and guiding the subjects to correctly sign their names and the date.
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Objective To explore the effect of age on the fracture healing through bioinformatical analysis of gene ex?pression data in GEO, and to screen critical molecular targets and pathways involved in this process. Methods Through R programming language, we identified different expressed genes between 26/52 week old rats and 6 week old rats in every time points of the experiment (No fracture;3 days, 1 week, 2 weeks, 4 weeks and 6 weeks after fracture). By comparison of these different expressed genes, those genes that may contribute to fracture healing were identified. Function annotation was conducted based on DAVID database and PPI network that was constructed via STRING database. Results Compared with 6 week old rat, 52 week old rat show more different genes at 2, 4 and 6 weeks after fracture as well as more than intact rats. At the time point of 6 weeks after fracture, 26 week old rat present 4 different genes while 52 week old rat present 99 differ?ent genes compared with 6 week old rat. We totally found 99 genes that might play important roles in the process of fracture healing. These genes involved in biological process related to bone healing, immune, inflammatory and etc. Also, two screened gene enriched KEGG pathways were identified: ECM-receptor interaction and Arachidonic acid metabolism. Through the analysis of PPI network, Pcna, Fn1, Casp3 and etc, who present high density connectivity in PPI network, were screened out. Conclusion Pcna, Casp3 and Fn1 and etc might play important roles in fracture healing through affecting ECM-receptor interaction and Arachidonic acid metabolism.
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Objective To investigate the geometric feature of femoral medullary cavity through CT scanning and it's matching with femoral intramedullary nail,and to analysis the reason for difficulties in implanting distal lock pin.Methods Thirty dried femur specimens were measured through CT scanning,and twenty images were taken evenly according to the total length of shaft of femur from each femur.In each image,the data of the central axis point and eight points around medullary cavity wall in X and Y axes were obtained,which were used to reconstruct the three-dimensional models of medullary cavity,central axis,intramedullary nail by computer software.And the models were overlapped for comparison.Then the coronal and sagittal fold line charts for central axis of medullary cavity were drawn.The inserting process of intramedullary nail was simulated to observe whether the nail would punch out of the medullary cavity wall.Results The central axis of femoral medullary cavity and intramedullary nail were overlapped and compared.They matched well in the coronal plane,but the curves of femoral medullary cavity were larger than those of intramedullary nails in sagittal plane.While simulating the inserting process of intramedullary nail,6 nails punched out of the medullary cavity wall in coronal plane (20％,6/30),so did 13 nails in sagittal plane (43％,13/30).Conclusion Intramedullary nails match well with most of the femoral medullary cavities.However,the anatomic structure of the femoral medullary cavity differs individually.Curves of some femoral medullary cavity are large,which can cause deformation of intramedullary nail,and this is the main reason for the failure of distal locking.
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Objective To study the differences in retinoic acid receptor γ(RARγ) mRNA expression levels in blood leukocytes between antipsychotic-free and antipsychotic-naive schizophrenic patients and healthy control,especially in different genders. Methods Forty-three acute schizophrenic patients who were antipsychotic-naive or antipsychotic-free for at least three months (male = 34, female = 9) and 39 age- and sex-matched healthy subjects (male =25 ,female = 14) were included for blood leukocytes expression of RAR γ mRNA ,using real-time PCR technique. Results Kolmogorov-Smirnov Z analysis showed a significant increase of RARγ mRNA (P =0.041) level in blood leukocytes of pooled schizophrenic patients(0. 027 ± 0. 003) than in the healthy subjects (0. 020 ± 0.002). The elevation was mainly found in the female patients (0. 030 ± 0.003). Within-sex analysis showed that the female schizophrenic patients showed a trend increase (P = 0. 166) of RAR γmRNA expression compared with the male patients (0. 026 ± 0. 001) and exhibited greater RARγ mRNA expression (P = 0. 014)when compared with the female healthy subjects(0. 018 ±0.004). Conclusions The present findings showed an abnormal expression of leukocyte RARγ mRNA level in antipsychotic-free and antipsychotic-naive schizophrenia especially in the female patients. Blood RARγ markers could add to the diagnosis and individualized pharmacotherapy of schizophrenic patients ,especially the female patients.