Application of volume replacement techniques in breast conserving surgery for breast cancer treatment / 中华外科杂志

Objective: To examine the application of volume replacement techniques in breast conserving surgery for breast cancer. Methods: The clinic data of 76 breast cancer patients underwent a breast conserving surgery with volume replacement techniques at the Breast Center, Beijing Tongren Hospital, from June 2019 to June 2021 were analyzed retrospectively. All patients were female, aged (42.6±6.4) years (range: 32 to 56 years). Tumor staging inlcuded stage ⅡA in 36 cases, stage ⅡB in 24 cases, stage ⅢA in 12 cases, stage ⅢB in 4 cases. Three types of techniques included the lateral thoracic adipofascial flaps in 47 cases, the upper abdominal wall adipofascial flaps in 22 cases and the latissimus dorsi myocutaneous flap in 7 cases. The specimen volume of tumor expansion resection in breast conserving surgery was measured, while the operative time used for volume replacement techniques, postoperative drainage retention time, postoperative complications and patients' satisfaction with the breast shape were recorded. Results: The specimen volume of tumor was (100.9±24.2) ml (range: 55 to 157 ml) in lateral thoracic adipofascial flap group, (88.4±14.5) ml (67 to 118 ml) in upper abdominal wall adipofascial flap group, (179.7±22.9) ml (range: 155 to 220 ml) in latissimus dorsi myocutaneous flap group. The operative time used to restore the breast shape of the three groups were (52.9±9.0) minutes (range: 45 to 70 minutes), (63.2±8.8) minutes (range: 50 to 70 minutes) and (99.3±3.4) minutes (range: 95 to 105 minutes), respectively. The postoperative drainage retention times of the three groups were (8.6±1.2) days (range: 7 to 10 days), (9.4±0.9) days (range: 8 to 10 days) and (11.4±1.3) days (range: 10 to 13 days), respectively. All the 76 patients were evaluated for their satisfaction with the cosmetic outcomes, 64 patients (84.2%) were strongly satisfied and 12 patients (15.8%) were generally satisfied. The postoperative complications included fat liquefaction in 6 cases (2 cases in the lateral thoracic adipofascial flap group and 4 cases in the upper abdominal adipofascial flap group) and seroma in 4 cases (each 2 cases in the lateral thoracic adipofascial flap group and the latissimus dorsi myocutaneous flap group). Conclusions: For patients with large tissue loss during breast conserving surgery, the corresponding volume replacement techniques, including lateral thoracic adipofascial flaps, upper abdominal wall adpofascial flaps and latissimus dorsi myocutaneous flaps, should be reasonably selected for repair according to the tumor site and the size of the intraoperative breast loss, which can ensure the original volume and shape of the breast, with controllable postoperative complications.

Research progress in diagnosis, prophylaxis, and treatment of periprosthetic joint infections / 中华骨科杂志

Periprosthetic joint infection (PJI) is one of the destructive complications after artificial joint replacement, which leads to postoperative joint pain, prolonged hospital stays, repeated multiple operations, dysfunction and even mortality. However, there is no specific diagnosis method for PJI. Although some progress has been made in the research of pathogenic microorganisms, diagnostic criteria, prevention strategies and treatment regimens of PJI in recent years, the quick and accurate diagnose and reducing of postoperative PJI is still the hotspot and difficulty in the field of artificial joint replacement. Gram-positive bacteria are the most common pathogenic bacteria, the prevalence of multidrug resistant pathogens, mixed bacterial infections and culture negative bacteria remain increasing. The epidemiological data of pathogen can guide clinical diagnosis and empirical use of antibiotics, which can help reducing of resistant bacteria. The International Consensus Meeting (ICM) proposed new diagnostic criteria, refined secondary criteria and assigned detailed scoring rules. New biochemical markers (such as leucocyte esterase and α-defensin, etc.), sonication of prosthesis combined with gene detection, imaging detection (such as 3-phase bone scanning labeled with technetium-99m, etc.), and next-generation sequencing is helpful to improve the accuracy of PJI diagnosis. Scientific and standardized perioperative management programs and new preventive measures, such as intraoperative application of vancomycin powder and diluted iodophor irrigation, are benefit to prevent and reduce the occurrence of PJI. Two-stage revision is still the standard intervention for chronic PJI, while one-stage revision combined with intra-articular antibiotics injection can effectively eradicate PJI in patients with acute or some chronic PJI with clear pathogenic bacteria.

Incision selection for nipple-sparing mastectomy with implant-based breast reconstruction / 中华外科杂志

Objective: To examine the outcome of different incision selection for nipple-sparing mastectomy (NSM) with implant-based breast reconstruction (IBBR). Methods: Ninety-Two cases accepted NSM and IBBR from totally 1 002 cases of breast cancer admitted to Beijing Tongren Hospital Affiliated to Capital Medical University from June 2013 to December 2020 were analyzed retrospectively. All the patients were female, aging (42.0±7.5) years (range: 27 to 64 years). There were 12 patients at stage 0, 47 patients at stage Ⅰ, 17 patients at stage Ⅱ, and 16 patients at stage Ⅲ. The patients were divided in three groups by the incision: peri-areolar group (n=23), inframammary group (n=33) and lateral group (n=36). The age, tumor size, lymph node status, hormone receptor, operation method and postoperative complications were followed-up of three groups and compared by one-way ANOVA, χ2 test or Fisher's exact test and expansion to comparied. Results: There was no significant difference in operation time ((180.7±54.0) minutes vs. (176.9±48.1) minutes vs. (194.6±37.5) minutes, F=1.401, P=0.252), postoperative drainage volume ((497.5±226.0) ml vs. (495.4±182.5) ml vs. (519.8±172.0) ml, F=0.167, P=0.846) and drainage time ((8.8±3.8) days vs. (8.0±2.5) days vs. (8.3±2.9) days, F=0.542, P=0.583) among the peri-areolar, inframammary, and lateral groups. The cumulative postoperative complications were relatively higher in the peri-areola group (26.1%(6/23) vs. 0 vs.8.3%(3/36), χ²=9.675, P=0.004). All female patients were followed up for (49.0±25.6) months(range: 12 to 112 months). Breast cancer related death rate was 2.2% (2/92), local recurrence was 1.1% (1/92), regional recurrence was 4.3% (4/92), distant metastasis was 6.5% (6/92), and the disease-free survival rate was 88.0% (81/92). Conclusion: The surgical effects of the peri-areolar, inframammary and lateral incisions for NSM and IBBR are approximate, the total complication rate of the peri-areolar incision is slightly higher.

Surgical management of nipple areola complex in central breast cancer / 中华肿瘤杂志

Objective: To explore the surgical strategy of nipple areola complex (NAC) management in central breast cancer. Methods: A retrospective analysis was conducted on 164 cases of central breast cancer who underwent surgery treatment from December 2017 to December 2020 in the Breast Center of Beijing Tongren Hospital, Capital Medical University. Prior to the surgery, the tumor-nipple distance (TND) and the maximum diameter of the tumor were measured by magnetic resonance imaging (MRI). The presence of nipple invagination, nipple discharge, and nipple ulceration (including nipple Paget's disease) were recorded accordingly. NAC was preserved in patients with TND≥0.5 cm, no signs of NAC invasion (nipple invagination, nipple ulceration) and negative intraoperative frozen pathological margin. All patients with signs of NAC involvement, TND<0.5 cm or positive NAC basal resection margin confirmed by intraoperative frozen pathology underwent NAC removal. χ(2) test or Fisher exact test was used to analyze the influencing factors. Results: Of the 164 cases of central breast cancer, 73 cases underwent breast-conserving surgery, 43 cases underwent nipple-areola complex sparing mastectomy (NSM), 34 cases underwent total mastectomy, and the remaining 14 cases underwent skin sparing mastectomy (SSM). Among the 58 cases of NAC resection (including 34 cases of total mastectomy, 14 cases of SSM, and 10 cases of breast-conserving surgery), 25 cases were confirmed tumor involving NAC (total mastectomy in 12 cases, SSM in 9 cases, and breast-conserving surgery in 4 cases). The related factors of NAC involvement included TND (P=0.040) and nipple invagination (P=0.031). There were no correlations between tumor size (P=0.519), lymph node metastasis (P=0.847), bloody nipple discharge (P=0.742) and NAC involvement. During the follow-up period of 12 to 48 months, there was 1 case of local recurrence and 3 cases of distant metastasis. Conclusions: For central breast cancer, data suggest that patients with TND≥0.5cm, no signs of NAC invasion (nipple invagination, nipple ulceration) and negative NAC margin in intraoperative frozen pathology should be treated with NAC preservation surgery, whereas for those with TND<0.5 cm or accompanied by signs of NAC invasion, NAC should be removed. In addition, nipple reconstruction can be selected to further improve the postoperative appearance of patients with central breast cancer.

Research on distribution of invention patents of Chinese materia medica for treating high mortality diseases in China--analysis mechanism based on IPC number A61P / 中草药

Based on the International Patent Classification (IPC) A61P, this paper analyzes the distributional therapeutic situation of Chinese materia medica (CMM) in China dynamically and statically from the perspective of invention patent, then the list of 10 groups of A61P with the largest amount of invention patents application and effective amount is compared with the list of high mortality diseases in China, so as to verify the idea whether the R&D focus of CMM is on high mortality diseases, and put forward suggestions for the R&D directions and strategies of CMM in the treatment of high mortality diseases. The research finds that the R&D of CMM mainly focuses on treating high mortality diseases, except for the malignant tumors and mental disorders. In addition, the intellectual achievement of CMM in the treatment of digestive system diseases is the dominant direction. Under the background of internationalization and standardization of CMM, China needs to strengthen the R&D investment direction of CMM in the treatment of malignant tumors, mental disorders and other fields. The quantity and quality advantages of CMM in the treatment of digestive system diseases will be of significance, thus it needs to actively carry out patent distribution abroad. The role of technical evaluation in the cultivation of high-quality and high-value patents should be attached importance.

Five internal fixation methods for acetabular posterior column fracture: a finite element analysis / 中华创伤骨科杂志

Objective:To compare the biomechanical performance between 5 internal fixation methods for fracture of the acetabular posterior column using finite element analysis.Methods:One healthy female volunteer (50 years old, 160 cm in height and 63 kg in weight with a body mass index of 24.6 kg/m 2) was recruited for this study to undergo CT scan. Her CT scan data were imported into software Mimics15.0 in the format of DICOM to generate a 3D model of the pelvis. After pre-processing and accessory ligament structures added, a 3D finite element model of the pelvis was established and verified by software ANSYS. Next, software ANSYS was used to generate a model of acetabular posterior column fracture, on which models of 5 internal fixation methods (internal iliac-ischial plating, conventional posterior column plating, anterograde tensile screwing, lesser sciatic notch screwing and ischial tuberosity screwing) were established. Then stress was loaded onto the 5 internal fixation models to compare stress displacements of the fracture line on the articular surface and sites of stress concentration between the 5 internal fixation models. Results:The average stress displacement of the fracture line at the standing position was 6.13 μm for conventional posterior column plating, <6.85 μm for ischial tuberosity screwing, <7.07 μm for lesser sciatic notch screwing, <7.08 μm for internal iliac-ischial plating, and <7.85 μm for anterograde tensile screwing; the average stress displacement of the fracture line at the sitting position was 7.77 μm for conventional posterior column plating, <9.65 μm for internal iliac-ischial plating, <9.69 μm for anterograde tensile screwing,<10.1 μm for lesser sciatic notch screwing, and<10.20 μm for ischial tuberosity screwing. In all the 5 internal fixation models, the stress was chiefly concentrated at fracture ends.Conclusion:Internal iliac-ischial plating and conventional posterior column plating provide better stability than the hollow screws (anterograde tensile screwing, ischial tuberosity screwing and lesser sciatic notch screwing) for fracture of the acetabular posterior column.

An exploratory study to perfect the Letournel classification of acetabular fractures / 中华骨科杂志

Objectives To put forward the modified Letournel classification of acetabular fractures,and evaluate the guiding role of the modified Letournel classification in clinical work.Methods A retrospective study of 170 patients (178 sides) with acetabular fractures treated at Nanfang Hospital between January 2006 and August 2018 was performed.Among them 129 cases were males and 41 were females.The average age was 40.2±14.2 years (range,14-82 years).According to the Letournel classification,unclassifiable/atypical acetabular fractures were found out with plain Ⅹ-ray and plain CT scan and three-dimensional CT,and then their unclassifiable reasons were analyzed.Based on anatomical landmarks,clear boundaries of acetabular walls were defined on the 3D printed pelvic model.The structure of each column is a trihedron.The wall's fracture and column's fracture were distinguished using a theory that the wall's fracture involved two surfaces of column with interruption of continuity and column's fracture involved three.When column's fracture associated with wall's fracture,lowercase a,p and q were used representing comminuted areas of corresponding anterior and posterior wall,quadrilateral plate respectively.When column's fracture didn't associates with wall's fracture,it is marked with number 0.Finally,all fractures were classified according to the modified Letournel classification.The relationship between fracture type and surgical approach was analyzed.Results There was 51.7％ (92 sides) of acetabular fractures that couldn't be classified by the Letournel classification.Incomplete fracture lines (49 sides,53.3％),comminuted fractures (28 sides,30.4％),both of them (15 sides,16.3％) were their unclassifiable reasons.There were 8 types in the modified Letournel classification,including posterior wall fracture,posterior column fracture,anterior wall fracture,anterior column fracture,transverse fracture,T-shaped fracture,anterior column+posterior hemitransverse fracture,and both columns fracture.Posterior column+posterior wall fracture,transverse+posterior wall fracture had respectively become a form of posterior column fracture and of transverse fracture.According to the modified Letournel classification,the reclassification rate of 178 side fractures was 100％,which was significantly higher than 48.3％ (86/178) of the traditional Letournel classification,and the difference was statistically significant (x2=124.06,P＜ 0.001).100％ of posterior wall fracture and 80.00％ of posterior column fracture were treated by posterior approach.100％ of anterior column fracture and 73.68％ of both columns fracture were treated by anterior approach.Conclusion All acetabular fractures can be classified by the modified Letournel classification.The orientation of the comminuted walls reflects in part severity of the injury,better helps orthopaedic surgeons understand the morphology of acetabular fractures and select appropriate surgical approach.

Differentiation of anteroposterior pelvic compression type Ⅰ and Ⅱ injuries and severity evaluation / 中华创伤杂志

Objective To investigate the reliability of using the pubic symphysis diastasis of 25 mm and anterior separation distance of sacroiliac joint to differentiate anteroposterior compression (APC) type Ⅰ and Ⅱ injuries as well as assess the injury severity.Methods A total of 11 (seven males and four females) fresh cadaver specimens with 22 hemipelvis were collected.The pelvic APC injury test models including fixed hemipelvis (restricted group) and unfixed hemipelvis (non-restricted group) were established,with 11 hemipelvis in each group according to the random number table method.Meanwhile the specimens were divided into male group (14 hemipelvis) and female group (eight hemipelvis),simulating APC type injury external rotation hemipelvis.The public symophysis interval and anterior interval of sacroiliac joint of the original pelvis,the pubic symphysis diastasis and anterior diastasis of sacroiliac joint after anterior tibiofibular ligament failure,as well as the affected pelvis ligament and sacral ligament injury were recorded and compared between the restricted and non-restricted groups,male and female groups.Results There were no significant differences in the public symphysis interval of the original pelvis and anterior interval of sacroiliac joint between the restricted group and the non-restricted group (P ＞ 0.05).The pubic symphysis interval of the original pelvis was [(5.13 ± 0.61) mm] in male group and (4.03 ± 0.84)mm] in female group (P ＜ 0.05).When the anterior tibiofibular ligament ruptured,the pubic symphysis diastasis distance was (23.36 ± 7.27) mm,ranging from 12 to 41 mm,and the diastasis distance of anterior sacroiliac joint was (9.82 ± 3.25)mm,ranging from 5 to 18 mm.In terms of the public symphysis interval,there were no significant differences between male and female groups,restricted and the non-restricted groups (P ＞ 0.05).In terms of anterior interval of sacroiliac joint,there was significant difference between male and female groups (P ＜ 0.05) but no significant difference between the restricted and non-restricted groups (P ＞ 0.05).In the restricted group,sacrotuberous ligament injuries were found in four patients,and sacrospinous ligament injuries in five,whhile there were no obvious sacrospinous ligament and sacrotuberous ligament injuries in non-restricted group.There were 10 specimens with the pubic symphysis diastasis ≥23.36 mm and 10 specimens with the diastasis distance of anterior sacroiliac joint ≥9.82 mm (46％),and there were 15 specimens with at least the pubic symphysis interval ≥ 23.36 mm or the anterior interval of sacroiliac joint ≥ 9.82 mm (68％).Conclusions The public symphysis interval ≥ 23.36 mm or anterior interval of sacroiliac joint ≥ 9.82 mm can distinguish anteroposterior compression Ⅰ from Ⅱ injuries,and the combination of the two criteria can be beneficial to assessment of pelvic injury severity.

Finite element analysis of different internal fixation methods for acetabular T-shaped fractures / 中华创伤骨科杂志

Objective To investigate the biomechanical stability of 5 kinds of internal fixation for acetabular T-shaped fractures using finite element analysis.Methods After a three-dimensional model of normal pelvis was reconstructed using Mimics software,the model of acetabular T-shaped fracture was divided by Solidworks software.Models of acetabular T-shaped fracture fixated by 5 methods were reconstructed:(A) a reconstruction plate for anterior column + lag screws for posterior column,(B) lag screws for anterior column + a reconstruction plate for posterior column,(C) a reconstruction plate for anterior column + a medial ilioischial plate for posterior column (combination plating),(D) retrograde lag screws for 2 columns,and (E) a reconstruction plate for anterior column + and a posterior ilioischial plate for posterior column.Valuation was conducted with software Ansys to simulate 600 N loading on the terminal plate of S1 vertebral body at standing and sitting positions.The biomechanical stabilities were compared between the 5 models of internal fixation.Results At standing and sitting positions,the displacements of anterior column in modelA (0.522±0.121 mmand0.762±0.181 mm),modelC (0.512±0.207mmand0.730±0.181mm) and model E (0.513 ± 0.184 mm and 0.733 ± 0.166 mm) were significantly smaller than those in model B (0.622±0.224 mmand 1.328±0.537 mm) and in modelD (0.655±0.174mm and 1.591± 0.270 mm) (P ＜ 0.05).However,there were no statistically significant differences in anterior column displacements between models A,C and E or between models B and D (P ＞ 0.05).At standing and sitting positions,the displacements of posterior column in model B (0.631 ± 0.151 mm and 0.572 ± 0.693 mm),in model C (0.621 ± 0.195 mm and 0.538 ± 0.075 mm) and in model E (0.625 ± 0.192 mm and 0.544 ± 0.063 mm) were significantly smaller than those in model A (0.742 ±0.140 mm and 0.715 ±0.072 mm)and in modelD (0.754±0.247 mm and 0.717 ± 0.071 mm) (P ＜0.05).However,there were no statistically significant differences in posterior column displacements between models B,C and E or between models A and D (P ＞ 0.05).Conclusions In the treatment of acetabular T-shaped fractures,reconstruction plating has better stability than screwing.Reconstructive plating shows the best stability for anterior and posterior columns,followed by combination plating which is the best choice for reducing surgical injury.

Comparison of fixations with dynamic hip screw, percutaneous compression plate and proximal femoral nail anti-rotation for intertrochanteric femoral fractures with paries medialis defect / 中华创伤骨科杂志

Objective To compare the effects of fixations with dynamic hip screw (DHS),percutaneous compression plate (PCCP) and proximal femoral nail anti-rotation (PFNA) for treatment of intertrochanteric femoral fractures with paries medialis defect.Methods We reviewed the 82 patients with femoral intertrochanteric fracture and paries medialis defect who had been treated at our department from January 2011 to July 2016.They were 42 men and 40 women,aged from 27 to 91 years (average,73.0 years).According to the AO classification,72 cases belonged to type 31-A2.2,10 to type 31-A2.3.Of them,9 cases were treated with DHS,17 cases with PCCP and 56 cases with PFNA-1].The 3 groups were compared in terms of intraoperative blood loss,blood infusion,fluid infusion,operation duration,time for fracture union,postoperative complications and Functional Recovery Score (FRS) of the hip 12 months after operation.Results The fluid infusion [1,100 (850,1,100) mL] and intraoperative blood loss [60 (5,100) mL] in the PCCP group were significantly less than in the PFNA group [1,100 (1,000,1,700) mL and 150 (50,300) mL] and the operation duration (91.4 ± 29.2 min) in the former was significantly shorter than in the latter [121 (85,185) min] (P ＜ 0.05).No significant difference was found between the 3 groups in blood infusion (P ＞ 0.05).Of the patients,57 (8 DHS,12 PCCP and 37 PFNA ones) were followed up for an average of 47 months (from 15 to 85 months).There were no statistically significant differences between the 3 groups in time for fracture union,complications,or average FRS score of the hip 12 months after operation (P ＞ 0.05).Conclusions For unstable intertrochanteric fractures with paries medialis defect,it is not clear that intramedullary nails are superior to extramedullary fixation.Intramedullary nails like PFNA may be suggested for patients with better preoperative conditions while extramedullary fixation like PCCP suggested for those with poor general conditions.

Researches into biomechanical characteristics of sacroiliac complex / 中华创伤骨科杂志

Sacroiliac complex is a bone-ligament complex located at the back of the pelvic ring,including the sacroiliac joint,periarticular ligaments and pelvic floor muscles and fascia.The sacroiliac joint is an important structure to transfer the load on the torso and lower limbs and complete the mechanical conduction.Lower back pain associated with sacroiliac joint lesions is attracting more and more attention.Experiments and finite element analysis are important research methods for the sacroiliac complex injury because they can well display the biological mechanics of the joint,simulate the mechanisms of the injury and thus provide corresponding treatments for surgeons.This paper focuses on the mechanical characteristics of the sacroiliac complex,establishment and clinical application of the finite element models of the sacroiliac joint complex.

Establishment of a three-dimensional finite element model of pelvic anteroposterior compression for analysis of related ligamentous damages / 中华创伤骨科杂志

Objective To establish a three-dimensional finite element model of pelvic anteroposterior compression (APC) for analysis of mechanisms for related liganentous damages.Methods A finite element model and a laboratory mechanical model of APC were established using the same pelvic specimens.In a finite element model of normal pelvic bones and ligaments,after the right pelvis was fixated the pubic symphysis (PS) was sectioned.Next,a manual external mobile force was gradually applied to the left hemipelvis to make the PS diastasis 10,20,30,40,60,80 and 100 mm apart.The mechanical experiment revealed the anterior sacroiliac ligament (ASIL) was ruptured when the PS diastasis reached 28 mm.After the strain value of ASIL was calculated through the finite element model,it was applied to the other pelvic ligaments.The displacement in front of the sacroiliac joint (SIJ),stress,strain and extent of injury and disruption of sacrotuberous/sacrospinous ligaments (STL/SSL) with a corresponding PS diastasis were observed and recorded.Results ASIL failed at the point when the PS diastasis was 28 mm and the displacement in front of SIJ was 7.41 ± 1.14 mm.The strain and maximum principal stress of ASIL calculated in the finite element model were 259.5％ and 543.24 MPa respectively.The maximum principal stress value of SSL was 35.00 MPa at the point of failure when the PS diastasis and the displacement in front of SIJ were 51 mm and 15.23 ±2.88 mm,respectively.When the PS diastasis and the displacement in front of SIJ were 100 mm and 7.5 mm respectively,the maximum principal stress value of STL was 16.17 MPa but the strained ligament was not ruptured.When the pelvis was rotated externally step by step,the ASIL failure was followed by the rupture of SSL but not necessarily by the STL failure.Conclusion As the finite element pelvic bone-ligament model established in this study can effectively simulate the mechanisms for APC injury,it can be used to evaluate different extents of pelvic ligamentous injury,providing a basis for the biomechanical study of pelvic bones and ligaments.

Diversity of agronomic traits of Paris polyphylla var. chinensis and their correlation with rhizome yield and active compositions / 中国中药杂志

The supply deficiency of crude medicinal plant of Paris polyphylla var. chinensis has become a bottleneck for related medicinal industry. An important approach to increase herbal production is to breed high-yield cultivated variety, which characterized ideal plant morphology. In the present study, we collected 99 wild germplasm resources of P. polyphylla and then measured their 12 main agronomic traits and contents of polyphyllin Ⅶ,Ⅵ,Ⅱ,Ⅰ. Followed analyses were used to characterize those traits and explore the potential connection with herbal yield or quality. The results showed that: ①There was ample morphological diversity in wild P. polyphylla, whose variation of agronomic traits reduced according to followed order: content of polyphyllin, weight of dry rhizome, petiole length, stem length, petal length, pedicel length, sepal length, leaf width, leaf length, sepal width, leaf number, stamen number, petal number. ② Most of those traits were significantly correlated to each other and generally represented the characterization of photosynthetic organs or reproductive organ. ③The total content of polyphyllin Ⅶ,Ⅵ,Ⅱ,Ⅰvaried between 0.02% and 0.87% and averagedat 0.13%, which showed no significant correlation with any agronomic trait. ④Plant breeders should play more attention on those germplasm resources with large leaves, large sepals and high stem.

Safety of screw placement on the medial iliosciatic plate for acetabular posterior column: a comparison between males and females by 3D reconstruction technique / 中华创伤骨科杂志

Objective To compare the safe zone and safe angles between males and females for screw placement on the medial iliosciatic plate for acetabular posterior column using 3D reconstruction technique.Methods Normal pelvic CT scans of 52 adults (27 males and 25 females;aged from 18 to 74 years,averaging 47.2 years) were obtained to create pelvic 3D models.After the acetabulum was thickened by 5 mm,the width (d) of the safe zone for placement of the medial iliosciatic plate was measured.After the vertical distance (w) between the vertex of the obturator canal and the greater sciatic notch was measured,the ratio (r) of d/w was calculated.The recombined innominatum model was cut through the center of the acetabulum with a plane perpendicular to the quadrilateral plate and the greater sciatic notch.The cross-section was marked as M.In males,4 points at distances of 1.0 cm,1.5 cm,2.0 cm and 2.5 cm anterior to the greater sciatic notch were marked.At the 4 points,the angulations (∠ a,∠b,∠ c and ∠ d) between the quadrilateral plate and the tangent line of the outer edge of the thickened acetabulum model were measured on the cross-section M.In females,3 points at distances of 1.0 cm,1.5 cm and 2.0 cm anterior to the greater sciatic notch were marked before ∠a,∠b,and ∠c were measured.The differences in the above parameters were compared between males and females.Results The width (d) of the safe zone for placement of the medial iliosciatic plate was 28.56 ±2.44 mm in males and 24.36 ±2.47 mm in females;the ratio (r) was 0.61 ± 0.07 in males and 0.54 ± 0.05 in females.The safe angulations for screw placement in males,∠ a,∠b,∠cand ∠d,were 88.04°±3.18°,77.81°±3.85°,68.01°±4.11°and56.81°±4.81° while those in females,∠a,∠b and ∠c,were 91.29°±4.52°,76.23°±3.82° and 62.79°±3.51°,respectively.There were statistically significant differences between males and females in values of d,r,∠ a and ∠ c (P ＜ 0.05).Conclusions In fixation of acetabular posterior column fractures using medial iliosciatic plate,the differences between males and females should be taken into account.Besides,specific safe angles should be chosen according to the position of the plate.

Study on HBV genotype distribution and clinical correlative indexes in patients with hepatitis B in Xi'an / 国际检验医学杂志

Objective To study the relationship and clinical significance of hepatitis B genotype distribution in Xi'an City and clinical relative indicators.Methods The nested PCR was used to amplify HBV DNA in 389 serum samples from HBV infected pa-tients in Xi'an City ,then polymerase chain reaction restriction fragment length polymorphism (PCR-RLFP) was used to identify HBV genotypes.Results Among 389 cases of HBV Infection in Xi'an City ,58 cases of HBV B genotype accounted for 14.9% (58/389) ,326 cases of HBV C genotype accounted for 83.8% (326/389) and 5 cases of HBV B/C mixed type accounted for 1.2% (5/389).The gender ,HBeAg positive rate ,HBV DNA load level ,ALT and AST had no statistical difference between HBV genotype B and C with the patients(P>0.05);There was no statistically significant in the distribution of B and C genotypes between the pa-tients with chronic hepatitis B and HBV carriers (P>0.05) ,but it had statistical difference between liver cirrhosis and hepatocellu-lar carcinoma(P<0.05).HBV genotype C was easier to develop liver cirrhosis even liver cancer than genotype B.Conclusion The three kinds of HBV genotype B ,C and B/C exist in the HBV infected persons in Xi'an City ,with the genotype C as the main geno-type ,genotype B takes the second and mixed genotype B/C is minimal.The liver cirrhosis occurrence has a certain relationship with the genotype C ,which suggesting that the genotype C is more likely to develop liver cirrhosis.

HPLC fingerprint of crude Cyathula officinalis and its processed products stir-fried with wine and salt and variation of their index components / 中草药

Objective: To reveal the variation regularity of chemical components in crude Cyathula officinalis and its processed products (stir-fried with yellow rice wine and salt), and promote the quality control of the herb. Methods: Agilent Zorbax Eclipse XDB-C18 column (250 mm×4.6 mm, 5 μm) was used with acetonitrile and 0.1% phosphoric acid solution in gradient elution mode. The detective wavelength was 266 nm and the flow rate was 0.5 mL/min. The fingerprints for 24 herbal samples were set up and 25 peaks were recorded with different retention time and peak areas. Three peaks were successfully identified as puerarin, cyasterone, and daidzein by comparing with the retention time of reference substances. The vectorial angle method was used to evaluate the similarity between fingerprints. The cluster analysis and principal component analysis were applied to studying the HPLC fingerprint and chemical pattern recognition. Results: The two processing techniques, stir-frying with wine and salt, both had significant effect on herbal chemical profiles. The contents of three known active components, puerarin, cyasterone, and daidzein, were not observed except a little increasing of the content of puerarin after the crude herbs were processed with salt. Conclusion: More precise active components of the processed products of C. officinalis need to future study to improve the current quality standard of C. officinalis in Chinese Pharmacopoeia. The method provided by this study is a powerful tool to identify and quality control between crude and processed C. officinalis because of its quantificational and visual evaluation system.

Cloning, subcellular lacalization and expression analysis of chloroplast-targeted Obg gene in Cyathula officinalis / 中国中药杂志

According to ObgC gene sequences from Cyathula officinalis genomic data, the specific primers were designed, and a full-length CoObgC cDNA (2 226 bp) was obtained by polymerase chain reaction (PCR) and rapid amplification of cDNA ends (RACE) methord. Sequence alignment showed that CoObgC gene contained a 1 818 bp open reading frame (ORF) encoding 605 amino acids. Sequence analysis predicted that molecular weight of CoObgC protein was about 66.39 kDa, the academic isoelectric point was 5.35, and the protein was stable protein. Then multiple sequence alignment was applied to construct phylogenetic tree. The real-time fluorescence quantification PCR (RT-qPCR) demonstrated that a high expression level in leaf, followed by root and flower, the low transcription was in stem. The recombinant vector pCABIA2300-CoObgC was constructed and introduced into tobacco epidermal cells by agrobacterium-mediated transformation, green fluorescence was tested and targeted to chloroplast under a laser scanning confocal microscope. These findings will be helpful to lay a foundation for studying the structure and function of CoObgC gene, and elucidating C. officinalis molecular biology experiment.

The diagnostic value of combined detection of four indexes in early diagnosis of nephropathy / 国际检验医学杂志

Objective To explore the value of joint detection of serum cystatin C (Cys C) ,retinol‐binding protein(RBP) ,urea ni‐trogen(BUN) and creatinine(Cr) in early diagnosis of nephropathy .Methods A total of 230 cases of inpatients with nephropathy form April 2013 to June 2014 were collected and divided into diabetic nephropathy group (130 cases)and hypertensive nephropathy group(100 cases) .Other 200 healthy individuals were collected as healthy control group .The serum levels of Cys C ,RBP ,BUN and Cr were detected by using the Hitachi 7180 automatic biochemistry analyzer .Results Compared with the healthy control group ,the sertum levels of Cys C ,RBP ,BUN and Cr were significantly increased in the diabetic nephropathy group ,and the serum levels of Cys C and RBP were significantly increased in hypertensive nephropathy group ,there were statistically significant differences (P0 .05) .Positive rates(81 .9% ) of the four indicators in the two nephropathy groups were high‐er than those in the healthy control group ,and the positive rate of joint detection of the four indicators was higher than single detec‐tion in patients with nephropathy .Conclusion Serum RBP and Cys C are sensitive indicators for early renal damage ,and combined with BUN and Cr could increase sensitivity of early diagnosis of nephropathy ,which has significant clinical value .

Investigation of serum total bilirubin reference range of healthy population in Northwest area of China / 国际检验医学杂志

0bjective To investigate the serum total bilirubin level of healthy population in northwest area of China.Methods According to the guiding principle and the screening standard of C28-P3,722 individuals conforming to the screening standard from October 2011 to January 2012 were collected.Serum total bilirubin was determined with diazo reagent method(Roche)on the P module of Hitachi 7600 automatic biochemistry analyzer,and the vanadate reagent method(WAKO)on the D module of the Hitachi 7600 automatic biochemistry analyzer,respectively.The detection results were analyzed between different analysis systems,between country and city and among different age groups by SPSS13.0.The top and bottom limitations of 95% reference interval recommen-ded by the C28-P3 file were calculated by the non-parametric method.Results Serum total bilirubin detection results had no statis-tically significant differences between the two kinds of detection methods,between rural and urban populations,among all ages and genders (P >0.05).The ultimate reference interval of serum total bilirubin in the northwest area was 2.19 -29.29 μmol/L.Con-clusion The differences of serum total bilirubin reference interval exist between the healthy population in the Northwest area of China and the current reference interval used in domestic and foreign population.Establishing the reference intervals of new bio-chemical test item suitable for China′s population will provide the scientific basis for the evaluation of disease diagnosis,treatment, prognosis judgment and health assessment in the Chinese population.

Physiological and biochemical change of Paris seed in after-ripening during variable temperature stratification / 中国中药杂志

In order to explore the dormancy physiological and biochemical mechanism of Paris seeds, the seed embryo growth courses, and the dynamic change of 5 enzymes, include SOD, POD, CAT, MDH, G-6-PDH were measured during variable temperature stratification. The results indicated that Paris seeds embryo grew quickly after 40 d in warm-stratification (18 ± 1) °C, at the meantime the metabolic activity was significantly strengthened. These facts showed that Paris seeds turned into physiological after-ripening process. After 60-80 d, the morphological embryo after-ripping process basically completed, and the following cold-stratification (4 ± 1) °C furthered Paris seed to finish physiological after-ripening. After 40 d, the activity of MDH decreased while G-6-PDH increased significantly. This showed that the main respiratory pathway of seed changed from TCA to PPP, which benifited breaking seed dormancy. In the whole period of stratification process, the activity variation of SOD and CAT was insignificantly and the activity of POD was enhanced significantly after shifting the seed in cold stratification process. This showed that SOD, CAT had no direct effects on breaking Paris seed dormancy but keeping the seed vigor, while the POD might involve in the process of Paris seed dormancy breaking.