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Objective:To investigate the specific types of lateral meniscus injury in Schatzker type II tibial plateau fractures and its potential correlation with CT features of the lateral plateau.Methods:The data of 213 patients with Schatzker II tibial plateau fractures from August 2014 to June 2021 were retrospectively analyzed, including 132 males and 81 females, aged from 29 to 61 years, with an average of 44.9 years. All patients underwent arthroscopic evaluation of fracture reduction immediately after open reduction and internal fixation (ORIF). According to the actual situation during the operation, the types and locations of lateral meniscus injury were determined and the patients were divided into the meniscus injury group and non-injury group. By measuring lateral plateau depression (LPD) and lateral plateau widening (LPW) of the lateral tibial plateau on CT images, the correlation of which and lateral meniscus injury was analyzed. The optimal critical values of LPD and LPW for predicting lateral meniscus injury were obtained by drawing the relevant receiver operating characteristic (ROC) curves.Results:The meniscus injury group (109 patients) mainly showed injuries involving the mid-body and posterior horn of lateral meniscus (98.2%, 107/109) and LPD was 13.1±3.2 mm; while the LPD of 104 patients without meniscus injury was 9.1±3.0 mm with a statistical difference ( t=3.98, P<0.001). The LPW of meniscus injury group and non-injury groups was 8.0±1.3 mm and 6.7±1.6 mm, respectively, and the difference was statistically significant ( t=2.68, P=0.011). The optimal predictive critical point of LPD and LPW was 7.6 mm (sensitivity 90.3%, specificity 64.7%, area under the curve 0.834) and 7.3 mm (sensitivity 80.5%, specificity 58.8%, area under the curve 0.722). Conclusion:Schatzker II tibial plateau fractures combined with lateral meniscus injury is usually characterized by meniscus-joint capsule separation, rupture and longitudinal fracture. The mid-body and posterior horn of lateral meniscus injury is more likely to occur when LPD> 7.6 mm and/or LPW> 7.3 mm on coronal CT images.
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Methods:A retrospective case-series study was performed to analyzed the data of 38 patients (38 feet) with displaced intra-articular calcaneal fractures admitted to Xuzhou Central Hospital from January 2016 to May 2018. There were 21 males (21 feet) and 17 females (17 feet), with the age of (33.7±6.2)years (range, 21-53 years). According to the Sanders' classification, 7 patients were classified as type II, 27 as type III and 4 as type IV. All patients underwent the procedure of subtalar arthroscopy combined with locking plate fixation through anterolateral longitudinal incision of the Achilles tendon procedure. The operation time, intro-operative management, incision healing, and post-operative complications (nerve, vessels and tendon injuries)were recorded. B?hler angle, Gissane angle, length, width and height of the calcaneus, and bone healing time were recorded at postoperative 2 days and at final follow-up. The visual analogue score (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) ankle and hindfoot scale, and Foot and Ankle Outcome Score (FAOS) were recorded at final follow-up, and were used to evaluate the clinical and functional outcomes.Results:All patients were followed up for 12-42 months [(18.7±5.3)months]. The operation time ranged from 45 to 100 minutes [(72.4±22.6)minutes]. Bone grafting was not observed, and microfracture of the posterior articular surface of the calcaneus were involved in 9 patients. The first-stage incision healing was achieved in all patients, without early complications of nerve, vessel and tendon injuries. The post-operative angles of B?hler and Gissane, length, width and height of the calcaneus were significantly improved compared to preoperative values ( P<0.01), while there were no significant difference at postoperative 2 days and at final follow-up ( P>0.05). At final follow-up, the VAS decreased from 5(3, 9)points to 0(0, 3)points, AOFAS improved from (68.3±10.5)points to (90.6±5.0)points, and FAOS improved from (66.9±9.1)points to (89.8±4.3)points, respectively ( P<0.01). According to the AOFAS ankle and hindfoot scale, the result was excellent in 27 patients, good in 8, and fair in 3, with the excellent and good rate of 92%. Conclusions:For displaced intra-articular calcaneal fractures, subtalar arthroscopy combined with locking plate fixation through anterolateral longitudinal incision of the Achilles tendon has advantages of precise fracture reduction, low postoperative complications and reliable functional outcomes.
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Objective To investigate the clinical efficacy and safety of wedge osteotomy combined with internal fixation for ulnar olecranon fracture of Mayo type ⅡB.Methods From July 2014 to December 2017,8 patients with ulnar olecranon fracture of Mayo type ⅡB were treated with wedge osteotomy of the ulnar olecranon combined with internal fixation.They were 6 men and 2 women,from 28 to 45 years of age (mean,31.4 years).The wedge osteotomy was planned preoperatively according to the literature data and the osteotomy lengths were measured postoperatively to confirm the safe range for the surgery.Fracture healing was evaluated by regular X-ray follow-up and therapeutic effects were assessed by the range of elbow motion and the Broberg-Morry scoring system.Results On average in this group,the olecranon osteotomy was 6.2 mm in length on the articular sudace and 14.5 mm at the basal part.The olecranon was shortened by 4.6 cm on average after operation.All the 8 patients were followed up for 14 to 20 months (average,16.4 months).The clinical fracture healing time ranged from 12 to 16 weeks,with an average of 14.3 weeks.Follow-ups revealed no fracture displacement,pain or internal fixation failure.No significant differences were found between the affected and the contralateral sides in the flexion,extension or range of motion of the elbow joint at 3 months or at one year after surgery (P ＞ 0.05).According to the Broberg-Morry scoring system,5 cases were rated as excellent,2 as good and one as fair at 3 months after surgery.The final follow-ups found no traumatic arthritis or joint instability.Conclusions As a new treatment alternative,wedge osteotomy combined with internal fixation can obtain satisfactory curative outcomes for ulnar olecranon fractures of Mayo type ⅡB.The wedge osteotomy was performed in a safe range for this group.
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Objective To explore changes of invasion capability of cancer stem cells loading miR30a derived from enlarging and proliferative axillary lymph node of patients with breast cancer in nude mice.Methods MiR30a oligonucleotide fragment loaded by adenovirus vector was transfected into breast cancer stem cells isolated from enlarging and proliferative axillary lymphnodes of patients with breast cancer,MDA-MB-231 cell lines as the control.The cancer cells were injected into axillary subcutaneous fat of the nude mice for several weeks,and then,the expression of Vimentin or N-Cadherin in tumor tissues of each group of the mice was determined by immunohistochemistry and western blot.Results The average transfection rate of cancer stem cells loaded by miR30a was 62.5％,while it was 78.2％ for MDA-MB-231.The tumor volume was larger in adenovirus vector groups or in control groups of nude mice than in experimental groups induced by mir30a.Vimentin or N-cadherin in tumor tissues was significantly downexpressed in experimental groups with mir30a ((13.1±1.7)％,(15.3％±2.1)％)compared with that in adenovirus vector groups or in control groups((21.1±1.4)％,(25.3±1.6)％,P＜0.05),respectively.The difference between adenovirus vector groups and in control groups had no significant difference (P＞0.05).After inoculated for 6 weeks,except the subcutaneous plantations,no distant metastasis in nude mice was found.MDA-MB-231 cell lines groups had similar results.Conclusion The proliferative and invasive capability of cancer stem cells can be inhibited by miR30a,suggesting a new therapy for breast cancer.
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Objective To analyze the risk factors for lower limb venous thromboembolism of patients undergoing hip fractures operation, reduce the incidence of VTE, improve the prognosis of patients. Methods From February 2016 to February 2017, 508 patients with hip fractures were involved in the study from Sino Japanese Union Hospital of Jilin University. The patients were divided into VTE group and VTE-free group. The data were analyzed concerning general clinical information, combined with other systemic diseases, smoking, operation-time, duration from injury to operation, fracture type, anesthetic techniques and so on. The risk factors of VTE were determined using Logistic regression analysis. Results The overall incidence of VTE in this cohort was 25.4％ (129/508). Multi-factor Logistic regression analysis revealed the following risks related to VTE:age 40-59 years(OR 25.986,95％CI 4.552-148.342)and age over 60 years (OR 66.672,95％CI 11.458-387.967 ), concomitant disease (OR 0.228,95％CI 0.105-0.495 ), smoking (OR 3.070, 95％CI 1.647-5.722 ), non-usage of prophylactic anticoagulants(OR 0.069, 95％CI 0.030-0.159), duration from injury to operation≥3 days(OR 9.966,95％CI 4.791-20.733). Conclusions Age, presence of concomitant disease, smoking, non-usage of prophylactic anticoagulants, duration from injury to operation are the risk factors for VTE in patients with hip fracture.
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Objective To study the abnormal alteration of regions in bipolar depression patients,so as to investigate its pathophysiologic mecha?nism. Methods Regional homogeneity(ReHo)technology of resting?state functional magnetic resonance imaging were used to compare 24 bipolar depression patients and 28 healthy controls. Results Compared to the healthy controls,the bipolar depression patients exhibited significantly higher ReHo value in the bilateral superior frontal gyrus,the bilateral middle frontal gyrus,the bilateral medial frontal cortex,the bilateral supplementary motor area,the left paracentral lobule and the left precentral gyrus(all P<0.001). Conclusion The abnormal function in the bilateral superior frontal gyrus,the bilateral middle frontal gyrus,the bilateral medial frontal cortex,the bilateral supplementary motor area,the left paracentral lobule and the left precentral gyrus may associate with the mechanism of pathophysiology in bipolar depression.
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Objective To investigate the micrometastatic lesion of tumor stem cells in the axillary swollen lymph nodes of breast cancer patients and the influence of miR30a on its invasive ability ,and to explore the feasibility of miRNAs anti‐breast cancer treatment .Methods The tumor stem cell‐like breast cancer cells were separated from the axillary swollen lymph nodes in breast cancer patients and cultured .miR30a oligonucleotide fragment was synthesized and transfected into human primary generation breast cancer cells by using adenovirus ,meanwhile the breast cancer cell line MDA‐MB‐231 was taken as the experimental control and the transfection efficiency was assessed by the fluorescence microscopy .The changes of tumor cell proliferation and invasiveness before and after transfection were detected by the Transwell chamber in vitro invasion assay .Western blot was used to detect the ALDH1 ,Vimentin and N‐Cadherin protein expression .Results The Transwell chamber in vitro invasion assay showed that the pri‐mary generation breast cancer cell had more strong invasive ability than MDA‐MB‐231 cell line ,their invasion indexes were (75 .3 ± 3 .2)% and (58 .4 ± 2 .8)% respectively ,the difference was statistically significant (P<0 .05) ,and after transfecting miR30a ,the in vitro invasiveness ability in these two kinds of cells were significantly weakened and their invasion indexes were (21 .4 ± 1 .9)% and (28 .2 ± 2 .3)% respectively ,the difference compared with the control group showed the statistical significance (P<0 .05) .Conclu‐sion The ALDH expression in partial axillary hyperplasia and swollen lymph nodes in the patients with breast cancer is increased , and the tumor micrometastasis may exist ,which should be completely cleaned in operation .miR30a inhibits the expression and inva‐sive ability of tumor stem gene .
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BACKGROUND:For reason of pathological particularity, treatments for young adult patients with lumbar disc herniation require more demanding procedures. Traditional discectomy and rigid fixation and fusion receive a lower clinical satisfaction rate because of their concomitant complications. Waveflex is a semi-rigid fixation system with non-fusion pedicle screws. Once combined with the technology of annulus repair, it can maintain the normal movement of the segments, and can thus raise clinical satisfaction rate. OBJECTIVE:To evaluate the short-term efficacy of the treatment of young adult lumbar disc herniation through the technology of the posterior Waveflex non-fusion pedicle screw elastic fixed smal window nucleus pulposus extirpation associated with annulus repair. METHODS: Thirty-eight patients with lumbar disc herniation were involved in this study, among which, 18 cases in the elastic fixation group were subjected to a posterior lumbar smal window nucleuspulposus extraction along with annulus repair together bound with Waveflex elastic fixation; the rest 20 cases in the nucleus pulposus removal group underwent simple nucleus pulposus extirpation. After these operations, a series of folow-up study was conducted, including: folow-up analysis of clinical efficacy and complications, colection of low-back pain visual analogue scores, colection of Japanese Orthopaedic Association scores (JOA), regular assessment of Oswestry dysfunction index, and reevaluation of the lumbar lateral radiographs related indicators. RESULTS AND CONCLUSION:Folow-up visits to the patients were conducted 12-20 months later since the operations. Both groups showed a better performance than before treatment in the pain visual analogue scale, low back pain JOA score, and Oswestry dysfunction index of low-back pain (P < 0.05) during the last visit. The pain visual analogue scale, low back pain JOA score, and Oswestry dysfunction index of low-back pain in the dynamic fixation group were superior to those in the nucleus pulposus removal group (P <0.05). Stil in the last folow-up, operative segment disc height in the dynamic fixation group was greater than that before treatment, and the operative segment range of motion was smaler than that before treatment (P <0.05). These results suggest that compared to nucleus pulposus removal, Waveflex system associated with nucleus pulposus excision annulus repair has a more satisfactory effect in the early recovery of lumbar spine function and exerts a positive effect on the stability of the operated segments in the treatment of lumbar protrusion of the intervertebral disc in young adults.
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Objective To investigate the impacts of prehospital endotracheal intubation on postoperative pulmonary infection in the patients with severe traumatic brain injury.Methods Retrospectively, the clinical data of 284 patients with severe traumatic brain injury admitted in the 97th Hospital of PLA from July 2007 to December 2012 were analyzed.The patients were classified into two groups according to the timing of endotracheal intubation, namely, prehospital intubation group and admission intubation group.The postoperative pulmonary infection incidence, occurrence time, and the duration of treatment of the two groups were studied.Results The incidences of postoperative pulmonary infection in patients intubated before and after admission were 38.0％ and 25.2％ respectively.Pulmonary infection occurred in the prehospital intubation group was at the (9.9 ± 0.6) d after admission, and in the admission intubation group was at the (11.6 ± 0.3) d after admission.The duration of treatment for postoperative pulmonary infection was (21.2 ± 7.2) days and (14.5 ± 9.0) days respectively.Compared with the patients intubated after admission, patients intubated before admission suffered higher incidence (P ＜ 0.05), earlier onset (P ＜ 0.05), and longer treatment duration of pulmonary infection (P ＜ 0.01).Conclusions Severe traumatic brain injury patients with prehospital endotracheal intubation are more susceptible to pulmonary infection.Avoiding the tracheal injury and bacterial contamination in the procedure could reduce the incidence of pulmonary infection.
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Five groups were assigned to include intrahepatic cholangiocarcinoma ( ICC, n=30 ) , liver cirrhosis (LC,n=30),metastatic carcinoma (MCA,n=30) and 30 healthy subjects.The serum level of GPC3 was measured by a sandwich method of enzyme-linked immunosorbent assay ( ELISA ) and alpha-fetoprotein (AFP) by microparticle enzyme immunoassay (MEIA).The serum levels of GPC3 and AFP were significantly higher than those of other groups (P<0.05).At a cut-off value of 3.5μg/L,the sensitivity and specificity of GPC3 in the diagnosis of HCC was 83.3%and 76.7%respectively.The sensitivity of combined measurement of GPC3 and AFP was better than GPC3 or AFP alone.Detectable GPC3 was significantly correlated with the presence of viral hepatitis markers and tumor size.However there was no obvious difference in tumor thrombi in portal vein ( PVTT), tumor number, age, gender or hepatic function of HCC.Thus,as a sensitive serum diagnostic marker for HCC ,GPC3 may be a good supplement to AFP in differentiating HCC from non-malignant chronic liver diseases and other liver cancers.
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Objective To analyze the reasons and treatment measures of cerebral infarction following operation of hypertensive cerebral hemorrhage. Methods Sixty-one patients with cerebral infarction following operation of hypertensive cerebral hemorrhage were retrospectively analyzed. Results The outcome was evaluated on basis of activities of daily lives (ADL): Ⅰ 10 cases, Ⅱ 11 cases, Ⅲ 14 cases, Ⅳ 8 cases, Ⅴ3 cases and death 12 cases. Conclusions The occurrence of cerebral infarction following operation hypertensive cerebral hemorrhage is associated with degree of the hemorrhage compression, vasospasm, hypertension,operative skill and postoperative management. The early operation, improved operative skill and hyperbaric oxygenation are the important factors for the prophylaxis and treatment of cerebral infarction.
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OBJECTIVE To analyze the susceptible factors and resistance of Acinetobacter baumannii in ICU,in order to create a novel thought of effective prevention and control of A. baumannii cross-infection. METHODS Specimens were collected from ICU patients with infections from Sep 2006 to Sep 2008. The infection characteristic was analyzed and the drug sensitivity was tested to know the risk factors of infection retrospectively. RESULTS The factors of low immunity,severe wound,invasive operation and using ventilator led to the serious cross-infection of A. baumannii in ICU .In vitro drug susceptibility test,the sensitive rates only to cefoperazone/sulbactam and amikacin were higher. They were 65.09% and 72.64%,respectively. CONCLUSIONS It has great significance in the prevention and control of A. baumannii cross-infection in ICU to strengthen the environment disinfection,were education of nosocomial infection knowledge among medical staff,executeing the hand-washing system strictly,useing the antibiotics rationally,keeping the susceptible crowd and adopting de-escalation strategy of prevention and control.
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OBJECTIVE To investigate the change in antibiotic resistance of Pseudomonas aeruginosa(PAE) in our hospital,for the guidance of rational use of antibacterials. METHODS We reviewed the isolation rates of antimicrobial agents from 2004 to 2007,and its construction ratio among the commonly encountered Gram-negative bacilli,and the resistance rates of P.aeruginosa to 14 kinds. RESULTS We totally isolated 823 strains of PAE and the isolation rates of PAE was 13.3% in 2004 but 18.5% in 2007.In the four years,there was the highest isolation rate of 72.54% in sputum and throat mucus specimens.The lowest resistance rate was to amikacin(from 12.2% to 6.21%,the average was 8.75%),and the next was to cefoperazone/sulbactam(from 6.10% to 12.26%,the average was 8.99%);the total resistance rates to ticarcillin and piperacillin was more than 36.00% and there was a lower resistance rate to ticarcillin/clavulanic acid(32.93%)after adding the enzyme inhibitor,while to piperacillin/tazobactam was 20.16%.Drug-resistance rate to ceftazidime was from 19.51% to 43.17%(the average was 33.05%);to cefepime from 22.34% to 34.16%(the average was 29.40%);to imipenem from 19.51% to 23.29%(the average was 22.60%);to meropenem from 11.17% to 18.18%(the average was 15.43%);to the fluoroquinolones antibiotics ciprofloxacin from 32.61% to 44.59%(the average was 38.52%);and to levofloxacin was 26.40% in average. CONCLUSIONS There is commonly increasing resistance of PAE.Reviewing the resistance situation dynamically and selecting the antibiotics reasonably can produce great significance for clinical therapy and postpon its multidrug-resistance.
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Objective:To investigate the role of recombinant E.coli LLO/OVA on regulating the function of murine CD4+ CD25+ Treg cells.Methods:After E.coli LLO/OVA or E.coli OVA vaccination,the murine spleen CD4+ CD25+ Treg,CD4+ CD25- T and CD11c cells were collected respectively by magnetic beads sorting.The concentration of IL-10 in the supernatant of mix cocultured CD4+ CD25+ Treg and CD11c cells,and the suppression role of CD4+ CD25+ Treg cells on the proliferation of CD4+ CD25- T cells were determined.The percentage of OVA specific CD8+ T cells in mouse spleen was analyzed by flow cytometry.The number of metastatic tumor nodules in lungs of the mice transplanted with B16-OVA subcutaneouly was compared before and after dilition of CD4+ CD25+ Treg cells in mice.Results:Compared to E.coli OVA,E.coli LLO/OVA significantly downregulated IL-10 secretion of CD4+CD25+Treg cells and attenuated the suppressive effect of CD4+ CD25+ Treg on the proliferation of CD4+ CD25- T cells(P