Assessment of the diagnostic value and prognosis of different detection markers in endocervical adenocarcinoma / 中华肿瘤杂志

Objective: To study the diagnostic value of different detection markers in histological categories of endocervical adenocarcinoma (ECA), and their assessment of patient prognosis. Methods: A retrospective study of 54 patients with ECA in the Cancer Hospital, Chinese Academy of Medical Sciences from 2005-2010 were performed. The cases of ECA were classified into two categories, namely human papillomavirus-associated adenocarcinoma (HPVA) and non-human papillomavirus-associated adenocarcinoma (NHPVA), based on the 2018 international endocervical adenocarcinoma criteria and classification (IECC). To detect HR-HPV DNA and HR-HPV E6/E7 mRNA in all patients, we used whole tissue section PCR (WTS-PCR) and HPV E6/E7 mRNA in situ hybridization (ISH) techniques, respectively. Additionally, we performed Laser microdissection PCR (LCM-PCR) on 15 randomly selected HR-HPV DNA-positive cases to confirm the accuracy of the above two assays in identifying ECA lesions. Receiver operating characteristic (ROC) curves were used to analyze the efficacy of markers to identify HPVA and NHPVA. Univariate and multifactorial Cox proportional risk model regression analyses were performed for factors influencing ECA patients' prognoses. Results: Of the 54 patients with ECA, 30 were HPVA and 24 were NHPVA. A total of 96.7% (29/30) of HPVA patients were positive for HR-HPV DNA and 63.3% (19/30) for HR-HPV E6/E7 mRNA, and 33.3% (8/24) of NHPVA patients were positive for HR-HPV DNA and HR-HPV E6/E7 mRNA was not detected (0/24), and the differences were statistically significant (P<0.001). LCM-PCR showed that five patients were positive for HR-HPV DNA in the area of glandular epithelial lesions and others were negative, which was in good agreement with the E6/E7 mRNA ISH assay (Kappa=0.842, P=0.001). Analysis of the ROC results showed that the AUC of HR-HPV DNA, HR-HPV E6/E7 mRNA, and p16 to identify HPVA and NHPVA were 0.817, 0.817, and 0.692, respectively, with sensitivities of 96.7%, 63.3%, and 80.0% and specificities of 66.7%, 100.0%, and 58.3%, respectively. HR-HPV DNA identified HPVA and NHPVA with higher AUC than p16 (P=0.044). The difference in survival rates between HR-HPV DNA (WTS-PCR assay) positive and negative patients was not statistically significant (P=0.156), while the difference in survival rates between HR-HPV E6/E7 mRNA positive and negative patients, and p16 positive and negative patients were statistically significant (both P<0.05). Multifactorial Cox regression analysis showed that International Federation of Obstetrics and Gynecology (FIGO) staging (HR=19.875, 95% CI: 1.526-258.833) and parametrial involvement (HR=14.032, 95% CI: 1.281-153.761) were independent factors influencing the prognosis of patients with ECA. Conclusions: HR-HPV E6/E7 mRNA is more reflective of HPV infection in ECA tissue. The efficacy of HR-HPV E6/E7 mRNA and HR-HPV DNA (WTS-PCR assay) in identifying HPVA and NHPVA is similar, with higher sensitivity of HR-HPV DNA and higher specificity of HR-HPV E6/E7 mRNA. HR-HPV DNA is more effective than p16 in identifying HPVA and NHPVA. HPV E6/E7 mRNA and p16 positive ECA patients have better survival rates than negative.

Progress in the treatment of varus-posteromedial rotation instability of the elbow / 中华创伤骨科杂志

As varus posteromedial rotatory instability (VPMRI) is not common, its injury mechanisms are complex and presents no obvious dislocation on X-ray, it may be considered as a simple coronoid fracture, likely leading to a missed diagnosis or misdiagnosis. Moreover, the treatment of VPMRI is also controversial. Conservative treatment or improper treatment can cause serious complications. Therefore, this review expounds on the injury mechanisms, anatomical structure, O'Driscoll classification, imaging examination, treatment and postoperative rehabilitation of this complicated elbow injury which is rare and difficult to treat clinically.

Effects of preoperative nutritional status on postoperative functional prognosis in elderly patients with proximal humerus fracture / 中华创伤骨科杂志

Objective:To investigate the effects of preoperative nutritional status on postoperative functional prognosis in elderly patients with proximal humerus fracture.Methods:From January 2020 to December 2020, 103 elderly patients (≥65 years old) were treated for proximal humerus fractures by open reduction and internal fixation at Department of Traumatology, Honghui Hospital Affiliated to Xi'an Jiaotong University. Upon admission, according to the Geriatric Nutrition Risk Index (GNRI), they were assigned into a normal nutrition group (55 cases, with GNRI≥92) and a malnutrition group (48 cases, with GNRI<92). The baseline data, preoperative hemoglobin level, time from injury to operation, intraoperative blood transfusion, postoperative complications, 1-year mortality, and Neer shoulder functional scores at 3 months, 6 months and the last follow-up were compared between the 2 groups.Results:The 2 groups were comparable because there were no significant differences in gender, injury side, Neer fracture classification, injury cause, or American Society of Anesthesiologists (ASA) grading ( P>0.05). The age of the malnutrition group was significant older than that of the normal nutrition group ( P<0.05). All patients were followed up for 9 to 16 months (mean, 13.6 months) after surgery. In the normal nutrition group and the malnutrition group, respectively, the preoperative hemoglobin level was (10.24±0.68) g/dL and (8.94±0.89) g/dL, the time from injury to operation (3.9±1.3) d and (5.8±1.2) d, the rate of intraoperative blood transfusion 14.5%(8/55) and 60.4%(29/48), the rate of postoperative complications 20.0%(11/55) and 39.6%(19/48), the 1-year mortality 1.8%(1/55)、4.2%(2/48), and the Neer shoulder function score (46.7±8.8) points and (43.2±5.6) points at 3 months after operation, (67.6±6.2) points and (76.3±5.5) points at 6 months after operation, and (80.4±5.0) points and (76.3±5.5) points at the last follow-up. Comparisons of all the above items showed significant differences between the 2 groups (all P<0.05). Conclusions:Preoperative malnutrition in elderly patients with proximal humerus fracture has adverse effects on preoperative waiting time, intraoperative blood transfusion, complications and postoperative shoulder function. Therefore, perioperatively, attention should be paid to the nutritional status of elderly patients to reduce their stress responses to fracture, surgery and anesthesia, and to improve their postoperative function and quality of life.

Data mining-based analysis of formulation rules for prescriptions containing herbal pair Acori Tatarinowii Rhizoma-Polygalae Radix / 中国中药杂志

By the in-depth excavation of prescriptions containing herbal pair Acori Tatarinowii Rhizoma-Polygalae Radix in the Dictionary of Traditional Chinese Medicine Prescriptions, this study analyzed their formulation rules, so as to provide reference for their clinical application and new drug development. First, the prescriptions containing Acori Tatarinowii Rhizoma-Polygalae Radix were collected from the Dictionary of Traditional Chinese Medicine Prescriptions, and their indications, herbal compatibility, and dosage forms were analyzed statistically using the Traditional Chinese Medicine Inheritance Support System(TCMISS). Meanwhile, the formulation rules and common dosage forms for the top four indications(amnesia, palpitation, mania, and epilepsy) sorted by frequency were analyzed with Apriori algorithm. A total of 507 prescriptions containing Acori Tatarinowii Rhizoma-Polygalae Radix were screened out, involving 15 indications(frequency>10) like amnesia, palpitation, mania, and epilepsy. There were 30 commonly used Chinese herbs(frequency≥60), with the Qi-tonifying herbs(Ginseng Radix et Rhizoma and Glycyrrhizae Radix et Rhizome), mind-tranquilizing herbs(Poria and Poria cum Radix Pini), and Yin-nourishing herbs(Angelicae Sinensis Radix and Ophiopogonis Radix) being the core ones. The commonly used dosage forms were honey pill, paste pill, decoction, and powder. These have indicated that the herbal pair Acori Tatarinowii Rhizoma-Polygalae Radix is often combined with Qi-tonifying, Yin-nourishing, and mind-tranquilizing herbs for the treatment of "heart or brain diseases" caused by phlegm production due to spleen deficiency, Qi and blood deficiency, and phlegm-turbidity blocking orifice. In the treatment of amnesia, supplementing essence and replenishing marrow are considered on the basis of tonifying Qi, nourishing Yin, and tranquilizing mind. In the treatment of palpitation and mania, tranquilizing mind is emphasized. In the treatment of epilepsy, the emphasis is placed on resolving phlegm, extinguishing wind, and stopping convulsion.

Association between preoperative hemoglobin amount and incidence of lower limb deep vein thrombosis following lower limb fracture / 中华创伤骨科杂志

Objective:To study the association between preoperative hemoglobin amount and incidence of lower limb deep vein thrombosis (DVT) in patients with lower limb fracture.Methods:A retrospective study was performed of the 2, 482 patients with lower limb fracture who had been treated at Department of Orthopaedics Trauma, Honghui Hospital Affiliated to Xi'an Jiaotong University from July 2014 to August 2019. They were 1, 174 males and 1, 308 females with an age of (60.6±19.3) years. Recorded were the patients' age, gender, injury time, hemoglobin amount, D-dimer measurement, combined medical conditions, time and results of ultrasound vein examination on both lower extremities. According to the ultrasound results, the patients were divided into a thrombosis group and a thrombosis-free group. The 2 groups were compared in hemoglobin amount. Logistic regression was used to analyze the relationship between preoperative hemoglobin amount and incidence of lower limb DVT. The patients were divided into 5 groups according to the quintile of hemoglobin amount; the incidences of thrombosis were compared between the 5 groups.Results:The total incidence of DVT in this cohort was 29.53%(733/2, 482). The hemoglobin amount in the thrombosis group was (116.57±19.24) g/L, significantly lower than that in the thrombosis-free group (124.76±19.79) g/L ( P<0.05). The preoperative hemoglobin amount was a risk factor for incidence of DVT after a lower limb fracture ( OR=0.985, 95% CI: 0.980 to 0.990, P<0.001). As the quintile level of hemoglobin increased, the incidence of DVT showed a downward trend. In comparison of the group with the highest DVT incidence (40.58%) and the group with the lowest DVT incidence (17.27%), the risk increased by 2.386 times (95% CI: 1.718 to 3.315). Conclusions:The preoperative hemoglobin amount can affect the DVT incidence after a lower limb fracture, and a low hemoglobin amount may more likely lead to lower limb DVT.

Minimally invasive plate osteosynthesis with versus without B-ultrasound surface localization of the upper arm nerves in treatment of fractures of the middle and upper humeral shaft / 中华创伤骨科杂志

Objective:To compare the minimally invasive plate osteosynthesis (MIPPO) with versus without B-ultrasound surface localization of the upper arm nerves in the treatment of fractures of the middle and upper humeral shaft.Methods:A retrospective analysis was conducted of the 105 patients who had been admitted to Department of Orthopaedic Trauma, Honghui Hospital for fractures of the middle and upper humeral shaft from August 2015 to May 2017. They were divided into 2 groups according to whether or not B-ultrasound surface localization of the upper arm nerves had been used in MIPPO. There were 52 cases in the B-ultrasound localization group and 53 cases in the simple MIPPO group. The 2 groups were compared in terms of operation time, intraoperative blood loss, fracture union time and complications. The shoulder joint functions were assessed at the last follow-up using the Neer shoulder joint function scoring.Results:There was no significant difference in the preoperative general data between the 2 groups, showing comparability between groups ( P>0.05). There were significant differences between the B-ultrasound localization group and the simple MIPPO group in operation time [(62.8±8.6) min versus (96.8±7.5) min], or intraoperative blood loss [(107.4±5.6) mL versus (215.4±7.2) mL]. Neer shoulder function scoring showed that the excellent and good rate in the B-ultrasound localization group [94.2% (49/52)] was significantly higher than that in the simple MIPPO group [81.1% (43/53)] ( P<0.05). Conclusions:In the MIPPO of fractures of the upper and middle humeral shaft, B-ultrasound surface localization of the upper arm nerves should be used as preoperative routines to reduce operation time and intraoperative blood loss to improve prognostic functions of the shoulder.

Deep vein thrombosis after closed fracture of lower extremity and blood types ABO / 中华创伤骨科杂志

Objective:To investigate the differences in incidence of deep vein thrombosis (DVT) after closed fracture of lower extremity between patients with different blood types ABO.Methods:A retrospective study was conducted in the 1, 951 patients who had been admitted to Department of Orthopaedics Trauma, Honghui Hospital Affiliated to Xi'an Jiaotong University for lower extremity fractures from August 2014 to June 2018. They were 924 males and 1,027 females with a mean age of 63 (46, 78) years (range, from 16 to 102 years). Of them, 572 were type O, 564 type A, 609 type B and 206 type AB. Venous ultrasonography was performed on both lower extremities within 12 hours after admission. The incidences of DVT after fracture were compared between different blood types in all the patients, patients with proximal fracture of the knee, peri-knee fracture and distal fracture of the knee, and patients<60 years old and ≥60 years old.Results:The incidences of DVT were, respectively, 26.75% (153/572), 28.72% (162/564), 34.32% (209/609) and 29.61% (61/206) for patients with blood type O, type A, type B and type AB. The DVT incidence for type B was significantly higher than that for type O ( P< 0.008). The incidences of DVT were, respectively, 28.74% (98/341), 28.99% (100/345), 39.45% (144/365) and 30.97% (35/113) for blood type O, type A, type B and type AB in the patients with proximal fracture of the knee. The DVT incidence for blood type B was significantly higher than those for blood type O and blood type A ( P< 0.008). There were no significant differences in the DVT incidence between different blood types ABO in the patients with peri-knee fracture, distal fracture of the knee,<60 years old or ≥60 years old( P>0.05). The incidences of DVT were, respectively, 30.99% (97/313), 33.33% (108/324), 45.22% (156/345), 34.74% (33/95) for blood type O, type A, type B and type AB in the patients ≥60 years old. The DVT incidence for blood type B was significantly higher than those for blood type O and blood type A ( P< 0.008). Conclusions:The incidence of DVT varied with different blood types ABO after lower extremity fracture. The highest DVT incidence was found in patients with blood type B. The impact of blood type on the DVT incidence after lower extremity fracture was mainly observed in the patients with proximal fracture of the knee or an age of ≥ 60 years old.

Study on synergistic inhibitory effect of ruxolitinib and decitabine on growth of HEL cells with TET2 knockdown / 中国药理学通报

Aim To explore the cytotoxic and synergistic effects of decitabine and ruxolitinib on HEL cells with TET2 knockdown. Methods Stable TET2 knockdown by shRNA was established in HEL cell line. The change of cell proliferation was measured by CCK-8 assay. The median lethal dose (IC50) and colony formation assay were used to evaluate the cytotoxic effects of decitabine and ruxolitinib, the synergistic effects of which was further analyzed by Chou-Talalay method. Results The inhibition of TET2 increased the proliferative capacity of HEL cells. HEL cell lines became resistant to decitabine following shRNA-media- ted TET2 inactivation. Colony formation assay showed that the drug sensitivity of decitabine and ruxolitinib both decreased in TET2 knockdown HEL cells. The synergistic inhibitory effects of ruxolitinib and decitabine on TET2 knockdown HEL cells were observed. Conclusion The combination of ruxolitinib and decitabine may be an effective therapeutic strategy for accelerated or blast phase MPN patients with JAK2V6m and TET2 mutations.

Mechanism of Shengjiang Powder in treating chronic tonsillitis in children based on network pharmacology and molecular docking / 中国中药杂志

Based on the network pharmacology and molecular docking method to explore the molecular mechanism of Shengjiang Powder in treating chronic tonsillitis in children. This research first based on the Traditional Chinese Medicine System Pharmacology(TCMSP) and the Bioinformatics Analysis Tools for Molecular Mechanism of Traditional Chinese Medicine(BATMAN-TCM), the effective active ingredients of the drugs contained in Shengjiang Powder were screened out by the pharmacokinetic(ADME) parameters, the targets were predicted, and then chronic tonsillitis disease in children targets were obtained by GeneCards database. Afterwards, the target protein names were standardized by the Uniprot database. The drug targets were matched with the disease targets to obtain the potential therapeutic targets of Shengjiang Powder. Cytoscape 3.8.0 software was used to screen out and construct the network diagram of "drug-components-core targets-disease". DAVID database and R language were used to conduct the enrichment analysis of core action targets. Finally, AutoDock software was used to conduct molecular docking between drug components with a high network medium value and core action targets. According to the findings, after standardized treatment, a total of 79 active ingredients of Shengjiang Powder were obtained; it was predicted to get 1 261 potential targets, 268 potential targets for treatment of chronic tonsillitis in children, and 29 core targets; and 81 entries of GO enrichment were determined(P<0.05), including 63 biological processes, 7 cell components, 11 molecular function items, 24 KEGG pathway enrichment items(P<0.05), mainly including cell cycle, inflammatory factors, viral infection, immune regulation and other signaling pathways. The results of molecular docking showed that main active components in Shengjiang Powder had a stable binding activity with the core targets. This study revealed the mechanism of Shengjiang Powder in the treatment of chronic tonsillitis in children, mainly by resisting virus, inhibiting inflammation, regulating immunity and other means to play a synergistic effect, so as to provide a theoretical basis for rational clinical application.

Incidence of deep venous thrombosis before hip arthroplasty and possible causes of postoperative thrombosis / 国际外科学杂志

Objective:To investigate the risk factors of deep venous thrombosis in patients before hip arthroplasty, and to explore the possible causes of postoperative thrombosis.Methods:The clinical data of 361 patients with hip arthroplasty treated in the Department of Orthopaedic Trauma of Xi′an Honghui Hospital from September 2015 to December 2019 were studied retrospectively, including 102 males and 259 females, aged 65 to 94 years, and the average age was 72.25 years old. All fracture patients were given subcutaneous injection of low molecular weight heparin calcium to prevent lower extremity thrombosis. The deep veins of both lower extremities were examined before and after operation. The general data of the two groups of patients were collected and recorded, including age, sex, whether complicated with medical diseases (essential hypertension, type 2 diabetes, coronary heart disease), serological indexes, time from injury to admission, and time from admission to operation. The software of SPSS 19.0 was used for statistical analysis.Results:The incidence of lower limb DVT, before operation was 29.92%, including 26 males (24.07%) and 82 females (75.93%). The results of multivariate logistic regression analysis showed that diabetes mellitus ( OR=2.127, 95% CI: 1.134-3.989, P=0.019), coronary heart disease ( OR=1.692, 95% CI: 1.056-2.713, P=0.029) and the time from injury to admission ( OR=1.677, 95% CI: 1.037-2.712, P=0.035) were independent risk factors for DVT in elderly patients undergoing hip arthroplasty. The incidence of lower limb DVT, after operation was 46.54%. After operation, proximal thrombus were occurred in 2 cases (1.19%), distal thrombus in 143 cases (85.12%), and mixed thrombus in 23 cases (13.69%). Postoperative thrombus was ipsilateral to the fracture limb in 84 cases (50.00%), thrombus was located in the healthy side of the fracture in 19 cases (11.31%), and DVT occurred in 65 cases (38.69%) in both lower limbs. Conclusions:Delayed admission longed than 48 hours, coronary heart disease and diabetes mellitus are the risk factors for the formation of DVT. The thrombus that existed before operation and did not disappear after operation accounted for 48.81% of the total incidence of postoperative thrombosis, and the new thrombus accounted for 51.19% of the total incidence of postoperative thrombosis. For the elderly patients with femoral neck fracture undergoing hip arthroplasty, ultrasonic examination of both lower limbs should be performed before and after operation to find the changes of thrombus in time and do a good job of prevention and treatment.

Functional anatomy and vertical biomechanics of the acromioclavicular joint / 中华创伤骨科杂志

Objective To determine the role of acromioclavicular ligament in maintaining the stability of acromioclavicular joint.Methods In 12 cadaveric specimens of normal shoulder joint which had been routinely treated by formalin,the coracoclavicular ligaments (trapezium and conical ligaments) were dissected and exposed after soft tissue was removed from the surface.The distribution of the insertion and starting points,appearance and attachment area of the trapezium and conical ligaments were observed.The lengths of the 2 ligaments,the coronal and sagittal lengths of the clavicular attachment area,the distances from the most lateral point to the distal end of the clavicle,and the angles at the coronal and sagittal positions of the 2 ligaments were measured.Subsequently,the 12 cadaveric specimens were randomly divided into 4 groups (n =3).Group A retained the intact acromioclavicular ligament,group B the intact coracoclavicular ligament,group C the intact trapezium ligament and group D the intact conical ligament.In an electronic machine for versatile mechanical tests,a 100 mm/min load speed was applied for destructive static stretching of the ligament specimens in the vertical direction.The load-displacement curves were recorded and drawn by a computer in connection with the biomechanical testing machine.The rupture strengths of the 4 ligaments were recorded.Results The average lengths of the conical and trapezium ligaments were 10.6 mm and 12.5 mm,respectively.The coronal and sagittal lengths of the clavicular attachment area of the conical ligament averaged 13.4 mm and 5.8 mm,respectively.The coronal and sagittal lengths of the clavicular attachment area of the trapezium ligament averaged 14.2 mm and 8.7 mm,respectively.The distances from the most lateral points of the conical and trapezium ligaments to the distal clavicle averaged 35.5 mm and 23.6 mm,respectively.The average angles at the coronal and sagittal positions were 6.2° and 11.3° for the conical ligament and 38.7°and 6.9° for the trapezium ligament,respectively.The average tensile force was 201.3 ± 1.9 N for the acromioclavicular ligament rupture,374.6 ± 1.4 N for the coracoclavicular ligament rupture,192.3 ±4.3 N for the trapezium ligament rupture,and 345.7 ± 1.1 N for the conical ligament rupture.Conclusions The roles and contributions of the conical,trapezium and acromioclavicular ligaments are different in maintaining the stability of the acromioclavicular joint.In anatomical reconstruction of the acromioclavicular joint,it is more important to reconstruct the conical ligament and to repair the acromioclavicular ligament simultaneously as much as possible.

Vital pulp preservation treatment in mandibular right first molar with vertical root fractures: a case report / 华西口腔医学杂志

This case presents vertical root fracture with vital pulp in mandibular right first molar. Examinations of the history, clinical tests, laser Doppler flowmetry, and radiographs revealed that the tooth showed positive response to electric pulp testing and was normal compared with the healthy control tooth. This study aimed to use a novel vital preserving surgical technique (microapical surgery and nanometer bioactive materials) to make an effective therapeutic decision for the vital tooth with vertical root fracture.

Functional anatomy and vertical biomechanics of the acromioclavicular joint / 中华创伤骨科杂志

Objective@#To determine the role of acromioclavicular ligament in maintaining the stability of acromioclavicular joint.@*Methods@#In 12 cadaveric specimens of normal shoulder joint which had been routinely treated by formalin, the coracoclavicular ligaments (trapezium and conical ligaments) were dissected and exposed after soft tissue was removed from the surface. The distribution of the insertion and starting points, appearance and attachment area of the trapezium and conical ligaments were observed. The lengths of the 2 ligaments, the coronal and sagittal lengths of the clavicular attachment area, the distances from the most lateral point to the distal end of the clavicle, and the angles at the coronal and sagittal positions of the 2 ligaments were measured. Subsequently, the 12 cadaveric specimens were randomly divided into 4 groups (n=3). Group A retained the intact acromioclavicular ligament, group B the intact coracoclavicular ligament, group C the intact trapezium ligament and group D the intact conical ligament. In an electronic machine for versatile mechanical tests, a 100 mm/min load speed was applied for destructive static stretching of the ligament specimens in the vertical direction. The load-displacement curves were recorded and drawn by a computer in connection with the biomechanical testing machine. The rupture strengths of the 4 ligaments were recorded.@*Results@#The average lengths of the conical and trapezium ligaments were 10.6 mm and 12.5 mm, respectively. The coronal and sagittal lengths of the clavicular attachment area of the conical ligament averaged 13.4 mm and 5.8 mm, respectively. The coronal and sagittal lengths of the clavicular attachment area of the trapezium ligament averaged 14.2 mm and 8.7 mm, respectively. The distances from the most lateral points of the conical and trapezium ligaments to the distal clavicle averaged 35.5 mm and 23.6 mm, respectively. The average angles at the coronal and sagittal positions were 6.2° and 11.3° for the conical ligament and 38.7°and 6.9° for the trapezium ligament, respectively. The average tensile force was 201.3±1.9 N for the acromioclavicular ligament rupture, 374.6±1.4 N for the coracoclavicular ligament rupture, 192.3±4.3 N for the trapezium ligament rupture, and 345.7±1.1 N for the conical ligament rupture.@*Conclusions@#The roles and contributions of the conical, trapezium and acromioclavicular ligaments are different in maintaining the stability of the acromioclavicular joint. In anatomical reconstruction of the acromioclavicular joint, it is more important to reconstruct the conical ligament and to repair the acromioclavicular ligament simultaneously as much as possible.

Value of perfusion CT quantitative analysis for predicting tumor regression grade after chemoradiotherapy in patients with rectal cancer / 国际肿瘤学杂志

Objective To explore the value of perfusion CT quantitative analysis for predicting tumor regression grade (TRG) after chemoradiotherapy in patients with rectal cancer.Methods From June 2016 to June 2018,94 rectal cancer patients diagnosed and treated in Cangzhou Central Hospital of Hebei Province were selected and were divided into reaction group (TRG 3-4) and non-reaction group (TRG 0-2) according to the results of surgical specimens.Perfusion CT was performed in both groups before treatment,and chemoradiotherapy and surgery were used.Baseline data and perfusion CT results including blood flow,blood volume,mean transit time (MTT),permeability surface (PS) were compared between the two groups,and receiver operating characteristic (ROC) curve was used to evaluate the predictive efficacy of perfusion CT indexes for chemoradiotherapy responsiveness.Results In this study,a total of 23 cases (24.47％) were responsive to chemoradiotherapy,and 71 cases (75.53％) were not responsive to chemoradiotherapy.Blood flow in reaction group [(38.60 ±7.13) ml · 100 g-1 · min-1] was significantly lower than that in non-reaction group [(67.39 ± 11.33) ml · 100 g-1 · min-1,t =3.273,P =0.001].MTT in reaction group was significantly longer than that in non-reaction group [(11.12 ±2.19) s vs.(6.88 ± 1.32) s,t =4.500,P ＜0.001].There was no significant difference in blood volume [(4.62 ±0.73) ml/100 g vs.(5.01 ± 1.04) ml/100 g] and PS [(13.72±3.82) ml · 100 g-1 · min-1 vs.(11.40 ±2.59) ml · 100 g-1 · min-1] between the two groups (t =0.818,P =0.415;t =0.409,P =0.683).The best cut-off points of blood flow and MTT for predicting chemoradiotherapy responsiveness were 50.89 ml · 100 g-1 · min-1 and 8.99 s,the area under the curve (AUC) was 0.825 and 0.922,and the AUC of combined prediction of chemoradiotherapy responsiveness was 0.982,which was significantly better than that of single prediction (Z =2.868,P =0.004;Z =2.051,P =0.004).The accuracy (91.49％) and specificity (90.14％) of combined prediction of chemoradiotherapy responsiveness were significantly better than those of single prediction (blood flow:accuracy 75.53％,specificity 73.24％;MTT:accuracy 79.79％,specificity 78.87％),and the differences were statistically significant (x2 =8.800,P =0.012;x2 =6.766,P =0.034).Conclusion Blood flow and MTT in perfusion CT have great predictive value for chemoradiotherapy responsiveness in patients with rectal cancer.

Study of deep venous thrombosis in lower extremities after femoral neck fracture / 国际外科学杂志

Objective To explore the causes of deep venous thrombosis of the lower extremities after femoral neck fracture.Methods To retrospectively analyze the clinical data of 483 cases of femoral neck fractures treated from September 2014 to December 2017 from Department of Traumatic Orthopedics,Xi'an Jiaotong University School of Medicine Affiliated Honghui Hospital.Please record the patient's complications,blood transfusion volume,reduction method,internal fixation,operative time,intraoperative blood loss,and postoperative thrombosis.Count data were expressed as percentage (％) and analyzed by x2 test between the two groups;measurement data were expressed as ((x) ± s),and two independent samples was used by t test.To calculate the incidence of postoperative deep venous thrombosis in patients with femoral neck fractures and to investigate the causes of deep vein thrombosis of the lower extremities after femoral neck fractures.Results Of the 483 patients,149 cases of deep vein thrombosis of the lower extremities occurred after surgery,with an incidence of 30.8％.The reduction method,internal fixation,and intraoperative blood loss all affected the occurrence of deep venous thrombosis after femoral neck fracture (P ＜ 0.05).Among the reset methods,367 cases were open and closed,33.2％ (122/367) had deep venous thrombosis,closed reduction was 116 cases,and 23.3％ (27/116) had deep venous thrombosis.The incidence of open reduction deep venous thrombosiswas higher than closed reduction;among the internal fixation methods,fixation,the incidence of deep venous thrombosis after total hip arthroplasty and intramedullary nailing was the highest,which was 52.8％ and 50.0％,respectively.The hemorrhage volume in the thrombosis group (246.9 ± 178.1) ml was higher than that in the non-thrombosis group(206.3 ± 126.7) ml.Conclusions The incidence of deep venous thrombosis after femoral neck fractures is high,and the way of reduction,internal fixation,bedtime before operation,and blood loss during operation can affect the occurrence of deep venous thrombosis after femoral neck fracture.There are many factors affecting deep venous thrombosis after femoral neck fracture.It is necessary to fully evaluate the risk of deep venous thrombosis after operation.

Preoperative deep venous thrombosis in female patients with lower extremity fracture in menstrual phase / 中华创伤骨科杂志

Objective To investigate the factors associated with preoperative deep venous thrombosis (DVT) in female patients with lower extremity fracture in menstrual phase.Methods A retrospective analysis was conducted of the 119 women with lower extremity fracture in childbearing age who had been treated at Traumatic Orthopaedics Center,Red Cross Hospital,Xi'an Jiaotong University Health Science College from October 2016 to October 2017.Of them,41 were in menstral phase,aged from 20 to 50 years (average,37.1 ± 8.9 years),and 78 were not,aged from 19 to 50 years (average,36.9 ± 8.0 years).The 2 groups were compared in terms of DVT incidence,D-dimer level,prothrombin time,partial prothrombin time,thrombin time,fibrinogen level,and preoperative bed time.Results The patients with menstruation had significantly higher incidence of lower extremity DVT (82.9％) and significantly longer preoperative bed time (9.1 ± 3.4 d) than those without menstruation did (14.1％ and 3.8 ± 2.2 d,respectively) (P ＜0.05).There were no significant differences between the 2 groups in the preoperative coagulation indexes:D-dimer,prothrombin time,partial prothrombin time,thrombin time or fibrinogen (P ＞ 0.05).Conclusions The incidence of preoperative DVT may be high the female patients with lower extremity fracture in menstrual phase,chiefly because of long preoperative bed time.Detection of D-dimer level is of limited significance in the screening for thrombosis in menstrual phase.Menstruation may not be a surgical contraindication.

Clinical effects of mini-locking plate with vertical or parallel technology for treatment of Dubberley type B capitellar fractures / 中华创伤杂志

Objective To investigate the clinical effects of mini-locking plate with vertical or parallel technology in the treatment of Dubberley type B capitellar fractures.Methods A case series study was done on clinical data of 17 cases of Dubberley type B capitellar fractures treated through operation with vertical or parallel mini-locking plate.There were 12 males and 5 females,with age range of 23-77 years (mean 56.4 years).The fractures were classified according to the Dubberley system,including type Ⅰ B in 2 cases,Ⅱ B in 6 and type Ⅱ B in 9.The operations were conducted through the Kocher approach at posterior-lateral rear elbow joint and the fractured bone was fixed firstly with Kirschner wire and mini screws after resetting and then with vertical or parallel mini locking plate.The surgery time and bleeding volume during the surgery were recorded.The position of fracture,healing,avascular necrosis of capitellum,heterotopic ossification,and traumatic arthritis were evaluated.At the final follow-up,the Mayo elbow performance score (MEPS) was used to evaluate the function of elbow,and flexion andextension of the elbow,swing of the forearm and inner stability of the elbow joint were evaluated.Results The surgery time was 50-90 minutes (mean 60 minutes).The bleeding volume during surgery was 40-120 ml (mean 60 ml).All patients were followed up for 12-24 months (mean 12.1 months).Anatomical reduction was seen in 12 cases and ahnost anatomical reduction in 5.None had vessel or nerve wound,and the wound was healed at phase Ⅰ within 10-12 days after operation.The clinical fracture healing time was 8-12 weeks (mean 11.4 weeks).At the final follow-up,the fractures were well healed without complications like fracture reduction loss,ischemic necrosis of the humerus,traumatic arthritis or heterotopic ossification of the elbow joint.MEPS in all cases was 60-100 points (mean 87.6 points).MEPS assessment result was excellent in 13 cases,good in 3 and fair in 1,with the excellent rate of 94％.At the final follow-up,the average activity of the elbow was 6 ° (0°-10°) for extension and 118 ° (90°-130°) for flexion,the average forearm pronation was 70° (60°-90°),the average forearm supination was 82° (70°-90°),and the inner stress test showed no instability.Conclusion Vertical or parallel mini-lockiug plate in the treatment of Dubberley type B capitellar fractures is associated with few complications,early functional exercise after operation,and satisfactory short-term outcome.

Clinical effects of mini-locking plate with vertical or parallel technology for treatment of Dubberley type B capitellar fractures / 中华创伤杂志

Objective To investigate the clinical effects of mini-locking plate with vertical or parallel technology in the treatment of Dubberley type B capitellar fractures.Methods A case series study was done on clinical data of 17 cases of Dubberley type B capitellar fractures treated through operation with vertical or parallel mini-locking plate.There were 12 males and 5 females,with age range of 23-77 years (mean 56.4 years).The fractures were classified according to the Dubberley system,including type Ⅰ B in 2 cases,Ⅱ B in 6 and type Ⅱ B in 9.The operations were conducted through the Kocher approach at posterior-lateral rear elbow joint and the fractured bone was fixed firstly with Kirschner wire and mini screws after resetting and then with vertical or parallel mini locking plate.The surgery time and bleeding volume during the surgery were recorded.The position of fracture,healing,avascular necrosis of capitellum,heterotopic ossification,and traumatic arthritis were evaluated.At the final follow-up,the Mayo elbow performance score (MEPS) was used to evaluate the function of elbow,and flexion andextension of the elbow,swing of the forearm and inner stability of the elbow joint were evaluated.Results The surgery time was 50-90 minutes (mean 60 minutes).The bleeding volume during surgery was 40-120 ml (mean 60 ml).All patients were followed up for 12-24 months (mean 12.1 months).Anatomical reduction was seen in 12 cases and ahnost anatomical reduction in 5.None had vessel or nerve wound,and the wound was healed at phase Ⅰ within 10-12 days after operation.The clinical fracture healing time was 8-12 weeks (mean 11.4 weeks).At the final follow-up,the fractures were well healed without complications like fracture reduction loss,ischemic necrosis of the humerus,traumatic arthritis or heterotopic ossification of the elbow joint.MEPS in all cases was 60-100 points (mean 87.6 points).MEPS assessment result was excellent in 13 cases,good in 3 and fair in 1,with the excellent rate of 94％.At the final follow-up,the average activity of the elbow was 6 ° (0°-10°) for extension and 118 ° (90°-130°) for flexion,the average forearm pronation was 70° (60°-90°),the average forearm supination was 82° (70°-90°),and the inner stress test showed no instability.Conclusion Vertical or parallel mini-lockiug plate in the treatment of Dubberley type B capitellar fractures is associated with few complications,early functional exercise after operation,and satisfactory short-term outcome.

Expression and significance of mTOR/4EBP1/HIF-1α/VEGF signaling pathway in lung tissues of asthmatic mice / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the expression and significance of the mammalian target of rapamycin (mTOR)/eukaryote initiating factor 4E binding protein 1(4EBP1)/hypoxia inducible factor-1α (HIF-1α)/vascular endothelial growth factor (VEGF) signaling pathway in asthmatic mice.</p><p><b>METHODS</b>Forty SPF level 6-8 week-old female Balb/C mice were randomly divided into control, asthma, budesonide and mTOR inhibitor (rapamycin) intervention groups (n=10 each). The asthmatic mouse model was prepared via OVA induction and challenge test. The intervention groups were administered with rapamycin at the dosage of 3 mg/kg by an intraperitoneal injection or budesonide suspension at the dosage of l mg by aerosol inhalation respectively 30 minutes before the OVA challenge. The control and asthma groups were treated with normal saline instead. The concentrations of HIF-1α and VEGF in bronchoalveolar lavage fluid (BALF) were examined using ELISA 24 hours after the last challenge. The pathological changes of lung tissue were observed by hematoxylin-eosin (HE) staining. The p-mTOR and p-4EBP1 from the lung tissues were detected by immunohistochemistry and Western blot. Pearson analysis was used to study the correlation between p-mTOR, p-4EBP1, HIF-1α, and VEGF expression.</p><p><b>RESULTS</b>Compared with the control group, inflammatory cell infiltration and secretions in the trachea increased in the asthma group. The levels of HIF-1α and VEGF in BALF and p-mTOR and p-4EBP1 expression in lung tissues also increased (P<0.01). Compared with the asthma group, inflammatory cell infiltration and secretions in the trachea were reduced in the two intervention groups, and the levels of HIF-1α and VEGF in BALF and p-mTOR and p-4EBP1 expression in lung tissues were also reduced (P<0.01). There were no significant differences in the above changes between the two intervention groups and control group (P>0.05). In the asthma group, there was a pairwise positive correlation between lung p-mTOR and p-4EBP1 expression and HIF-1α and VEGF levels in BALF (P<0.05). However, there were no correlations in the above indexes in the intervention groups and control group.</p><p><b>CONCLUSIONS</b>p-mTOR, p-4EBP1, HIF-1α and VEGF together are involved in the pathogenesis of asthma. Rapamycin treatment can block this signaling pathway, suggesting that this pathway can be used as a novel target for asthma treatment.</p>

Locking plate fixation of intertrochanteric fractures in patients with deformed proximal femur / 中华创伤骨科杂志

Objective To explore the clinical outcomes of locking plate fixation of intertrochanteric fractures in patients with deformed proximal femur.Methods A retrospective review was made of the 25 patients with intertrochanteric fracture and deformed proximal femur who had been treated from January 2009 to July 2015.They were 17 men and 8 women,from 22 to 76 years of age (mean,45.2 years).The proximal femoral deformities were postpoliomyelitis syndrome in 6 cases,fibrous dysplasia in 4,malunion in 13,and hip varus caused by implant breakage following intramedullary nailing in 2.By AO classification,there were 4 cases of type 31-A2.1,3 ones of type 31-A2.2,16 ones of type 31-A3.1,and 2 ones of type 31-A3.2.All the patients were treated by open reduction plus locking plate fixation.At the final follow-up,function of the affected hip was evaluated by the Hip Disability and Osteoarthritis Outcome Score (HOOS),and quality of life of the patients was evaluated using the SF-36 health survey questionnaire.Results The 25 patients were effectively followed up for 12 to 24 months (mean,17.4 months).No infection,pneumonia,fat embolism,or deep venous thrombosis of lower limb was observed.The fractures healed without nonunion or refracture after a mean time of 5.9 months (range,from 3 to 6 months) in the 25 patients.By the HOOS evaluation at the final follow-ups,the 25 patients scored,on average,83.7± 15.6 in pain,55.6± 14.1 in symptoms,53.6 ± 9.5 in daily living function,52.7 ± 8.9 in sports and recreational activities and 62.4 ± 12.3 in quality of life;by SF-36 evaluation,they had a mean total score of 71.2 ± 13.8.Both the HOOS and SF-36 scores were not significantly different from the pre-injury values (P ＞ 0.05).Conclusion Locking plate fixation is a simple and effective way for the intertrochanteric fractures complicated with deformed proximal femur because intramedullary nailing is difficult or infeasible.