Early cartilage lesion and 5-year incident joint surgery in knee osteoarthritis patients: a retrospective cohort study.

OBJECTIVE: to investigate the association between cartilage lesion-related features observed in knee osteoarthritis (OA) patients' first MRI examination and incident knee surgery within 5 years. Additionally, to assess the predictive value of these features for the incident knee surgery. METHODS: We identified patients diagnosed with knee OA and treated at our institution between January 2015 and January 2018, and retrieved their baseline clinical data and first MRI examination films from the information system. Next, we proceeded to determine joint space narrowing grade, cartilage lesion size grade, cartilage full-thickness loss grade and cartilage lesion sum score for the medial and lateral compartments, respectively. Generalized linear regression models examined the association of these features with 5-year incident knee surgery. Positive and negative predictive values (PPVs and NPVs) were determined referring to 5-year incident knee surgery. RESULTS: Totally, 878 participants (knees) were found eligible to form the study population. Within the 5 years, surgery was performed on 61 knees. None of the cartilage-related features had been found significantly associated with incident surgery. The results were similar for medial and lateral compartments. The PPVs were low for all the features. CONCLUSIONS: Among symptomatic clinically diagnosed OA knees, cartilage lesions observed in the first MRI examinations were not found to be associated with the occurrence of joint surgery within a 5-year period. All these cartilage-related features appear to have no additional value in predicting 5-year incident joint surgery.

Evaluating the relationship between Clinical G6PD enzyme activity and gene variants.

Glucose-6-phosphate dehydrogenase (G6PD) is a the first and rate-limiting enzyme that plays a critical role in G6PD deficiency, the most common enzyme disorder worldwide, is related to intravascular hemolysis. To determine the clinical enzyme activity level in different G6PD variants, we evaluated 15 variant from 424 clinical blood samples by using multicolor melting curve analysis and DNA sequencing. The results showed that the enzyme activities of the hemizygous deficient were 1.5-2.4 U/gHb, which was significantly lower than those of the heterozygous (P < 0.001) and the compound heterozygous variants (P < 0.05). Since the hemizygous of c.1024C > T (Chinese-5) mutation affects the kinetic parameters of G6PD and increase utilization of analogues, its enzyme activity is more than those of other mutations that mutated in the ß+α region of G6PD. The heterozygous enzyme levels ranged from 6.5-20.1 U/gHb; and there was no significant difference among different heterozygous variants (P > 0.05). The enzyme activity levels of the compound heterozygous mutation were mainly in the range of 1.7-3.8 U/gHb, which was much lower than that of the heterozygous mutation (P < 0.001). In summary, our findings revealed that the enzyme activity of G6PD in blood have a significant relationship with genotype of G6PD.

Analysis of initial sandplay characteristics among university students with different levels of loneliness.

BACKGROUND AND OBJECTIVE: Loneliness is detrimental to mental health, with university students at higher risk of feeling lonely than other population groups. The mental health of college students is a hot topic at present. Despite numerous studies exploring interventions for loneliness among university students. However, little research has explored early psychological manifestations of university students with different levels of loneliness. Despite numerous studies exploring interventions for loneliness among university students, little research has explored early psychological manifestations of university students with different levels of loneliness. Initial sandplay is a good tool to reveal psychological activity. Therefore, our study aims to explore the characteristics of initial sandplay application among university students with different levels of loneliness. METHODS: We recruited 60 volunteers from a university to perform a sandplay experiment from January to April 2021. The UCLA Loneliness Scale measured the levels of loneliness. These 60 participants were divided into the experimental group (n = 30) and control group (n = 30) according to their levels of loneliness. The experimental group included participants with a scale score of more than 44. Other participants with a scale score of less than 44 belong to the control group. We recorded their sandplay artwork and statistically analyzed it by the Sandplay Process Record Form. Group comparisons were performed using the t-test or Wilcoxon rank-sum test for continuous variables, and the chi-square test or Fisher's exact test for categorical variables. The logistic regression analysis by forward stepwise method was conducted to analyze the sandplay theme features for loneliness. RESULTS: Regarding the sandplay tools, the experimental group used fewer transportation tools (t=-3.608, p < 0.01) and more natural elements (t = 2.176, p < 0.05) than the control group. Moreover, the experimental group created more natural scenes (χ2 = 4.310, p < 0.05) and used less of the lower left (χ2 = 4.593, p < 0.05) and lower right (χ2 = 5.934, p < 0.05) spaces. With regards to sand changes, the experimental group was less likely than the control group to make substantial changes (χ2 = 5.711, p < 0.05) and more likely to make almost no changes (χ2 = 4.022, p < 0.05). In terms of the themes, the experimental group was more likely to exhibit sandplay artwork themes of emptiness (χ2 = 8.864, p < 0.05) and neglect (χ2 = 6.667, p < 0.05), and less likely to show themes of energy (χ2 = 5.079, p < 0.05). In the logistic regression analysis of the sandplay themes, emptiness (OR = 5.714, 95%CI: 1.724-18.944, p = 0.003) and neglect (OR = 7.000, 95%CI: 1.381-35.479, p = 0.010) were demonstrated a nominal association with high levels of loneliness among both groups (F = 16.091, p < 0.01, ΔR2 = 0.193), but failed to pass the Bonferroni testing correction (p threshold < 0.0025). CONCLUSION: University students with higher degree of loneliness do not like to drastic changes and prefer to use natural elements in element selection, while the control group likes to drastic changes and prefers to use transportation tools in element selection. Regression analysis of sandplay theme features revealed emptines and neglect may as significant associated factors for loneliness. We propose sandplay characteristics can help identify university students with different levels of loneliness during psychological evaluations. Therefore, it is important that the school and healthcare systems assist college students in identifying the loneliness through initial sandplay and carrying on the necessary psychological counseling to the lonely student population.

Ureteroscope/flexible combined with balloon in the treatment of ureteral stricture with stones in transplanted kidney: a report of 9 cases in a single center / 现代泌尿外科杂志

【Objective】 To evaluate the efficacy and safety of ureteroscope or flexible ureteroscope combined with balloon dilatation in the treatment of ureteral stricture with renal calculi in transplanted kidney. 【Methods】 The clinical data of 9 patients treated in our hospital during 2016 and 2022 were reviewed. The changes of the width of hydronephrosis, levels of creatinine and urea nitrogen, reoperation, and re-dwelling of stents were analyzed. 【Results】 One patient failed the operation because the guide wire could not be inserted, and the other 8 patients successfully completed the surgery. The stents were removed 6 to 8 weeks after surgery. During the follow-up of 8 to 48 months, no recurrence of renal calculi occurred; 5 patients had no recurrence of ureteral stricture; 3 patients (cases 4, 6, 9) underwent regular ureteral stent replacement due to hydronephrosis; the width of hydronephrosis, creatinine and urea nitrogen levels of 8 patients were significantly improved (P<0.05). 【Conclusion】 Ureteroscope/flexible with balloon dilatation is safe and effective in the treatment of transplanted kidney with ureteral stricture and kidney stones.

Prognostic Model Based on Preoperative FAR and SII Versus TNM Staging System in Evaluating Prognosis of Patients with Pancreatic Cancer After Radical Resection / 肿瘤防治研究

Objective To investigate the predictive value of preoperative fibrinogen/albumin ratio (FAR) and systemic immune inflammation index (SII) on the postoperative prognosis of patients with pancreatic ductal adenocarcinoma. Methods An ROC curve was used in determining the best cutoff values of FAR and SII and then grouped. The Cox proportional hazards model was used in analyzing the prognostic factors of radical pancreatic cancer surgery, and then a Nomogram prognostic model was established. C-index, AUC, and calibration curve were used in evaluating the discrimination and calibration ability of the Nomogram. DCA curves were used in assessing the clinical validity of the Nomograms. Results The optimal cutoff values for preoperative FAR and SII were 0.095 and 532.945, respectively. FAR≥ 0.095, SII≥ 532.945, CA199≥ 450.9 U/ml, maximum tumor diameter≥ 4 cm, and the absence of postoperative chemotherapy were independent risk factors for the poor prognosis of pancreatic cancer (P<0.05). The discrimination ability, calibration ability, and clinical effectiveness of Nomogram prognostic model were better than those of the TNM staging system. Conclusion The constructed Nomogram prognostic model has higher accuracy and level of discrimination and more clinical benefits than the TNM staging prognostic model.

Characteristics in Initial Sandplay of Optimal and Non-optimal Family Functioning Among High School Students.

Objective: The purpose of this study is to explore the characteristics of the initial sandplay of high school students with poor family function, by studying the initial sandplay of high school students with different levels of family function, so as to provide the basics for the psychological assessment and intervention of high school students. Significance: To provide data support for high school students' mental health education and sandplay therapy, and to apply sandplay as an intervention method to play a healing role in high school mental health work. Methods: High school students (N = 345) were divided into 11 groups and participated in a sandplay experiment for 8 weeks from February to March 2021. Each group completed the Chinese version of the Epstein et al. Family Assessment Device. Samples with scores of one standard deviation below and above the sample mean were placed in the low family functioning group (n = 30; 15 girls) or high family functioning group (n = 30; 15 girls), respectively. The initial sandplay was evaluated on multiple dimensions using an established coding system. Results: Samples with low family functioning used fewer animal figurines in their sandplay (t = 2.176, p < 0.05); had more family scenes (χ2 = 4.356, p < 0.05); fewer rural scenes (χ2 = 4.344, p < 0.05); and fewer healing themes (t = -2.336, p < 0.05). In particular, there were fewer examples of connected healing themes (χ2 = 7.500, p < 0.05); in-depth healing themes (χ2 = 5.455, p < 0.05); and more hindered trauma themes (χ2 = 4.812, p < 0.05). Logistic regression analysis was conducted using the sandplay characteristics as predictors of group membership. Using forward stepwise selection, themes of hindered trauma (B = -2.030) and connected healing (B=1.765) were shown to be significant predictors of group membership (F = 17.784, P < 0.01, ΔR 2 = 0.214). Conclusion: Students who reported high and low family functioning showed significant differences in their sandplay characteristics. We propose sandplay characteristics can help identify low family functioning of adolescents during psychological evaluations.

Clinical features and treatment of "Non-dislocated hyperextension tibial plateau fracture".

BACKGROUND: To explore the epidemiological characteristics, clinical characteristics, treatment strategies, and clinical results of non-dislocated hyperextension tibial plateau fracture. METHOD: A total of 25 cases of non-dislocated hyperextension tibial plateau fracture patients were collected (12 males and 13 females), aged 27-79 years. Preoperative tibial plateau posterior slope angle was - 10~0° (average - 5.2°). Preoperative MRI showed 5 cases of MCL injury, 3 cases of PLC complex injury, and 2 cases of PLC + PCL injury. The change of tibial plateau posterior slope angle was more than 10° in patients with ligament injury, and the patients with a tibial plateau posterior slope angle change less than 10° had no ligament injury; 6 patients with simple column fracture had a ligament injury, 2 patients with bilateral column fracture had a ligament injury, and 2 patients with three column fracture had a ligament injury. RESULTS: Patients were followed up for 12-24 months (average 16.4 months). The operative time was 65-180 min (average 124 min), and the blood loss was 20-200 ml (average 106 ml). The plate was placed on the anterior part of tibial plateau. Evaluation of postoperative fracture reduction was as follows: 20 cases reached anatomic reduction, 5 cases reached good reduction (between 2 and 5 mm articular surface collapse), and the excellent rate of fracture reduction was 100%. The fracture healing time was 3-6 months (average 3.3 months). The postoperative knee Rasmussen score was 18-29 (average 24.9), and the postoperative knee joint mobility was 90-130° (average 118°). Two patients suffered superficial infection. CONCLUSIONS: The main imaging characteristic of "non-dislocated hyperextension tibial plateau fracture" is the change of tibial plateau posterior slope angle. The injury of single anteromedial column/anterolateral column fracture is easy to combine with "diagonal" injury, and when the tPSA changes more than 10°, it is easy to be combined with ligament injury. By reducing the joint articular surface and lower limb force line, repairing the soft tissue structure, and reconstructing the knee joint stability, we can get satisfactory results. TRIAL REGISTRATION: It was a retrospective study. This study was consistent with the ethical standards of the Second Affiliated Hospital of Zhejiang University Medical College and was approved by the hospital ethics committee and the trial registration number of our hospital was 20180145 .

Correction to: miR-762 modulates thyroxine-induced cardiomyocyte hypertrophy by inhibiting Beclin-1.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

The clinical characteristics and management strategy of non-dislocated hyperextension tibial plateau fractures / 中华骨科杂志

Objective:To explore the epidemiological characteristics, clinical characteristics, treatment strategies and clinical results of non-dislocated hyperextension tibial plateau fracture.Methods:A total of 25 cases of non-dislocated hyperextension tibial plateau fracture patients were collected, including 12 males and 13 females, aged 27-79 years with an average age of 51±15 years. Causes of injury: 18 cases of traffic accident, 2 cases of heavy injury, 5 cases of falling injury. Schatzker classification of tibial plateau fracture: 4 cases of type II, 5 cases of type IV, 13 cases of type V, 3 cases of type VI. Three columns theoretical classification: 4 cases of simple lateral column, 5 cases of simple medial column, 7 cases of medial column+lateral columns, 9 cases of three columns. Preoperative tibial plateau posterior slope angle was -10-0 degrees, average-5.2 degrees. Preoperative MRI showed 5 cases of medial collateral ligament (MCL) injury, 3 cases of posterolateral complex (PLC) complex injury, 2 cases of PLC+ posterior cruciate ligament (PCL) injury and 10 cases of menisci injury. The change of tibial plateau posterior slope angle was more than 10 degrees in patients with ligament injury, 5 patients had a tibial plateau posterior slope angle change more than 15 degrees, 5 patients had a tibial plateau posterior slope angle change more than 10 degrees, and the patients with a tibial plateau posterior slope angle change less than 10 degrees had no ligament injury; 6 patients with simple lateral column or medial column fracture had a ligament injury, 2 patients with medial column+lateral column fracture had a ligament injury, and 2 patients with three column fracture had a ligament injury.Results:All patients were followed up for 12-24 months, with an average of 16.4 months. The operation time was 124±33 min (65-180 min), and the bleeding volume was 106±48 ml (20-200 ml). All patients were treated by open reduction and internal fixation. According to the characteristics of fracture, targeted reduction of articular surface and restoration of lower limb force line were carried out. The plate was placed on the anterior part of tibial plateau to fix the fracture fragment. Evaluation of postoperative fracture reduction: 20 cases were anatomic reduction, 5 cases were good reduction (between 2-5 mm articular surface collapse), and the excellent rate of fracture reduction was 100%. Internal fixation: 4 cases were treated with simple lateral plate, 2 cases with simple medial plate, 15 cases with medial+ lateral plate, 1 case with medial plate+ lateral anchor suture, 1 case with medial plate+ posterior screw, 1 case with lateral plate+ fibular screw, 1 case with medial plate + lateral plate+ lateral anchor suture. The meniscus was repaired in 8 patients, including 5 medial and 3 laterals. The fracture healing time was 3-6 months (mean 3.3 months). The postoperative knee Rasmussen score was 24.9±3.5 (18-29), and the postoperative knee joint mobility was 118°±9° (90°-130°). Superficial infection occurred in 2 patients.Conclusion:The main imaging characteristic of "non-dislocated hyperextension tibial plateau fracture" is the change of tibial plateau posterior slope angle. The injury of single anteromedial column/anterolateral column fracture is easy to combine with the "diagonal" injury, and when the tibial plateau posterior slope angle changes more than 10 degrees, it is easy to be associated with peripheral ligament injury. By using open reduction and internal fixation, restoring the joint articular surface and lower limb force line, repairing the soft tissue structure and ligament, and reconstructing the stability of knee joint, we can achieve satisfactory results.

Effect of occlusal thickness design on the fracture resistance of endocrowns restored with lithium disilicate ceramic and zirconia / 华西口腔医学杂志

OBJECTIVE@#This study aimed to investigate the effect of occlusal thickness design on fracture resistance of endocrowns restored with lithium disilicate ceramic and zirconia.@*METHODS@#A total of 24 artificial first mandibular molars were randomly divided into four groups with six teeth in each group as follows: group lithium disilicate ceramic-2 mm (lithium disilicate ceramic, with an occlusal thickness of 2 mm and a retainer length of 4 mm); group lithium disilicate ceramic-4 mm (lithium disilicate ceramic, with an occlusal thickness of 4 mm and a retainer length of 2 mm); group zirconia-2 mm (zirconia, with an occlusal thickness of 2 mm and a retainer length of 4 mm); and group zirconia-4 mm (zirconia, with an occlusal thickness of 4 mm and a retainer length of 2 mm). After adhesive cementation (RelyX Ultimate Clicker), all specimens were subjected to thermocycling (10 000 cycles). The specimens were subjected to fracture resistance testing at a 135° angle to the teeth at a crosshead speed of 0.5 mm·min⁻¹ in a universal testing machine. Data were analyzed with ANOVA and Tukey's HSD test by SPSS 15.0. The failure modes were classified.@*RESULTS@#The fracture resistances of groups lithium disilicate ceramic-
2 mm, lithium disilicate ceramic-4 mm, zirconia-2 mm, and zirconia-4 mm were (890.54±83.41), (2 320.87±728.57), 
(2 258.05±557.66), and (3 847.70±495.99) N respectively. Group zirconia-4 mm had the highest fracture resistance, whereas group lithium disilicate ceramic-2 mm had the lowest.@*CONCLUSIONS@#The fracture resistance of molar endocrown with zirconia is higher than that with lithium disilicate ceramic. Increasing the occlusal thickness can improve the fracture resistance but increase the risk of fracture of abutment.

Predicting the number of visceral leishmaniasis cases in Kashgar, Xinjiang, China using the ARIMA-EGARCH model

Objective: To forecast the visceral leishmaniasis cases using autoregress integrated moving average (ARIMA) and hybrid ARIMA-EGARCH model, which offers a scientific basis to control visceral leishmaniasis spread in Kashgar Prefecture of Xinjiang, China. Methods: The data used in this paper are monthly visceral leishmaniasis cases in the Kashgar Prefecture of Xinjiang from 2004 to 2016. The sample data between 2004 and 2015 were used for the estimation to choose the best model and the sample data in 2016 were used for the forecast. Time series of visceral leishmaniasis started on 1 January 2004 and ended on 31 December 2016, consisting of 1 790 observations reported in Kashgar Prefecture. Results: For Xinjiang, the total number of reported cases were 2 187, the male-to-female ratio of cases was 1:1.42. Patients aged between 0 and 10 years accounted for 82.72% of all reported cases and the largest percentage of visceral leishmaniasis cases was detected among scattered children who accounted for 68.82%. The monthly incidences fitted by ARIMA (2, 1, 2) (1, 1, 1)

Comparison of measurement methods of lower limb length in hip arthroplasty for femoral neck fracture / 中国骨伤

OBJECTIVE@#To compare the accuracy of three methods for measuring the length of both lower limbs in hip arthroplasty for femoral neck fracture in the elderly, and to introduce a "shoulder to shoulder" anatomical location marking method for femur.@*METHODS@#From January 2017 to January 2019, 90 elderly patients with femoral neck fracture were treated with hip replacement, including 39 males and 51 females, aged 65 to 96(78.0±7.4) years, 56 cases of total hip and 34 cases of hemi hip. According to garden classification, there were 7 cases of typeⅡ, 63 cases of type Ⅲ and 20 cases of type Ⅳ. The patients were divided into three groups according to different measurement methods:contralateral contrast method (group A) of 19 cases, shuck test method (group B) of 28 cases, and "shoulder to shoulder" anatomical marker localization method (Group C) of 43 cases. The accuracy of the three methods was compared by measuring the length difference of lower limbs in vitro and imaging.@*RESULTS@#All patients completed the operation successfully. After total hip arthroplasty, the length of lower limbs in group A was(12.9±8.6) mm, and that in group B was(10.3±4.4) mm. After hemiarthroplasty, the length of lower limbs in group A was (13.2±7.2) mm, group B was (8.7±3.5) mm, and group C was (6.3±2.8) mm; the measurement results of unequal length of lower limbs after total hip arthroplasty were(12.9±8.1) mm in group A, (9.6±4.0) mm in group B and (6.6±2.6) mm in group C. The results of factorial analysis of variance showed that the differences among the three groups were statistically significant (@*CONCLUSION@#The "shoulder to shoulder" anatomic localization marking method can reduce the length of lower limbs simply, effectively and accurately in the elderly patients with femoral neck fracture hip replacement.

[Study on low temperature moisture regain drying characteristics of different grades of Angelicae Sinensis Radix based on Weibull distribution function].

The drying process of different grades of Angelicae Sinensis Radix under low temperature and resurgence conditions was simulated based on the Weibull distribution function,in order to clarify the low-temperature moisture regain drying characteristics of different grades of Angelicae Sinensis Radix,and explore the effect of grade and drying conditions on the drying process of Angelicae Sinensis Radix. Research results indicated that the Weibull function can be used to simulate different grades of Angelicae Sinensis Radix low-temperature moisture regain drying process,and the lower the drying temperature,the smaller the grade,and the better the simulation effect. The grade and drying temperature showed a significant effect on the low-temperature moisture regain drying process of Angelicae Sinensis Radix,and the effect of temperature on the relative moisture regain rate of Angelicae Sinensis Radix was greater than the grade. The relative moisture regain rate of different grades of Angelicae Sinensis Radix at 40 ℃ was higher than 55 ℃,and the relative moisture regain rate at 40 ℃ was first class > second class > third class. After drying,the moisture ratio at 40 ℃ was lower than that at 55 ℃; the effect of the grade on the effective diffusion coefficient of dry water was greater than the temperature. Under different conditions of 40 ℃ and 55 ℃ moisture regain,the effective diffusion coefficient of water was between 2. 941 6×10-6-7. 991 5×10-6 and3. 093 8×10-6-8. 483 8×10-6 for different grades. Under the same temperature conditions,the effective diffusion coefficient of water was first class > second class > third class. Therefore,Weibull function can be used to study and simulate the drying characteristics of different grades of Angelicae Sinensis Radix under low-temperature moisture regain conditions,providing experimental basis for the improvement of traditional drying technology of Angelicae Sinensis Radix and the optimization of drying process of different specifications or grades of Angelicae Sinensis Radix.

miR-762 modulates thyroxine-induced cardiomyocyte hypertrophy by inhibiting Beclin-1.

PURPOSE: Whether autophagy plays a key role in thyroxine-induced cardiomyocyte hypertrophy, and whether the role of autophagy in thyroxine-induced cardiomyocyte hypertrophy is related to targeting of Beclin-1 by miR-762 remains unclear. This research focused on testing these two hypotheses. Importantly, the results of this study will help us better understand the molecular mechanisms of thyroxine-induced cardiomyocyte hypertrophy. METHODS: In vivo and in vitro, RT-PCR, western blot, and dual luciferase reporter assay were performed to understand the molecular mechanism of thyroxine-induced cardiomyocyte hypertrophy. HE staining, Masson staining, transmission electron microscopy, and immunofluorescence were used to observe intuitively changes of hearts and cardiomyocytes. RESULTS: Our results showed that in vivo, serum TT3, TT4, and heart rate were significantly upregulated in the T4 group compared with the control group. Moreover, the surface area of cardiomyocytes was significantly increased in the T4 group, and the structural disorder was accompanied by obvious hyperplasia of collagen fibers. The expression of ANP, and ß-MHC was significantly upregulated in the T4 group. In addition, LC3 II/LC3 I, Beclin-1 and the count of autophagic vacuoles were significantly upregulated, but miR-762 was significantly downregulated in the T4 group compared to the control group. Subsequently, a dual luciferase reporter assay suggested that Beclin-1 was the target gene of miR-762. In vitro, the results for the T3 group were consistent with the results for the T4 group. Furthermore, cardiomyocyte hypertrophy and autophagic activity were attenuated in the T3 + miR-762 mimic group compared with the T3 group. In contrast, cardiomyocyte hypertrophy and autophagic activity were aggravated in the T3 + miR-762 inhibitor group compared with the T3 group. CONCLUSIONS: miR-762 modulates thyroxine-induced cardiomyocyte hypertrophy by inhibiting Beclin-1.

Revision strategy for malunited tibial plateau fracture caused by failure of initial treatment.

OBJECTIVE: The aim of this study was to evaluate our treatment algorithm and results in revision surgery of malunited tibial plateau fracture after failure of initial treatment. METHODS: Our revision strategy was as follows: First, we determined the presence of any infection. Second, we determined whether the patient required total knee arthroplasty (TKA). Third, based on the characteristics of the tibial plateau fracture malunion, patients underwent one of the following surgical methods to achieve reduction: original fracture line osteotomy, tibial tubercle + original fracture line osteotomy, fibula head + original fracture line osteotomy, and metaphyseal open window reduction rod technique. The results was assessed with healing time, Rasmussen score, knee range of motion and complication rates. RESULTS: A total of 25 patients 16 men and 9 women; Mean age: 47.4 years (range: 35-63 years) underwent tibial plateau fracture revision operation. The time interval between the two surgeries was 2-24 months. The follow-up time was 12-30 months, and the operation time was 120-300 min. All patients received bone union at the last follow-up. The healing time was 3-6 months. The postoperative Rasmussen score was 19-29 (mean 23.8) compared with 14.4 points before the operation (p < 0.05). The postoperative knee joint activity was 60-110° (mean 95.0°), compared with 57.8° before the operation (p < 0.05). Six patients still had a 2-mm collapse on the articular surface, and 4 patients still had slight valgus (<5°). Except for 2 TKA cases, fracture reduction was excellent in 15 cases and good in 8 cases, with a good rate of 100%. Superficial wound infections occurred in 3 patients. CONCLUSION: Because revision of tibial plateau fracture malunion caused by failure of initial treatment is difficult, it is necessary to create a detailed surgical plan before the operation. Satisfactory clinical effects can be obtained if the correct revision strategy is used. The key to success is adopting a proper revision strategy according to the unique characteristics of the patient's tibial plateau fracture malunion. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.

[Study on history of processing and drying of Angelicae sinensis].

Angelicae sinensis Radix( ASR) is a commonly used medicinal material in Chinese medicine,widely used in clinical practice of Chinese medicine,Gansu province is the genuine production area of ASR. This paper studies the evolution law of drying method of ASR,the results showed that drying process was the key affection of the medicinal properties and quality of ASR,and it was an important reflection of the authentic properties of ASR. The drying history of ASR has gradually changed from the earliest shade drying to various drying methods. The Chinese Pharmacopoeia stipulates that the drying method of ASR is"fumigation drying",and the traditional drying method can not meet the processing needs of the origin. In recent years,the new drying methods and drying effects on the quality of ASR are more.

SMARCA4-deficient primary thoracic sarcoma:a clinicopathological analysis of five cases / 中华病理学杂志

Objective@#To investigate the clinicopathological characteristics of SMARCA4- deficient thoracic sarcomas.@*Methods@#The clinical features and CT scans of SMARCA4-deficient thoracic sarcomas (n=5) diagnosed at Fudan University Cancer Hospital from December 2016 to October 2018 were reviewed. Hematoxylin-eosin staining, immunohistochemistry and targeted next generation sequencing were performed in available cases along with a literature review.@*Results@#All 5 patients were males with age ranging from 32 to 65 years (average 54 years; median 61 years). Four patients were smokers except one with unknown smoking history. The average maximum diameter of tumor was 5.6 cm. Tumor primary sites included thoracic wall,thoracic cavity,lung and mediastinum. Histologically,tumor cells formed solid sheets or anastomosing islands with brisk mitotic figures accompanying with large areas of necrosis. Three cases focally exhibited rhabdoid morphology and vesicular chromatin. Immunohistochemically, SMARCA4, SMARCA2 and Claudin-4 were negative in all cases and all tumors demonstrated SOX2 and SMARCB1 nuclear positive staining. Among 3 cases analyzed by targeted next generation sequencing, concurrent SMARCA4 and p53 mutation was detected in all three cases. Mutations of STK11, ERBB4, NF2, GNAS, MTOR,MET and FGFR1 amplification were also detected among the three cases. The follow-up information was available in all 5 cases. Two patients died of the tumor. One relapsed multiple times after surgeries but was alive with disease. Two patients received radical excisions without relapse.@*Conclusions@#SMARCA4-deficient thoracic sarcoma is a rare but highly-aggressive tumor with dismal prognosis. The tumor is featured by rhabdoid morphology histologically and distinctive immunohistochemical and molecular phenotype.

Current status and prospect of surgical treatment of liver cancer / 中华外科杂志

With the rapid development of liver surgery,minimally invasive techniques have been widely used in liver surgery. Many challenging liver can be performed laparoscopically to decrease the surgical trauma. At the same time,the efficiency and accuracy of liver surgeries have been highly improved by the advanced assisted technology of liver surgery. The purpose of this article is to summarize the current situation of liver surgery as well as the future of liver surgery.

Reoperation strategy of malunited tibial plateau fracture / 中华骨科杂志

Objective@#To explore the revision strategy of the malunited tibial plateau fracture and to analysis the main points of four common revision operations and the clinical effect.@*Methods@#From January 2012 to December 2016, 18 patients (5 males and 13 females) aged 35-60 years (average 49.7 years) underwent tibial plateau revision surgery in our hospital were collected. The time from the second revision operation to the first operation was 2-24 months (average 10.4 months). Our revision strategies were as follows: Firstly, to determine whether there is an infection or not. If there was infection, we changed the original internal fixation to external fixator to control infection. Secondly, todetermine whether the patient could suffer re-reduction and internal fixation. If the patient was older (>65 years old) or with severe local bone defect, total knee arthroplasty should be performed. Thirdly, patients were divided into four operation modes according to the tibial plateau fracture malunion type: 1. the original fracture line osteotomy; 2. the tibial tubercle + original fracture line osteotomy; 3. tibial metaphyseal window-rod reduction; 4. the osteotomy of fibula head and original fracture line osteotomy.@*Results@#All patients were followed up for 12-30 months (average 16.8 months), and the operation time was 120-300 min (average 185 min). 2 cases were infected before operation and the original internal fixation were removed to instead of external fixator;1 patient underwent total knee arthroplasty; 3 cases were treated with metaphyseal open window-rod reduction and internal fixation; 6 cases were operated with the original fracture line osteotomy and internal fixation; 4 cases were treated with tibial tubercle osteotomy+original fracture line osteotomy and internal fixation; 2 patients underwent fibular head osteotomy+ original fracture line osteotomy and internal fixation. All patients achieved bony union at the last follow-up. The healing time was 3-6 months (mean 3.6 months). The postoperative knee Rasmussen score was 19-29 (average 22.9), compared with average 14.4 points before operation (t=-10.169, P=0.001). The postoperative range of motion of knee joint was 60-110 degrees (mean 94.5 degrees), compared with average 55 degrees before operation (t=-5.773, P=0.001). The post-operative VAS pain score was average 1.1 points, compared with average 4.2 points before operation (t=8.960, P=0.001). Fracture reduction was excellent in 12 cases and good in 5 cases, with the excellent and good rate of 100%. 3 patients still had 2mm collapse on the articular surface, while 3 patients still had mild valgus (less than 5 degrees). There were 2 cases of superficial infection of the wound surface after operation.@*Conclusion@#It was difficult to revise the malunion of tibial plateau fracture and it was necessary to make a detailed operation plan before the operation. Satisfactory clinical effects could be obtained for the patients by correct revision strategy. The key to success was the proper revision strategy which was adopted according to the different characteristics of the tibial plateau fracture malunion of the patients.

Effect of Umbilical Moist-heat Application of Da Chengqitang in Treating Gastrointestinal Motility of AECOPD Combined with Type Ⅱ Respiratory Failure NIV with Abdominal Distension / 中国实验方剂学杂志

Objective: To observe the efficacy of umbilical moist-heat application of modified Da Chengqitang in treating ventosity after noninvasive ventilation, and the regulatory effect on level of gastrointestinal motility hormone. Method: One hundred and sixty patients were randomly divided into control group and observation group by random number table. Patients in control group got mosapride citrate tablets, 5 mg/time, 3 times/days. In addition tothe therapy in control group, patients in observation group was also given mbilical moist-heat application of modified Da Chengqitang, 30 min/time, 2 times/day. And a course of treatment was 7 days. Before and after treatment, degree of abdominal distention was measured by a tape and subjective evaluation. Time of recovery of bowel sounds, remission of abdominal distention, exhausting and defecation, and the total time of using respirator, pressure of using respirator, and the total days of using respirator were recorded. And levels of gastrin (GAS), motilin (MTL), vasoactive intestinal peptide (VIP) and somatostatin (SS) were detected. Result: According to the rank sum test, the clinical effect in observation group was superior to that in control group (Z=2.484, PZ=2.456, PPPPP2, PaCO2, GAS, MTL were higher than those in control group, whereas PaCO2, VIP and SS were lower than those in control group (PPConclusion: Umbilical moist-heat application of modified Da Chengqitang can relieve abdominal distention and dyspnea, reduce intraperitoneal pressure, improve the recovery of gastrointestinal function, and regulate gastrointestinal hormone level.