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【Objective】 To evaluate the clinical efficacy of utilizing auxiliary steel plates in conjunction with autologous platelet-rich plasma (PRP) therapy for the treatment of bone non-union following intramedullary fixation of long shaft fractures in the limbs. 【Methods】 From January 2020 to September 2022, 33 patients with non union after intramedullary fixation of long shaft fractures of the limbs admitted to the orthopedic trauma ward of the 960th Hospital of the PLA Jonit Logistics Support Force were selected as the research subjects, including 28 males and 5 females.The age range was 22 to 55 years, with an average of (37.2±6.7) years. The patients were divided into the experimental group (n=15) and the control group (n=18) in order of admission. All patients retained intramedullary fixation, and the fracture end was fixed with reconstruction steel plates. According to the random number table method, 15 cases in the experimental group were treated with autologous iliac bone transplantation combined with intraoperative and postoperative autologous PRP. The activated autologous PRP was fully fused with the patient′s autologous iliac bone during surgery and transplanted to the bone defect site.Ultrasound guidance was used to accurately locate the location. Autologous PRP was injected 10 mL/(person) occasion on the 14 th and 28 th day after surgery respectively. Eighteen cases in the control group received the treatment of autologous iliac bone transplantation at the bone defect site only. The clinical healing status of fractures between the two groups of patients were observed and compared. 【Results】 All 33 patients were followed up for a complete period of 9 to 30 months, with an average of (11.8±2.7) months. Compared with the control group, the clinical fracture healing time (months) was 5.25±1.18 vs 7.27±1.38 (P<0.05); The healing rate was 93.3%(14/15)vs 61.1%(11/18) (P<0.05). 【Conclusion】 The combination of intraoperative and postoperative use of autologous PRP and auxiliary steel plates could promote the healing of bone non union after intramedullary fixation of long shaft fractures in the limbs, which is beneficial for early functional exercise of patients.
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ObjectiveTo determine the death level, change trend and life loss of pancreatic cancer among residents in Yuyao, and to provide scientific reference for the prevention and control of pancreatic cancer. MethodsThe death monitoring data of registered residents in Yuyao from 2014 to 2021 were collected to calculate crude mortality rate(CMR), standardized mortality rate (SMR), potential years of life lost (PYLL), average years of life lost (AYLL), PYLL rate (PYLLR), average annual percent change (AAPC) and other indicators. ResultsFrom 2014 to 2021, 860 cases of pancreatic cancer died in Yuyao, accounting for 6.25% of all malignant tumor deaths in the same period. The average annual mortality rate was 12.86/100 000, the age-standardized rate by Chinese standard population (ASRC) was 7.08/100 000, and the age-standardized rate by world Segi’s population (ASRW) was 5.17/100 1000. The CMR showed an upward trend in eight years (t=-5.076, P=0.002). 493 men died of pancreatic cancer with an average annual mortality of 14.95/100 000, ASRC of 8.13/100 000, and ASRW was of 6.24/100 000. 367 women died of pancreatic cancer with an average annual mortality rate of 10.82/100 000, ASRC of 6.02/100 000, and ASRW of 4.14/100 000. The mortality rate of men was higher than that of women (χ2=22.191, P<0.001). The minimum death age of pancreatic cancer is 27.52 years old, the maximum death age is 94.52 years old, and median age (Q1, Q2) of death was [71.13(63.21, 78.87)] years old. The death age of men [69.61(62.30, 77.06)] was less than that of women [72.48(64.63, 81.09)] (t=-3.820, P<0.001). The mortality rate of pancreatic cancer showed an upward trend with age (χ2trend=1 110.844, P<0.001), and the 75 year old mortality rate (75.58/100 000) fell after reaching the peak. PYLL caused by death of pancreatic cancer in 8 years was 9 775.00 person years, AYLL was 14.33 person years, and PYLLR was1.53‰. ConclusionPancreatic cancer is an important cause of death for residents in Yuyao, which has a huge loss of life. It is necessary to formulate targeted prevention and control strategies, with the middle-aged and elderly as the key population, to reduce the incidence and death of pancreatic cancer.
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Objective:To investigate the combination of internal fixation for periprosthetic fractures of the proximal femur (PFFF) after hip arthroplasty.Methods:The data of 58 patients with periprosthetic fractures after hip arthroplasty from May 2008 to March 2022 were retrospectively analyzed, including 31 males and 27 females. The average age was 75.5±18.2 years (range, 35-95 years). There were 39 total hip arthroplasty and 19 hemiarthroplasty; 37 biological prosthesis and 21 cemented prosthesis. Intraoperative periprosthetic fractures occurred in 6 cases and 52 cases postoperatively. Unified classification system (UCS): UCS IV.3A1 type 2 cases, 3A2 type 1 case, 3B1.1 type 19 cases, 3B2.1 type 25 cases, 3B3 type 2 cases, 3C type 9 cases. Fracture site: 3 cases in zone A (greater trochanter), 46 cases in zone B (around the femoral stem), and 9 cases in zone C (distal to the tip of the femoral stem. Internal fixation is composed of primary and secondary fixation, the main fixation method was the cerclage of steel wire or titanium cable, locking compression plate, and locking attachment plate fixation. The secondary fixation method was the cerclage of titanium cable, which was required to cover three zones A, B and C to form an overall balanced fixation. The modified Harris hip scores (mHHS), plate length, working length and screw number of different internal fixation combinations were compared.Results:The follow-up time was 54.2±21.6 months (range, 11-86 months). All patients showed signs of fracture healing at 10.2±1.5 weeks (range, 7-13 weeks) after operation, and bony union was observed at 19.6±1.3 weeks (range, 17-22 weeks) after operation. No delayed union or nonunion was observed. After operation, one case had a stress fracture and was revised with double-plate internal fixation; one case had a failed internal fixation and was revised with double-plate internal fixation and a large allograft bone graft. The mHHS score of UCSIV.3B2.1 group (80.3±4.6) was the lowest at 6 months after operation, and the difference between the groups of different types was statistically significant ( F=256.72, P<0.001). The score of simple internal fixation group (91.6±4.2) was higher than that of revision combined with internal fixation group (81.9±4.1), and the difference was statistically significant ( t=8.32, P<0.001). The plate length and working length were 24.9±2.5 cm and 12.6±1.7 cm for UCS IV.3B1.1, 25.4±2.6 cm and 13.6±1.8 cm for 3B2.1 and 28.1±2.5 cm and 4.9±1.9 cm for 3C, respectively ( F=5.33, P=0.005; F=6.78, P<0.001). The number of screws in zone A was significant difference among different UCS types ( F=52.67, P<0.001); UCS IV.3B1.1 (6.5±2.3) and 3B2.1 (6.7±2.2) were more than 3B3 (3.5±1.5) and 3C (3.7±1.6). The number of screws in zone B was significant difference among different UCS types ( F=42.15, P<0.001); The number of UCS IV.3B1.1 (2.3±1.6) and 3B2.1 (2.8±1.9) were significantly more than that of 3B3 (1.0±0.5) and 3C (1.2±0.6). The number of screws in zone C was significant differences among different UCS types ( F=39.62, P<0.001); The number of UCS IV.3B1.1 (3.8±1.9) and 3B2.1 (3.9±1.7) were more than that of 3B3 (2.0±0.5), the difference was statistically significant ( P<0.05). Conclusion:The function of hip after simple internal fixation of proximal femoral periprosthetic fractures was better than that of those who underwent revision at the same time; the number of screws of UCSIV.B1 and B2 is more than that of B3.
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Objective:To explore whether CD5 + CD19 + B cells has the function of secreteing interleukin-10 (IL-10) in vitro, and to further investigate its possible effects and mechanisms on CD8 + cells in the process of hepatitis B virus (HBV) infection. Methods:From July 2017 to June 2018, at Wuxi Second People′s Hospital Affiliated to Nanjing Medical University, 23 patients with chronic hepatitis B (chronic hepatitis B group), 18 patients with liver cirrhosis (liver cirrhosis group) and 19 healthy individuals in the same period as healthy controls (healthy control group) were enrolled. Peripheral blood mononuclear cell (PBMC) were isolated and cultured. CD5 + CD19 + B cells were isolated. The cells were analyzed by flow cytometry. The ratio of high CD5 + CD19 + B cells content (>6 % of lymphocytes), the secretion of IL-10 by CD5 + CD19 + B and the ratio of high IL-10 + cells content (>4 % of lymphocytes) of three groups were compared. The effects and possible mechanisms of CD5 + CD19 + B cells on the secreting of interferon-γ (IFN-γ) by CD8 + cells were analyzed. Liver biopsy and immunohistochemistry examination were conducted in 18 patients (13 patients with chronic hepatitis B and 5 patients with liver cirrhosis) and the expression of CD5 + CD19 + B cells in human liver tissues was analyzed. Chi square test and Fisher exact probability test were used for statistical analysis. Results:The ratio of high CD5 + CD19 + B cells content of liver cirrhosis group was higher than that of healthy control group (8/18 vs. 2/19) and the difference was statistically significant (Fisher exact probability test, P=0.029). The precentage of CD5 + CD19 + B cells in healthy control group ( n=10), chronic hepatitis B group ( n=23) and liver cirrhosis group ( n=18) accounted for 81.6%, 82.3% and 70.1%of IL-10 + cells, respectively, and the number of patients with high IL-10 + cells precentage was 2, 7 and 2, respectively. There were no statistically significant differences among three groups (all P>0.05). After stimulated with lipopolysaccharide and cultured for 48 hours, the precentage of CD8 + IFN-γ + cells in lymphocytes of healthy control group ( n=10), chronic hepatitis B group ( n=10) and liver cirrhosis group ( n=10) were compared, and the differences were not statistically significant (all P>0.05). After CD5 + CD19 + B cells were eliminated, the precentage of CD8 + IFN-γ + cells in lymphocytes increased in 5, 4 and 4 patients of healthy control group ( n=10), chronic hepatitis B group ( n=10) and liver cirrhosis group ( n=10). After adding IL-10 receptor blocker, the precentage of CD8 + IFN-γ + cells in lymphocytes in PBMC increased compared with that before the addition of IL-10 receptor blocker (7.23% vs. 6.87%). The results of immunohistochemistry examination of liver biopsy indicated that CD4 + and CD8 + cells were strong expressed in portal area of liver tissue of patients, while CD5 + and CD19 + were less expressed. Conclusions:CD5 + CD19 + B cells do not show obvious quantitative and functional differences in the process of chronic HBV infection, however the ability of CD8 + cells to secrete IFN-γ, which may be achieved by secreting IL-10 rather than by direct contact between cells.
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Objective@#To analyze Internet behaviors of children and adolescents and their influencing factors, and to provide scientific basis for health education guidance and prevention measures.@*Methods@#A stratified cluster sampling method was used. From January to June 2019, 30 955 primary school students in 16 provinces (municipalities), from eastern, central, and western economic zones of China were selected to conduct a questionnaire survey, regarding general demographics, diet and exercise, tobacco, alcohol and sleep, Internet and electronics usage, etc.@*Results@#Among them, 43.1% of students had never been online with girls (44.7%) higher than boys (41.8%)(χ2=21.04, P<0.01); 1.3% of students reported online time for more than 4 hours a day, boys were significantly higher than girls(χ2=15.87, P<0.01); Internet addiction was detected in 2.4% of elementary school students, with boys (3.0%) higher than girls(1.7%)(χ2=331.77, P<0.01), and the trend increases with grade. With sixth grade (3.3%) were significantly higher than children from the first grade (0.8%) and other grades(χ2=163.96, P<0.01). Children’s tendency to Internet addiction was 11.9%, of which boys were 13.0% and girls were 10.6%, boys were significantly higher than girls(χ2=117.66, P<0.01). Pearson correlation analysis revealed that, after controlling gender age, boarding school, family relationship, single parents and regrouped families, smoking, drinking sugary drinks, eating fried foods, and left-behind were positively related to Intenet addiction(r=0.06, 0.07, 0.27, 0.44, 0.07, 0.11, 0.09, P<0.01), while medium and high intensity sports, effective physical education, health education in school, AIDS education and parental restrictions on TV and computer games, were negatively associated with internet addiction(r=-0.74, -0.65, -0.04, -0.05, -0.63, P<0.01).@*Conclusion@#The internet addiction of Chinese primary school students is common and increases by year. High-intensity, high-density sports, effective physical education, and health education could help prevent Internet addiction among children.
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Objective@#The aim of this study is to investigate the effect of G9a inhibitor BIX-01294 on attenuating cell proliferation in human lung adenocarcinoma A549 cell line and the underlying molecular mechanism.@*Methods@#Treated with BIX-01294, the growth and proliferation of A549 cells were detected by MTT assay and colony formation assay, and its impact on cell apoptosis was analyzed using flow cytometry. By Western blot, we explored the alterations in the expression of apoptosis-related proteins and the G9a catalysate, H3K9me and H3K9me2. In addition, in the pretreatment with caspase inhibitor Z-VAD-FMK, we detected the apoptotic dependence of BIX-01294 attenuating impact on A549 cell proliferation.@*Results@#Compared with the control group, the histone methyltransferase G9a inhibitor BIX-01294 attenuated cell proliferation in A549 cells in a dose- and time-dependent manner. There were 42.5±8.7 colonies after BIX-01294 (10 μmol/L) treatment for 7 days, while 172.7±23.0 colonies in the control group, with a statistical significance (P<0.05). After treatment with BIX-01294 (10 μmol/L) for 24 hours, the cell apoptotic rate was(47.6±8.4)%, with a significant difference in comparison with the control group [(7.2±3.6)%, P<0.05]. The expression of G9a catalysate, H3K9me and H3K9me2 was downregulated, the same with anti-apoptotic protein Bcl-2, while the proteins in mitochondrial apoptosis pathway, Bax, Bak and cleaved caspase-9, were upregulated, so was the expression of cleaved caspase-3 and cleaved PARP, and there was no alteration in the expression of cleaved caspase-8, which is a protein related with death receptor apoptosis pathway. Furthermore, after Z-VAD-FMK pretreatment, the cell apoptotic rate was decreased significantly, and the expression of apoptosis-related proteins were downregulated.@*Conclusions@#Our results indicate that BIX-01294 can attenuate cell proliferation in lung adenocarcinoma, and it can be considered as one of the underlying mechanisms, the apoptosis may be induced by activating mitochondrial pathway.
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Objective To evaluate the clinical outcomes of periprosthetic femoral fractures (PFF) following hip arthroplasty utilizing locking compression plates (LCP) in regard to tips and tricks on the construction of LCP augmented with locking attachment plate (LAP) and titanium cables (TC).Methods A total of 41 cases of PFF follow hip arthroplasty (THA 3,Hemi-arthroplasty 2) between May 2008 to April 2016 have been retrospectively analyzed.There were 13 males and 28 females with an average age of 70.5±8.6 years,including 11 case of Unified Classification System (UCS) type Ⅳ.3B1.1,21 cases of B2.1 and 9 cases of type C.All were closed fractures caused by simple fall in terms of low-energy injury.Surgical options depended on individual configuration of the fractures with the combination of LCP and LAP or TC.In respect of reduction techniques,minimally invasive plate osteosynthesis (MIPO) was used in 5 cases for type B1.1 and 8 cases for type C,Mini-open in 6 cases for type B1.1 and 1 case for type C.Posterolateral approach with open reduction internal fixation were selected for type B2.1.The patients were followed up periodically.Harris score,Mukundan criteria and complications were recorded.Results Five cases died of the comorbidities (heart failure 3,pulmonary infection 1,multiple organs failure 1) within 1 year postoperatively.The follow-up rate was 78.0% (32 out of 41 cases) and the average follow-up time was 41 months (ranging 11 to 71 months).No malunion,no reduction lost,no hardware failure,no hip dislocation and revision surgery following PFF care found.All cases showed the signs of fracture healing from 8 to 12 (average 10 weeks) postoperatively except 2 cases of delay union.The postoperative complications shown in 11 cases,including 2 cases of superficial infection of the wound,6 cases of deep vein thrombosis (popliteal vein 2,intramural gastrocnemius vein 4) and 3 cases of the prosthetic loosening.Harris score at the latest follow-up were 91.5±2.1 for group B1.1,77.5±4.2 for group B2.1 and 83.5±3.8 for group C.The LCP lengths were 248.9±24.3 mm,258.6±25.2 mm,280.4±24.0 mm for group B1.1,B2.1 and C respectively.The LCP length of group B1.1 was short than that of group C (P<0.05).The screw numbers for the proximal fragments were 6.1±1.8,6.5±0.7 and 3.8±0.7 for group B1.1,B2.1 and C respectively.The number of screws used in B1.1 and B2.1 were more than that in C (P<0.05).The screw numbers for the distal fragments were 3.5±0.5,3.9±0.5 and 5.1±0.8 for group B1.1,B2.1 and C respectively,indicating less screws used in B1.1 and B2.1 than that in C (P<0.05).The cable numbers were 1.9±1.3,2.5±0.9 and 3.7±0.7 respectively for group B1.1,B2.1 and C (P<0.05).The LAP used in 2,12 and 6 cases for type B 1.1,B2.1 and C respectively without significant difference statistically (P>0.05).Conclusion Utilizing LCP for PFF following hip arthroplasty can achieve satisfactory short and mid-term clinical outcomes with the prerequisites of precise and individualized preoperative planning.LCP augmented by LAP and TC is a reliable option with low complication rate.However,type C PFF needs longer plate with more screws at distal fragment and more titanium cables.
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Objective To evaluate the diagnostic performance of the histogram analysis of mono-exponential and intravoxel incoherent motion(IVIM) models to the dualistic model of epithelial ovarian cancer(EOC). Methods Forty female patients with histopathologically proven epithelial ovarian cancer underwent preoperative MR examination. Scanning sequences included conventional imaging, diffusion-weighted magnetic resonance imaging with 11 b values (0, 30, 50, 100, 150, 200, 400, 600, 800, 1 000, 1 500 s/mm2) and dynamic contrast enhanced MRI (DCE-MRI). Based on the dualistic model of EOC, all patients were divided into two groups:typeⅠ(low grade, n=16) and typeⅡ(high grade, n=24). ADC, D, D*and f maps and their corresponding histograms were generated by post-processing software. Based on an entire-tumour measurement, the following histogram parameters were recorded, respectively: (a) Mean; (b) the 10th percentile (10th);(c) the mean of the top 10 percent (MeanL);(d) the 90th percentile (90th);(e) the mean of the bottom 10 percent (MeanR). Two types were compared using independent sample t test or Mann-Whitney U test. And areas under ROC curve between two groups were assessed. Results For ADC , D, and f, all indices(Mean,10th,MeanL,90th,MeanR) of the histogram were significantly lower in typeⅡthan in type Ⅰ(P0.05). D demonstrated a comparable accuracy with ADC in differentiating the grade of EOC (area under curve: Mean, 0.898 vs. 0.893; 10th, 0.880 vs. 0.846; MeanL, 0.878 vs. 0.858; 90th, 0.895 vs. 0.839; MeanR, 0.872 vs. 0.814), and both ADC and D have better performance than f. Conclusion It is feasible to stratify the grade of EOC by mono-exponential and IVIM models with histogram metrics,diagnositic efficiency of ADC and D values are higher.
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Objective To evaluate the diagnostic performance of multi ? b value DWI to differentiate pancreatic adenocarcinoma from healthy pancreas using the apparent diffusion coefficient (ADC) and parameters derived from the intravoxel incoherent motion (IVIM) theory. Methods Forty?eight patients with histopathologically proven pancreatic adenocarcinoma and fifty patients with healthy pancreas were examined at 3.0 Tesla using a single?shot echo?planar imaging DWI pulse sequence. Eight b?values ranging from 0 to 1 000 s/mm2 were used. ADC, diffusion coefficient (D), perfusion?related diffusion (D*) and perfusion fraction (f) were compared between pancreatic adenocarcinoma and healthy pancreas, t test or Mann?Whitney U test was used to compare the MRI parameters, ROC was used to evaluate the diagnostic efficiency. Results In comparison to healthy pancreatic tissue, a significant reduction of the ADC, D*and f was found in pancreatic adenocarcinoma [healthy pancreatic tissue:(1.68±0.31)×10-3mm2/s, 27.10×10-3mm2/s, (36.92±12.47)%;pancreatic adenocarcinoma:(1.51±0.37)×10-3mm2/s, 13.90×10-3mm2/s, (30.06±19.84)%] (P0.05). In the ROC?analyses, the area under curve for D* was the largest (0.727), followed by f and ADC in order (0.680 and 0.669). Conclusion Using the IVIM DWI approach, the D*, f and ADC value are useful for differentiating pancreatic adenocarcinoma from healthy pancreatic tissue.
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To establish a method for the simultaneous determination of the active ingredients ( codeine phosphate, brompheniramine maleate, chlorpheniramine maleate, ephedrine hydrochloride and guaifenesin) in compound codeine phosphate oral preparations by capillary electrophoresis ( CE) . Methods:The method employed an uncoated capillary column ( eCAPTM ) from Beck-mann company (50 cm × 75 μm);the electrophoresis voltage was at 10 kV;20 mmol·L-1 phosphate buffer solution (pH 7. 5) was used;the UV measurement was at the wavelength of 214 nm. Results: The studied components had good linear ranges (r≥0. 995) within the range of the investigated concentrations. The recovery was no less than 96%. Conclusion:The presented method can be ap-plied in the content determination of active ingredients in compound codeine phosphate oral preparations from different enterprises. It is simple, efficient and universal, which facilitates the market supervision in a fast and valid manner.
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Objective To investigate the value of intravoxel incoherent motion (IVIM) model of diffusion weighted MRI in assessing grades and enhancement patten of uterine cervical cancer. Methods Thirty one patients with pathologically proven cervical cancer, who underwent MRI scan preoperatively, were analyzed retrospectively and were divided into 3 groups according to their pathological grading of cacer, including 6 with G1 cancer, 17 with G2 and 8 with G3. The diameter of each lesion was≥1 cm. 10 b values (0, 30, 50, 100, 150, 200, 400, 800, 1 000, 1 500 s/mm2) were used in DWI, and DCE-MRI was performed with a time resolution of 9.8 s. Parameters of DWI (ADC, D, f, D*) and semiquantitative parameters of DCE-MRI (Slop, Maxslop, CER, Washout, AUC90) were measured. One-way ANOVA analysis of variance and Pearson correlation were used to analyze normally distributed continuous data. Kruskal-Wallis H test and Spearman correlation were used to analyze abnormally distributed continuous data. Tumor volume and all of the MRI parameters were compared as well as correlated with pathological grading.The perfusion parameters derived from IVIM were correlated with those derived from dynamic enhanced MR imaging. The sensitivity and specificity of f value to to diagnose G3 cervical cancer and the best cutoff were calculated from areas under the ROC curves.Results Tumor volume of G1,G2 and G3 cancers were(33.8±31.1),(19.6±16.9)and(31.2±29.1)cm3(F=1.147,P=0.332), respectively.ADC values of the three groups were(1.03 ± 0.11)× 10-3,(1.00 ± 0.10)× 10-3 and(0.90 ± 0.05)× 10-3mm2/s,respectively(F=4.619,P=0.018).D values of the three groups were (0.80 ± 0.11) × 10-3, (0.77 ± 0.06) × 10-3and (0.69 ± 0.06) × 10-3mm2/s ,respectively(F=5.272, P=0.011).f values of the three groups were 0.20±0.02, 0.22±0.03 and 0.24± 0.03, respectively (F=3.524, P=0.043).All of the others were of no significant difference (P>0.05).Both ADC and D correlated negatively with tumor grading (r=-0.464 and-0.493, P=0.009 and 0.005, respectively). f value correlated positively with tumor grading (r=0.436, P=0.014).Areas of ADC, D and f value under ROC curves to diagnose G3 cancers were 0.179, 0.147 and 0.690, respectively. While the cut-off value of f was 0.22, the diagnostic performance for G3 cancer was with a sensitivity of 75.0% (6/8) and a specificity of 60.9% (14/23). The value of f had weak positive correlations with Slop, Maxslop, CER and AUC90 of semiquantitative analysis of DCE-MRI (r=0.319, 0.337, 0.293 and 0.344, respectively, P<0.01). Conclusion IVIM model of multi-b value DWI may provide information in the assessment of differentiation and en hancement pattern of cervical cancer.
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Objective To investigate the efficacy and safety of treatment of urethral complete broken injury with double ureteroscopic urethral realignment.Methods A clinical data of 26 cases of urethral complete broken injury who had underwent double ureteroscopic urethral realignment were retrospectively analyzed.Results The patients were confirmed by urinary tract imaging for urethral complete broken injury.The catheters were inserted successfully into bladders and removed at 6 weeks after operations.The operative time was 25-53 (39.0 ± 12.4) min.Twenty patients gained fluent urination after removal of catheter,with maximum urine flow 17-28 ml/s after 6 weeks.Six cases had urethral stricture.Among them,2 cases received urethral expansion,3 cases received transurethral cold knife incision,and 1 case received urethral anastomosis.All of them gained fluent urination.Conclusion Treatment of urethral complete broken injury with double ureteroscopic urethral realignment is feasible,superior and reproducible.
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Objective To discuss the clinical efficacy of internal fixation assisted by thoracoscope in treatment of rib fractures.Methods The study enrolled 180 patients with rib fractures associated with thoracic deformity hospitalized from July 2010 to June 2013.Ninety out of the patients were operated on by thoracoscope-assisted internal fixation (operation group),and the remaining 90 fractures were treated non-operatively (non-operation group).Clinical markers recorded were duration of pain,time of ventilator use,hospital length of stay and complications.Patient mental health was measured with self esteem scale (SES).Patient mobility was evaluated at follow-up.Results Between operation and non-operation groups differences were observed in duration of pain [(3.1 ± 1.0)d vs (8.9 ± 1.2) d],time of ventilator use [(3.0 ± 1.0) d vs (4.8 ± 1.0) d] and hospital length of stay [(10.0 ± 1.1) d vs (15.8 ± 1.0) d] (P < 0.01).SES in operation group was (28.3 ± 2.1) versus (24.4 ± 3.3) points in non-operation group (P < 0.01).No major complications occurred in operation group,but there were 20 pleural effusion,15 severe thoracic collapse or deformity,14 lung infection,10 refractory chest pain and 2 upper limb dysfunction in non-operation group (P <0.01).Two patients presented mobility limitation in operation group,but 12 had evident loss of mobility in non-operation group (P <0.01).Conclusions Thoracoscope-assisted internal fixation is effective to accelerate the pace of recovery,relieve pains,reduce complications and thus can be a priority method for treatment of rib fractures.
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AIM: This work aims to design a modified Fraser's classification and report the clinical outcomes of a series of 28 floating knees. METHODS: Between January 2006 and December 2009, 31 consecutive patients with 31 floating knees were treated at the Affiliated Hospital of Nantong University. In total, 28 cases were available for analysis. The floating knees were classified based on a modified Fraser's classification. Twelve cases were temporarily stabilised by an external fixator. Definitive fixation was performed for tibia and femur fractures using either nailing or plating. Functional outcomes were assessed according to the criteria established by Kalstrom and Olerud. The patients were followed up for a mean of 29 months (range, 12-60 months). RESULTS: The floating knees were classified as three types: type I, extra-articular fracture; type II, articular surface involved; and type III, patella involved. Type II injuries were subdivided into type IIA injury (articular simple) and type IIB injury (articular complex). According to the modified classification, there were 11 cases of type I, 2 cases of type IIA, 8 cases of type IIB and 7 cases of type III injury. Complications were found in seven cases, including three cases of infection, two cases of knee instability and two cases of knee stiffness. The functional outcomes were 7 excellent, 13 good, 5 acceptable and 3 poor. The excellent or good rate was 91% (10/11) in type I, 100% (2/2) in type IIA, 63% (5/8) in type IIB and 43% (3/7) in type III injuries. CONCLUSION: The modified Fraser's classification provides a more reliable basis for surgeons to monitor results and compare treatment results with other surgeons. According to the modified classification, the results of type IIA injury appeared to be comparable to those of type I injury. Type IIB and type III injuries represent the fracture types with the worst prognosis.
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Fracture Fixation/methods , Fractures, Bone/classification , Knee Injuries/classification , Knee Injuries/surgery , Adolescent , Adult , Aged , Aged, 80 and over , Bone Nails , Bone Plates , External Fixators , Female , Fractures, Bone/surgery , Humans , Joint Instability/surgery , Male , Middle Aged , Retrospective Studies , Treatment Outcome , Young AdultABSTRACT
Objective To compare three different internal fixations using dual plates in treatment of type C distal humerus fractures.Methods A total of 59 patients with type C distal humerus fractures fixed with dual plates between January 2004 and December 2008 were enrolled in the study,including 34 patients managed by perpendicular dual plate internal fixation (Group A),14 patients by dorsal dual plate internal fixation (Group B),and 11 patients by parallel dual plate internal fixation (Group C).Functional outcomes of injured elbow joints were assessed using Mayo elbow performance score (MEPS).Fisher' s exact probability,chi-square test and variance analysis were used to compare the perioperative variables among groups.Results The patients were followed up for average 28 months (range,12-55 months),which showed that all fractures were smoothly healed with satisfactory curative effects in each group.There were no significant differences with respect to functional outcomes among three groups.The patients with surgery difficulty in Group C were more than those in other two groups.Besides,an additional intercondylar screw was always required in Groups A and B,but rarely in Group C.Conclusions All internal fixations with three dual plates are effective in management of type C distal humeral fractures.The location of plates is determined by experiences of orthopedic surgeons and specific fracture type.
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Objective To compare the clinical effect between retropubic extraperitoneal laparoscopic prostatectomy with prostatic urethra preservation and transurethral resection of the prostate (TURP) for giant benign prostatic hyperplasia (BPH).MethodsThe clinical data and follow-up of 128 cases of giant BPH were analyzed retrospectively.Seventy-two cases underwent TURP (TURP group) and 56 cases underwent retropubic extraperitoneal laparoscopic prostatectomy with prostatic urethra preservation ( laparoscopic group ).The operation time,blood loss,gland mass excision,bladder washing time,catheterization time,hospital stay,hospital cost,international prostate symptoms score (IPSS) and quality of life questionnaires (QOL),maximum flow rate (MFR),residual urine volume (RUV) were compared between two groups.ResultsThe bladder washing time,catheterization time,hospital stay in laparoscopic group were less than those in TURP group[0 d vs.(2.8 ± 1.2) d,(2.3 ± 0.6) d vs.(5.2 ± 1.5) d,(4.2 ± 0.5) d vs.(7.5 ±0.5) d],gland mass excision in laparoscopic group was more than that in TURP group [(100.2 ±25.4) g vs.(85.6 ± 15.5) g],there were significant differences between two groups(P< 0.05).There was no significant difference in the operation time,blood loss,hospital cost between two groups (P > 0.05).There were significant differences in IPSS,QOL,RUV and MRF before and after 3,6 months treatment for two groups [ laparoscopic group:(9.1 ± 3.4),(7.5 ± 2.5 ) scores vs.(27.5 ± 5.8) scores,( 1.8 ± 1.1 ),( 1.6 ± 0.8)scores vs. (5.5 t0.5) scores,(26.5 ± 11.5),(22.4 ± 12.6) ml vs. (145.0 ±48.0) ml,(17.6 ±8.4),(20.2 ± 5.4) ml/s vs.(8.3 ± 3.5) ml/s;TURP group:(9.2 ± 3.8),(7.8 ± 2.2) scores vs.(28.5 ± 5.4) scores,( 1.9 ± 1.2),( 1.7 ± 0.6) scores vs.(5.0 ± 0.5 ) scores,(28.5 ± 12.9),(23.0 ± 11.7) ml vs. ( 155.0 ± 47.0) ml,( 17.8 ± 9.2),( 19.8 ± 4.5 ) ml/s vs.(7.2 ± 3.2 ) ml/s ] (P < 0.01 ),but there was no significant difference between two groups (P > 0.05).ConclusionsThe clinical effect of two microtrauma surgery are good.Laparoscopic technique is a feasible treatment option for patients suffered from giant BPH for which has the benefit of a quicker recovery,shorter hospital stay,less complications,no bladder washing.
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ObjectiveTo investigate the inhibitory effects and related toxicity of all-trans-retinoic acid(ATRA) combined with arsenic trioxide(As2O3) on transplanted human bladder neoplasms in nude mice.MethodsThe subcutaneously transplanted tumor models of human bladder neoplasms in nude mice were established and then it was randomly divided into four teams: Saline group, ATRA group, As2 O3 group and the combination of ATRA and As2 O3 group.Each group composed of 10 nude mice and received intratumor injection in the following 14 d.The tumor growth inhibitory rate was calculated.The pathological changes of tumor,cardiac, liver, and kidney were observed after H.E.staining.The expression of MVD (Marked with CD43) and VEGF were detected by SP of immunohistochemistry.Blood routine examination and hepatic and nephritic functional examination was carried out to evaluate the side-effects.Results The tumor growth was significantly suppressed in ATRA group(inhibitory rate was 41.82%) and As2O3 group (inhibitory rate was 43.77%) compared with saline group.When ATRA combined with As2O3 ,inhibitory effects were improved(inhibitory rate was 68.55%).The difference of growth inhibitory rate between each group was obviously significant(x2 =26.81, P <0.01).There was less expression of MVD (Marked with CD43) and VEGF in ATRA group and As2 O3 group and the combination group compared with saline group (ODVEGF = 19.23 + 2.32,20.72 + 2.01,17.16 ± 1.59,27.33 ± 2.17, respectively; ODMVD = 44.77 + 8.25,43.39 + 7.41, 30.56 + 7.71,141.12 + 8.38, respectively), and the suppressed effect in the combination group was most significant (t = 3.16,3.08,3.37, P < 0.01).WBC inhibition was seen in ATRA group and As2O3 group and the combination group, but no significantly difference among them(P >0.05).Hepatic and nephritic toxicity were not found.ConclusionsCombination of ATRA and .As2O3 had obvious synergistic effects on transplantéd tumor of human bladder neoplasm in nude mice, and moderate white blood cell inhibition and no hepatic or nephritic toxicity.
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Objective To investigate the expression and significance of Matriptase and HAI-1 protein in prostate cancer (CaP). Methods Specimens of 46 prostate cancers,20 benign prostate hyperplasias (BPH),10 high-grade intraepithelial neoplasias (PIN),and 10 normal prostates (NP) were used. Expressions of Matriptase and HAI-1 proteins in specimens were detected by SP of immunohistochemistry. The results were analyzed in relation to the clinicopathological data. Results The protein levels of Matriptase in CaP tissues were significantly higher than PIN tissues(Z=-2.150,P=0.032),and the expression of matriptase in CaP and PIN was higher than that in BPH and NP (Z=-3.270,P=0.001;Z=-2.817,P=0.005). No statistically significant difference was observed between BPH and NP group (Z=-0.895,P=0.325). A progressive increase in the protein levels of Matriptase was observed with increasing tumor grade (rs=0.583,P<0.01) and clinical stages(rs=0.611,P<0.01)in CaP specimens. The protein levels of HAI-1 in BPH and NP tissues were significantly higher than CaP and PIN tissues(Z=-3.277,-3.315,P<0.01),the levels of HAI-1 in PIN were higher than CaP (Z=-2.310,P=0.020). No statistically significant difference was found between BPH and NP (Z=-0.872,P=0.330). A progressive decrease in the protein levels of HAI-1 was observed with increasing tumor grades(rs=-0.634,P<0.01) and clinical stages(rs=-0.521,P<0.01). The expressions of Matriptase and HAI-1 in CaP tissues showed negative correlations(rs=-0.712,-0.560,-0.465,respectively,P<0.01). Conclusions The abnormal expressions of Matriptase and HAI-1 proteins may be important events during the progression of CaP in humans. Matriptase and HAI-1 Protein may be used as parameters for assessing the malignancy and prognosis of CaP.
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Objective To discuss the main causes, necessity and strategy of reoperation in patients with differentiated thyroid cancer. Methods The clinical data of 124 patients with thyroid cancer who needed reoperation from 2000 to 2010 were analyzed retrospectively. Results In the 124 patients with thyroid cancer required for reoperation, 75 cases were misdiagnosed as benign thyroid tumor and previously received local nodulectomy or subtotal lobectomy, in which the extent of resection was not enough; in 39 cases, the first time surgical modality were unsuitable, of which 27 cases with cervical lymph node metastasis were not performed cervical lymph node dissection, and 12 cases with cervical lymph node metastasis cancer were only performed lymph node biopsy, and the diagnosis of thyroid cancer was ignored. 10 cases suffered reoperation because of failure to diagnosis thyroid cancer by quick pathologic diagnosis. The rate of residual cancer was 50% (62/124) by final pathologic diagnosis,and the rate of complication was 4.03% (5/124). Conclusion Misdiagnosis of thyroid cancer as benign thyroid tumor is the main cause of reoperation. Reoperation is necessary for those patients who received nonstandardized operation. The key points of avoiding reoperation are to improve cognitive level of operator for thyroid cancer, to emphasize the routine application of quick pathologic diagnosis during operation of thyroid and select the best suitable surgical modality.
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This paper focused on the brain magnetic resonance (MR) images, which is one of the key problems in image processing. A novel segmentation method based on watershed transform and wavelets transform is presented for white matter in thin sliced single-channel brain magnetic resonance scans. The original image is smoothed by using anisotropic filter and over-segmented by the watershed algorithm. Finally, the brain MR image is segmented automatically by using the multicontext wavelets-based thresholding (MCWT) method. The result of the experiment indicates that the algorithm can obtain segmentation result fast and accurately.