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Objective:To investigate the therapeutic effects of internal fixation via the posterolateral combined posteromedial approach in the treatment of posterior pilon fracture (Klammer type Ⅲ).Methods:A retrospective study was performed to analyze the 69 posterior pilon fractures (Klammer type Ⅲ) which had been treated by internal fixation with hollow screws or a buttress plate at Department of Orthopaedic Trauma, Yantai Shan Hospital from January 2015 to January 2020. There were 36 males and 33 females with an age of (45.3±10.0) years and duration from injury to surgery of (6.0±1.5) d. They were assigned into 2 groups according to different surgical approaches. The observation group (41 cases) was treated through the posterolateral combined posteromedial approach while the control group (28 cases) through the posterolateral approach alone. The therapeutic effects were evaluated by comparing the 2 groups in terms of incision length, intraoperative bleeding, operation time, fracture union time, fracture reduction (evaluated by the Burrwell-Charnley radiological score), the ankle-hindfoot score of American Orthopaedic Foot and Ankle Society (AOFAS) and complications.Results:There was no significant difference in the preoperative general data between the 2 groups, showing comparability ( P>0.05). All the 69 cases were followed up for (16.9±4.0) months, revealing primary healing of all the incisions and no vascular injury or wound infection. The incision length [(11.2±1.8) cm] and operation time [(76.0±6.6) min] in the observation group were significantly shorter than those in the control group [(12.4±1.9) cm and (79.7±6.8) min], the excellent and good rate of reduction in the observation group (97.6%, 40/41) was significantly higher than that in the control group (89.3%, 25/28), and the ankle-hindfoot scores of AOFAS at 1, 3 and 12 months after operation in the observation group [(78.4±5.6), (79.5±2.8) and (86.9±2.1)] were significantly higher than those in the control group [(75.2±5.5), (78.0±3.2) and (85.8±2.3)] (all P<0.05). There was no significant difference in the intraoperative bleeding between the 2 groups ( P>0.05). In the control group, 2 patients developed numbness in the dorsum of foot, which gradually disappeared after 3 months of treatment, but no other complications like persistent pain or flexor contracture within 1 year after operation. Conclusion:In the treatment of Klammer type Ⅲ posterior pilon fracture, the posterolateral combined posteromedial approach can result in satisfactory therapeutic effects, because the surgical approach can fully expose the fracture and facilitate better reduction.
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Objective:To study the effect of glucosamine combined with sodium hyaluronate on serum interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α) levels in patients with Kashin-Beck disease (KBD).Methods:In a prospective design, patients with KBD admitted to South Hospital of Yantaishan Hospital from January 2017 to January 2019 were selected and divided into control, observation, and replacement groups. The control group was treated with glucosamine sulfate, the observation group was treated with intra-articular injection of sodium hyaluronate on the basis of the control group, and the replacement group was treated with artificial knee arthroplasty. The clinical efficacy, visual analogue scale (VAS) and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) of the three groups were compared before treatment, 6 weeks and 6 months after treatment. Blood samples were collected from the patients, and the serum levels of IL-1β and TNF-α were measured by enzyme-linked immunosorbent assay (ELISA) to compare the serum levels of IL-1β and TNF-α in the three groups before treatment, 6 weeks and 6 months after treatment.Results:The age of patients in the control group was (53.76 ± 7.33) years old, including 19 males and 23 females. The age of patients in the observation group was (54.18 ± 7.06) years old, including 20 males and 22 females. The age of the replacement group was (55.17 ± 6.43) years old, including 17 males and 13 females. The total effective rate in observation group (92.86%, 39/42) was significantly higher than that of the control group (76.19%, 32/42, χ 2 = 4.459, P < 0.05). At 6 weeks and 6 months after treatment, the VAS scores in the observation group [(4.10 ± 1.21), (3.16 ± 0.95) points] were significantly lower than those in the control group [(5.48 ± 1.17), (4.06 ± 0.74) points, P < 0.05]; at 6 weeks after treatment, the VAS score in the replacement group [(3.28 ± 0.89) points] was significantly lower than that in the observation group ( P < 0.05). At 6 weeks and 6 months after treatment, the WOMAC scores in the observation group [(40.72 ± 4.19, 25.86 ± 3.02) points] were significantly lower than those in the control group [(48.29 ± 2.16), (36.81 ± 3.13) points, P < 0.05]; the WOMAC scores in the replacement group [(29.68 ± 4.22), (23.57 ± 3.86) points] were significantly lower than those of the observation group ( P < 0.05). The serum levels of IL-1β [(9.28 ± 2.74), (6.85 ± 2.27) pg/ml] and TNF-α [(12.66 ± 4.54), (10.34 ± 3.48) pg/ml] in the observation group were significantly lower than those in the control group [(12.78 ± 2.79), (10.36 ± 2.63), (15.51 ± 4.63), (14.64 ± 4.27) pg/ml, P < 0.05], the serum levels of IL-1β [(6.12 ± 3.55), (5.39 ± 2.23) pg/ml], TNF-α [(10.42 ± 3.13) , (8.19 ± 3.15) pg/ml] in the replacement group were significantly lower than those in the observation group at 6 weeks and 6 months after treatment ( P < 0.05). Conclusion:Glucosamine combined with intra-articular injection of sodium hyaluronate can relieve inflammation, improve pain and promote joint function recovery in patients with KBD, but there is still a certain gap compared with knee arthroplasty.
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Objective To investigate the significance of whole mount sections after radical prostatectomy in the diagnosis of prostate cancer.Methods The data of 210 patients with radical prostatectomy in the Department of Urology of Northern Jiangsu People's Hospital from April 2018 to July 2015 were collected,of which 150 cases (control group) were examined with routine tissue section examination and 60 cases (study group) were examined with whole mount sections.The age of the study group and the control group were (69.0 ± 5.0) years and (70.0 ± 7.0) years respectively,and PSA was (18.8 ± 2.5) ng/ml and (19.3 ± 2.1) ng/ml respectively.The BMI of the study group was (23.0 ± 1.2) kg/m2,and the control group was (22.8 ± 0.6) kg/m2.The preoperative Gleason score of the study group and the control group were 7.9 ±0.9 and 7.7 ± 1.6 respectively.There were 137 patients (91.3％) with clinical stage cT1-T2 and 13 patients with cT3(8.7％) in control group.In the study group,there were 51 cases (85.0％) with clinical stage cT1-T2,and 9 cases with cT3 (15.0％).There was no significant difference between the two groups (P ＞ 0.05) in term of the patients' demographics.The postoperative Gleason score,positive surgical margin,seminal vesicle invasion lymph node metastasis and pathological stage were compared between the two groups.Results The median prostate volume of the study group was 45.2 (18.3-121.5) ml,and 47.1 (2 1.3-124.2) ml in the control group.The operation time of the study group was 138.2 (119.5-234.1) mins,and 133.5 (116.8-228.2) mins in the control group.In the control group,there were 8 cases(5.3％) with seminal vesicle invasion,and 8 cases (5.3％) with lymph node metastasis.The pathological stages were pT2-T3 in 145 cases(96.7％),and pT4 in 5 cases (3.3％) in control group.The postoperative Gleason score was 8.0 ± 0.9 in control group.In the study group,17 patients (28.3％) with seminal vesicle invasion were pathologically indicated,and there were 6 patients (10.0％) with lymph node metastasis.The pathological stages were pT2-T3 of 57 cases(95.0％),and pT4 of 3 cases (5.0％),postoperative Gleason score was 7.7 ± 1.0 in study group.There was no statistically significant difference in seminal vesicle invasion,lymph node metastasis,pathological stage and postoperative Gleason score between the two groups (P ＞ 0.05).There were 23 patients (15.3％) with positive margins in the control group,and 28 patients(46.7％) in the study group,which showed significant difference (P ＜0.01).For small lesions,there were 7 cases (4.7％) and 22 cases (36.7％) in the control group and the study group,respectively,which showed significant difference (P ＜ 0.01).There were 17 cases (28.3％) of increased Gleason score in the study group,while 31 cases (20.7％) in the control group,with no statistical difference (P =0.232).Conclusions The whole mount section technique can effectively improve the positive surgical margin and the small lesions detection rate in the pathological evaluation of radical prostatectomy,and provide a precise pathological diagnosis for the postoperative treatment and follow-up of the patients.
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<p><b>BACKGROUND</b>The trochanteric fixation nail (TFN) can be used to treat stable and unstable fractures of intertrochanteric hip fractures. We study the common lateral migration that occurs with telescoping of intertrochanteric hip fractures treated with TFN and identify the predictors and relationships to clinical outcomes.</p><p><b>METHODS</b>Patient demographic information, fracture type (Arbeitsgemeinschaft für Osteosynthesefragen (AO)/Orthopaedic Trauma Association (OTA) classification), radiographic data, and clinical data were collected. Lateral migration with telescoping was measured. Statistical analyses were performed to determine which variables predicted lateral migration with telescoping. Patient outcome scores were recorded using the Modified Harris Hip Score (MHHS), Hip Outcome Score-Activity of Daily Living (HOS-ADL), and Visual Analog Scale for pain.</p><p><b>RESULTS</b>Two hundred and twenty-three patients (67 males, 156 females) fitted the radiographic and follow-up (average 24.6 months) criteria. The average age was 77.2 years. The average lateral migration with telescoping was 4.8 mm. Twenty-one patients (9.4%) had excessive lateral migration with telescoping ( = 10 mm). The quality of calcar reduction (P = 0.01) and unstable fracture patterns (P = 0.006) were significant predictive factors of lateral migration with telescoping. The mean outcome scores (MHHS and HOS-ADL) were 80.1 points and 78.7 points, respectively. All subjects had no significant relationship to lateral migration with telescoping (P > 0.05). Of all the patients who developed lateral migration with telescoping, only one required removal of the blade for hip pain and all patients went on to uneventful union at an average time of 4.5 months.</p><p><b>CONCLUSIONS</b>Lateral migration with telescoping is a common mechanical complication of intertrochanteric hip fracture treated with the TFN procedure. It was predicted by the quality of calcar reduction and fracture type. However, this did not affect stable fixation and fracture healing, so rarely leads to clinical problems.</p>
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Bone Nails , Follow-Up Studies , Fracture Fixation, Internal , Methods , Hip Fractures , Classification , General Surgery , Retrospective Studies , Treatment OutcomeABSTRACT
To validate whether down-regulation of microRNA-203 (miR-203) in hepatocellular carcinoma (HCC) is involved in HCC progression by targeting survivin. MiR-203 mimics was transfected into HepG2 cells to enhance miR-203 expression, and miR-203 inhibitor was transfected into HepG2 cells to inhibit miR-203 expression. The effect of up-regulation and down-regulation of miR-203 on survivin expression of HepG2 cells was evaluated using Western blot assay. The effect of miR-203 or survivin expression on the proliferation of HepG2 cells was detected using the CKK-8 assay. Over-expression of miR-203 significantly inhibited the expression of survivin in HepG2 cells (p < 0·05), and down-expression of miR-203 significantly promoted the expression of survivin in HepG2 cells (p < 0·05). Both over-expression of miR-203 and down-regulation of survivin suppressed proliferation of HepG2 cells significantly compared with negative control. Low expression of miR-203 contributes to the progression of HCC via targeting survivin.
Subject(s)
Carcinoma, Hepatocellular/pathology , Gene Expression Regulation, Neoplastic , Inhibitor of Apoptosis Proteins/physiology , Liver Neoplasms/pathology , MicroRNAs/physiology , Neoplasm Proteins/physiology , RNA, Neoplasm/physiology , Cell Division , Down-Regulation , Hep G2 Cells/cytology , Hep G2 Cells/metabolism , Humans , Inhibitor of Apoptosis Proteins/biosynthesis , Inhibitor of Apoptosis Proteins/genetics , MicroRNAs/antagonists & inhibitors , RNA, Messenger/biosynthesis , RNA, Neoplasm/antagonists & inhibitors , RNA, Neoplasm/biosynthesis , RNA, Small Interfering/pharmacology , Survivin , Transfection , Up-RegulationABSTRACT
[Objective]To study the clinical results of treatment of local osteochondral fracture lesions on the talus dome associated with ankle fracture using autologous osteochondral transplantation.[Method]There were 18 patients with osteochondral fracture defects of the talus dome associated with ankle fracture, male 10, female 8, with the average age 33.5 years (18~49 years). Transplantation procedure was osteochondral cylinders from non-weight bearing surface of the ipsilateral knee and implant the donor graft into the recipient holes of talus cartilaginous defects with press-fit technique. The outcomes were assessed on the basis of ankle functional rating score, radiographic findings and MRI findings.[Result]The patients were followed up for 17 to 40 months (mean, 28 months). The ankle functional rating score was measured by the Baird and Jackson functional rating score system. The averaged scores was 96.3?3.5,excellent in 14 cases, good in 3 cases and fair in 1 case. The rate of being excellent and good was 94.4%.The rate of posttraumatic arthritis was 5.6% (1/18) and osteochondritis dissecans was 5.6% (1/18).[Conclusion]Autogenous osteochondral transplantation using ipsilateral knee osteochondral grafts is an effective surgical procedure on treating acute local osteochondral fracture lesions of the talus associated with ankle fracture.
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To evaluate the implication of methymalonic acid (MMA) in the early diagnosis of neural tube defects (NTD), a quantitative assay for MMA was established by using gas chromatography-mass spectrometry with stable isotope of MMA as an internal standard. Amniotic fluid and maternal urine MMA concentration, maternal serum folate, red blood cell folate and vitamin B12 levels were measured in the middle term of NTD-affected and normal pregnancies. Amniotic fluid and maternal urine MMA concentrations in the middle term of NTD affected pregnancies (1.4 +/- 0.9 micromol/L, and 22.1 +/- 12.6 nmol/micromol creatinine) were significantly higher than that of normal pregnancies (1.0 +/- 0. 4 micromol/L, and 2.5 +/- 1.1 nmol/micromol creatinine). There was no significant difference between normal and NTD pregnancies for serum folate, red blood cell folate and vitamin B12 levels. The results suggested that MMAs in amniotic fluid and maternal urine are sensitive markers for early diagnosis of NTD. Vitamin B12 is an active cofactor involved in the remethylation of homocycteine and its deficiency is an independent risk factor for NTD. MMA is a specific and sensitive marker for intracellular vitamin B12 deficiency. This study suggests that it is necessary to monitor the vitamin B12 deficiency and advocates vitamin B12 supplementation with folate prevention program.
Subject(s)
Adult , Female , Humans , Pregnancy , Amniotic Fluid , Chemistry , Biomarkers , Urine , Folic Acid , Blood , Methylmalonic Acid , Urine , Neural Tube Defects , Diagnosis , Metabolism , Pregnancy Trimester, Second , Prenatal Diagnosis , Vitamin B 12 , BloodABSTRACT
To evaluate the implication of methymalonic acid (MMA) in the early diagnosis of neural tube defects (NTD), a quantitative assay for MMA was established by using gas chromatography-mass spectrometry with stable isotope of MMA as an internal standard. Amniotic fluid and maternal urine MMA concentration, maternal serum folate, red blood cell folate and vitamin B12 levels were measured in the middle term of NTD-affected and normal pregnancies. Amniotic fluid and maternal urine MMA concentrations in the middle term of NTD affected pregnancies (1.4 +/- 0.9 micromol/L, and 22.1 +/- 12.6 nmol/micromol creatinine) were significantly higher than that of normal pregnancies (1.0 +/- 0. 4 micromol/L, and 2.5 +/- 1.1 nmol/micromol creatinine). There was no significant difference between normal and NTD pregnancies for serum folate, red blood cell folate and vitamin B12 levels. The results suggested that MMAs in amniotic fluid and maternal urine are sensitive markers for early diagnosis of NTD. Vitamin B12 is an active cofactor involved in the remethylation of homocycteine and its deficiency is an independent risk factor for NTD. MMA is a specific and sensitive marker for intracellular vitamin B12 deficiency. This study suggests that it is necessary to monitor the vitamin B12 deficiency and advocates vitamin B12 supplementation with folate prevention program.
Subject(s)
Amniotic Fluid/chemistry , Biomarkers/analysis , Biomarkers/urine , Folic Acid/blood , Methylmalonic Acid/analysis , Methylmalonic Acid/urine , Neural Tube Defects/diagnosis , Neural Tube Defects/metabolism , Pregnancy Trimester, Second , Prenatal Diagnosis , Vitamin B 12/bloodABSTRACT
Objective To compare the clinical results of operation and manual reduction and plaster immobilization in management of senile comminuted distal radial fractures.Methods Retrospective analysis of the clinical data was done for the 178 senile patients with comminuted distal radial fracture who were treated from January 2000 to September 2004 in our department.102 cases were treated with manual reduction and plaster immobilization,46 cases with external fixator and limited internal fixation,and 30 cases with T-plate internal fixation.Results Follow-up duration averaged 27 months(13 to 52 months).According to Dienst criteria,the excellent rate of functional outcome was 93.5%for external fixator combined with limited internal fixation,78.4%for manual reduction and plaster immobilization and 80.0%for T-plate internal fixation.The differences were statistically significant(P
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Objective To compare the clinical results of radial head resection with those of open reduction and internal fixation in treatment of Mason type- Ⅲ comminuted fracture of radial head. Methods 58 cases of Mason type- Ⅲ radial head fracture were treated in our department from January, 1983 to July, 2005. 28 cases had resection of the fractured redial head, while the other 30 cases had open reduction and internal fixation. The outcomes were assessed on the basis of pain, motion, strength, radiographic findings, and elbow functional rating score. Results The resection group had a mean follow- up of 5.5 years (2 to 6), while the internal fixation group had 10 years (3 to 13). The average pain VAS (visual analog scale) score was 18.7 (11 to 25) for the resection group and 23.5 (17 to 25) for the fixation group with a P value of 0.0023. The elbow extension averaged - 12.4? in the resection group and - 5.8? in the fixation group (P0.05) , but the decrease of elbow extension and forearm rotation differed statistically between the 2 groups (P
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To explore the role of cerebro-spinal flu id(CSF)glutamate and nitric oxide (NO) in the pathogenesis of neonatal hypoxic- ischemia encephalopathy (HIE), glutamate and NO in CSF were determined in 24 new born infants with HIE and 8 normal control infants, respectively. The results sh owed that the levels of glutamate and NO in CSF were significantly higher in the neonates with moderate and severe HIE than those in both of the control group an d neonates with mild HIE.There was an obviously positive relationship between le v els of glutamate and NO. It is concluded that glutamate and NO play an important role in the pathogenesis of neonatal HIE.
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Objective: We examined the cause、level of pathology、onset of symptoms、time taken to treatment and outcome of 14 patients with cauda equina syndrome(CES) to determine how these factors influenced the eventual outcome.Methods:14 patients with CES treated at our hospital between 1991 and 1997 underwent laminectomy followed by bilateral decompression.The mean time of followup was 35 months(range 22～48months).Logistical regression analysis was used to manage the data.Results:Out of 14 patients,11 had satisfactory recovery at 2 years postdecompression;3 patients were left with some residual dysfunction.Conclusion:There was a clear correlation between delayed decompression and the poor overall outcome,as well as the presence of perineal anaesthesia and significant sphicter dysfuncation.
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Objective To assess the efficacy and the optimum dose of recombinant human ery- thropoietin(rhEpo) in the treatment of the anemia of premature.Methods 40 preterm infants with less than 35 weeks of gestational age and less than 2000gin of birth weight were randomly assigned to receive subcutaneous rhEpo 150U?kg~(-1)?t~(-1)(n=10) 250U?kg~(-1)?t~(-1)(n=15),three times weekly for 6 weeks,or no treatment(control,n=15).Results Postnatal decline of hemoglobin(Hb) and hematocrit (Hct) were lessened in the treated groups,particularly in the rhEpo 250U?kg~(-1)?t~(-1)group; and there were significant differences in each groups by analysis of variance(all P0.05).Serum iron dropped,more significantly in the treated groups than in control group (all P0.05).After treatment,serum levels of erythropoietin was higher in rhEpo 250U?kg~(-1), t~(-1) group than in both rhEpo 150U?kg~(-1)?t~(-1) and control groups (P0.05).No side effects related to rhEpo therapy were observed.Conclusious RhEpo therapy for premature infants is effective and dose-dependent.Therapy is more efficient when given in high dose.It can reduce or replace the need for blood transfusion.
