Post-COVID-19 Pandemic Rebound of Macrolide-Resistant Mycoplasma pneumoniae Infection: A Descriptive Study.

The rebound characteristics of respiratory infections after lifting pandemic control measures were uncertain. From January to November 2023, patients presenting at a teaching hospital were tested for common respiratory viruses and Mycoplasma pneumoniae using a combination of antigen, nucleic acid amplification, and targeted next-generation sequencing (tNGS) tests. The number and rate of positive tests per month, clinical and microbiological characteristics were analyzed. A rapid rebound of SARS-CoV-2 was followed by a slower rebound of M. pneumoniae, with an interval of 5 months between their peaks. The hospitalization rate was higher, with infections caused by respiratory viruses compared to M. pneumoniae. Though the pediatric hospitalization rate of respiratory viruses (66.1%) was higher than that of M. pneumoniae (34.0%), the 4094 cases of M. pneumoniae within 6 months posed a huge burden on healthcare services. Multivariate analysis revealed that M. pneumoniae-infected adults had more fatigue, comorbidities, and higher serum C-reactive protein, whereas children had a higher incidence of other respiratory pathogens detected by tNGS or pathogen-specific PCR, fever, and were more likely to be female. A total of 85% of M. pneumoniae-positive specimens had mutations detected at the 23rRNA gene, with 99.7% showing A2063G mutation. Days to defervescence were longer in those not treated by effective antibiotics and those requiring a change in antibiotic treatment. A delayed but significant rebound of M. pneumoniae was observed after the complete relaxation of pandemic control measures. No unusual, unexplained, or unresponsive cases of respiratory infections which warrant further investigation were identified.

Clinical presentation and magnetic resonance imaging characteristics of lymphocytic hypophysitis: a systematic review with meta-analysis.

Introduction: This meta-analysis was performed to analyze the clinical presentation, magnetic resonance imaging (MRI) characteristics, and the management of lymphocytic hypophysitis (LYH). Material and methods: Four different databases were searched from January 2010 to December 2020, two researchers independently conducted literature screening, data extraction, and quality evaluation. We used a random effects meta-analysis to calculate summary relative risks with 95% CI. Results: This meta-analysis showed that the percentage of women among LYH patients was 78%. LYH was associated with pregnancy in 15% of female patients, with headache (49%) and symptoms of central diabetes insipidus (CDI) (45%) being the most frequent presentation. In 24% of LYH patients, there was an association with another autoimmune disease. The incidence of secondary hypogonadism, secondary hypoadrenalism, secondary hypothyroidism, and growth hormone deficit was 54%, 49%, 43%, and 22%, respectively. Pituitary contrast enhancement (63%), symmetrical pituitary enlargement (60%), thickening of the pituitary stalk (58%), sella mass or suprasellar extension (58%), and loss of posterior pituitary hyperintensity (50%) were typical MRI findings. Regarding LYH treatment, the percentage of patients who had observation or hormone replacement, steroid therapy, and surgery was 43%, 36%, and 34%, respectively. Conclusions: It is of great significance to fully understand the clinical characteristics of lymphocytic hypophysitis, reduce missed diagnosis and misdiagnosis, avoid unnecessary surgery and maintain normal pituitary function.

[Clinical efficacy of combined therapy in children with stage 4 neuroblastoma]. / 儿童4期神经母细胞瘤联合治疗的临床疗效观察.

OBJECTIVES: To study the early clinical efficacy of combined therapy of stage 4 neuroblastoma. METHODS: A retrospective analysis was performed on the medical data and follow-up data of 14 children with stage 4 neuroblastoma who were diagnosed in Hong Kong University-Shenzhen Hospital from January 2016 to June 2021. RESULTS: The median age of onset was 3 years and 7.5 months in these 14 children. Among these children, 9 had positive results of bone marrow biopsy, 4 had N-Myc gene amplification, 13 had an increase in neuron-specific enolase, and 7 had an increase in vanilmandelic acid in urine. Based on the results of pathological examination, differentiated type was observed in 6 children, undifferentiated type in one child, mixed type, in one child and poorly differentiated type in 6 children. Of all the children, 10 received chemotherapy with the N7 regimen (including 2 children receiving arsenic trioxide in addition) and 4 received chemotherapy with the Rapid COJEC regimen. Thirteen children underwent surgery, 14 received hematopoietic stem cell transplantation, and 10 received radiotherapy. A total of 8 children received Ch14.18/CHO immunotherapy, among whom 1 child discontinued due to anaphylactic shock during immunotherapy, and the other 7 children completed Ch14.18/CHO treatment without serious adverse events, among whom 1 child was treated with Lu177 Dotatate 3 times after recurrence and is still undergoing chemotherapy at present. The median follow-up time was 45 months for all the 14 children. Four children experienced recurrence within 2 years, and the 2-year overall survival rate was 100%; 4 children experienced recurrence within 3 years, and 7 achieved disease-free survival within 3 years. CONCLUSIONS: Multidisciplinary combined therapy is recommended for children with stage 4 neuroblastoma and can help them achieve better survival and prognosis.

Identification and validation of an immune-associated RNA-binding proteins signature to predict clinical outcomes and therapeutic responses in colon cancer patients.

BACKGROUND: The immune infiltration of patients with colon cancer (CC) is closely associated with RNA-binding proteins (RBPs). However, immune-associated RBPs (IARBPs) in CC remain unexplored. METHODS: The data were downloaded from The Cancer Genome Atlas (TCGA) and the patients were divided into four immune subgroups by single sample gene set enrichment analysis (ssGSEA), in which weighted gene correlation network analysis (WGCNA) identified modules of co-expressed genes correlated with immune infiltration. Univariate (UCR) and multivariate Cox regression (MCR) analyses were applied to screen survival-associated IARBPs. Then, a prognostic signature was performed on TCGA dataset. Risk model was constructed based on the TCGA dataset. Based on the median risk score, CC patients were subdivided into low- and high-risk groups. Furthermore, the accuracy and prognostic value of this signature were validated by using Kaplan-Meier (K-M) curve, receiver operating characteristic (ROC). We further validated the findings in Gene Expression Omnibus (GEO) database. Finally, we evaluated the association between gene expression level and drug sensitivity. RESULTS: Based on the infiltration of immune cells, the TCGA patients were divided into four subgroups. In total, we identified 25 IARBPs, after differential expression and WGCNA analysis. Subsequently, two IARBP signatures (FBXO17 and PPARGC1A) were identified to be significantly associated with the overall survival (OS) of CC patients. K-M survival analysis revealed that the low-risk group correlated with prolonged OS. The prognostic signature was an independent prognostic factor and reflects the immune status of CC patients. Finally, FBXO17 was related with drug sensitivity of bleomycin, gemcitabine, and lenvatinib. PPARGC1A was related to drug sensitivity of dabrafenib, vemurafenib, and trametinib. CONCLUSION: A novel two immune-associated RBPs that was established that may be useful in predicting survival and individualized treatment.

Meta-analysis on the effect of pituitary adenoma resection on pituitary function.

OBJECTIVE: A meta-analysis was conducted on the effect of pituitary adenoma resection on pituitary function. METHODS: The Cochrane Library, Ovid, PubMed, the Excerpta Medica Database (EMBASE), and the Chinese Biomedical Literature Databases (CBM) were searched to find trials about the evaluation of pituitary target glands before and after pituitary adenoma resection. The databases were searched from the earliest available trials until the end of September 2019. Based on the inclusion and exclusion criteria, two researchers independently selected literature, extracted data, and evaluated the quality of the studies, and then used Revman 5.2 software to conduct a meta-analysis. RESULTS: Eleven clinical trials were included, with a total of 3,237 subjects. Meta-analysis showed that the number of patients with hypofunction of the thyroid and gonadal axes substantially decreased after pituitary tumour resection, and that the difference was statistically significant: odds ratio (OR) = 1.72 [95% confidence interval (CI), 1.18-2.52; P = 0.005] and OR = 2.06 (95% CI, 1.42-3.00; P = 0.0002). The number of patients with a poor total suprarenal gland axis after pituitary tumour resection did not change significantly compared to the number found before the operation; the difference was not statistically significant: OR = 1.04 (95% CI, 0.72-1.48; P = 0.85). However, the number of patients who had adrenal axis dysfunction both before and after the operation was significantly reduced, and the difference was statistically significant: OR = 1.46 (95% CI, 1.21-1.78; P = 0.0001). CONCLUSION: The function of the thyroid and gonadal axes of pituitary gland tumour patients can be improved, to some extent, after pituitary tumour resection. Patients with pituitary tumours who have hypofunction of the adrenal axis can recover effectively after tumour resection.

[Evaluation of short-term clinical effect of minimally invasive total hip arthroplasty with direct anterior approach in lateral position].

OBJECTIVE: To investigate the short-term clinical effect of direct anterior approach (DAA) in total hip arthroplasty(THA). METHODS: From January 2018 to September 2018, the data of 30 patients(33 hips) who underwent the first THA using the side lying DAA completed by the same operation team were followed up and evaluated. There were 19 males and 11 females;the age was 58 to 80 (69.0±5.4) years old;the visual analogue scale (VAS) of pain was used, Harris scoring system, operation time, intraoperative blood loss, related complications and hip radiographs were evaluated in clinical and imaging aspects. RESULTS: Thirty patients (33 hips) were followed up for 12 to 20(14.3±3.7) months, operation time (66.0±7.2) min and intraoperativehemorrhage (156±32) ml. The position of acetabulum prosthesis was examined by imaging:anteversion angle (18.6±3.6)° and abduction angle (41.2±4.8)° respectively. The VAS score was improved from 7 to 9(8.1±1.4) before operation to 1 to 3(1.9±0.7) at 1 month after operation. Harris score of hip joint improved significantly, from 28 to 46(35.4±5.2) before operation to 76 to 92 (88.6±4.5) at 1 month after operation, 74 to 93 (85.6±6.9) at 6 months after operation, and 79 to 95 (90.7±8.1) at 12 months after operation, the difference was statistically significant(P<0.05). Complications occurred in 3 cases of fracture of the proximal femur, including 1 case of hip sprain fracture due to careless walking one month after operation. Considering that incomplete fracture may have occurred during the operation, 1 case of avulsion fracture of anterior inferior iliac spine, no deep infection, no dislocation. There were 1 case of injury of lateral femoral cutaneous nerve and 2 cases of injury of tensor fascia lata, among which 1 case was complete incision of the edge of the hook. CONCLUSION: The primary THA with DAA in lateral position has a good short;term clinical effect, can meet the needs of patients' rapid recovery, and is a safe and effective surgical approach.

[Clinical study of Jiawei Xiaoyao Powder(JWXYP) on preventing delirium in elderly patients with hip fracture after operation].

OBJECTIVE: To study the effect of soothing liver, relieving depression, invigorating spleen and reinforcing blood on reducing delirium in elderly patients with hip fracture. METHODS: From December 2014 to June 2018, 180 elderly patients with hip fracture admitted were divided into treatment group and placebo group according to the order of admission:90 patients in treatment group were treated with Jiawei Xiaoyao Powder(JWXYP), including 32 males and 58 females, with an average age of(72.12±4.92), involving 67 cases of femoral trochanter fractures and 23 cases of femoral neck fractures; 35 cases underwent dynamic hip screw fixation, 31 cases underwent intramedullary fixation and 24 cases underwent artificial hip replacement. In the placebo group, 90 patients were treated with placebo, including 37 males and 53 females, with an average age of(72.91±5.43) years old, involving 69 cases of femoral trochanteric fractures and 21 cases of femoral neck fractures, including 37 cases underwent dynamic hip screw fixation, 30 cases underwent intramedullary fixation and 23 cases underwent artificial hip replacement. The age, sex, injury site, intraoperative bleeding volume, postoperative drainage, operation time, anesthesia time, post-operative pain score, post-operative hemoglobin, post-operative CRP, delirium severity(DRS) score and delirium occurrence were observed and compared between the two groups. RESULTS: All patients were followed up until delirium returned to normal, postoperative delirium was found in 12 cases (13.33%) in the treatment group and in 39 cases(43.33%) in the placebo group, the treatment group was significantly better than the placebo group. The monitoring indexes of the two groups were compared:post-operative pain score(P=0.002), post-operative hemoglobin(P=0.012), post-operative CRP(P=0.042). CONCLUSIONS: JWXYP can relieve liver depression, invigorate spleen and invigorate blood circulation, reduce pain, inflammatory stimulation and supplement blood volume after operation, and significantly reduce the incidence of delirium after operation.

Overexpression of long noncoding RNA LINC01419 in esophageal squamous cell carcinoma and its relation to the sensitivity to 5-fluorouracil by mediating GSTP1 methylation.

BACKGROUND: Genome-wide sequencing investigations have identified numerous long noncoding RNAs (lncRNAs) among mammals, many of which exhibit aberrant expression in cancers, including esophageal squamous cell carcinoma (ESCC). Herein, this study elucidates the role and mechanism by which LINC01419 regulates the DNA methylation of glutathione S-transferase pi 1 (GSTP1) in relation to ESCC progression and the sensitivity of ESCC cells to 5-fluorouracil (5-FU). METHODS: LINC01419 and GSTP1 levels were quantified among 38 paired ESCC and adjacent tissue samples collected from patients with ESCC. To ascertain the contributory role of LINC01419 in the progression of ESCC and identify the interaction between LINC01419 and GSTP1 promoter methylation, LINC01419 was overexpressed or silenced, and the DNA methyltransferase inhibitor 5-Aza-CdR was treated. RESULTS: Data from the GEO database (GSE21362) and the Cancer Genome Atlas displayed elevated levels of LINC01419 and downregulated levels of GSTP1 in the ESCC tissues and cells. The silencing of LINC01419 led to decreased proliferation, increased apoptosis, and enhanced sensitivity to 5-FU in ESCC cells. Notably, LINC01419 could bind to the promoter region of the GSTP1 gene, resulting in elevated GSTP1 methylation and reduced GSTP1 levels via the recruitment of DNA methyltransferase among ESCC cells, whereby ESCC progression was stimulated accompanied by reduced ESCC cell sensitivity to 5-FU. GSTP1 demethylation by 5-Aza-CdR was observed to reverse the effects of LINC01419 overexpression in ESCC cells and the response to 5-FU. CONCLUSION: Highly expressed LINC01419 in ESCC promotes GSTP1 methylation, which ultimately acts to promote the event of ESCC and diminish the sensitivity of ESCC cells to 5-FU, highlighting a novel potential strategy to improve 5-FU-based chemotherapy in ESCC.

[Treatment of Schatzker IV tibial plateau fractures with arthroscopy combined with MIPPO technique].

OBJECTIVE: To discusses the clinical effects of arthroscopy combined with minimally invasive percutaneous plate osteosynthesis(MIPPO) technology in treating Schatzker IV tibial plateau fractures. METHODS: From January 2012 to January 2016, 19 patients with Schatzker type IV tibial plateau fractures were treated with arthroscopy combined with minimally invasive technique including 12 males and 7 females with an average age of 46.5 years old ranging from 19 to 78 years old. Patients were suffering knee pain, swelling, flexion and extension limited, and other symptoms preoperative. Patients were followed up and assessed by Rasmussen knee function score. RESULTS: No infection, traumatic arthritis, and knee joint valgus occurred after operation. Nineteen cases were followed up for 12 to 24 months with an average of 18.6 months. Fracture healing time was 3 to 5 months with an average of 3.8 months. The knee pain and limited mobility improved significantly. The range of autonomic movement of joints was from 90 to 136 degrees. According to Rasmussen functional score criteria, the total score was 27.00±2.49, the result was excellent in 16 cases, good in 2 cases, fair in 1 case. CONCLUSIONS: Arthroscopic treatment for Schatzker type IV tibial plateau fractures combined with MIPPO can simultaneously treat internal structural injuries such as meniscus and other knee joints, with less trauma, fewer complications, and faster joint function recovery, but we must strictly grasp surgical indications and avoid expanding injuries.

Antioxidant xanthones and anthraquinones isolated from a marine-derived fungus Aspergillus versicolor.

Chemical examination of an EtOAc extract of cultured Aspergillus versicolor fungus from deep-sea sediments resulted in the isolation of four xanthones, eight anthraquinones and five alkaloids, including a new xanthone, oxisterigmatocystin D (1) and a new alkaloid, aspergillusine A (13). High resolution electron impact mass spectrometry (HR-EI-MS), FT-IR spectroscopy, and NMR techniques were used to elucidate the structures of these compounds, and the absolute configuration of compound 1 was established by its NMR features and coupling constant. Furthermore, the biosynthesis pathway of these xanthones and anthraquinones were deduced, and their antioxidant activity and cytotoxicity in human cancer cell lines (HTC-8, Bel-7420, BGC-823, A549, and A2780) were evaluated. The trolox equivalent antioxidant capacity (TEAC) assay indicated most of the xanthones and anthraquinones possessing moderate antioxidant activities. The Nrf2-dependent luciferase reporter gene assay revealed that compounds 6, 7, 9, and 12 potentially activated the expression of Nrf2-regulated gene. In addition, compounds 5 and 11 showed weak cytotoxicity on A549 with the IC50 values of 25.97 and 25.60 µmol·L-1, respectively.

Effects of the long-term consumption of hydrogen-rich water on the antioxidant activity and the gut flora in female juvenile soccer players from Suzhou, China.

Expending a considerable amount of physical energy inevitably leads to fatigue during both training and competition in football. An increasing number of experimental findings have confirmed the relationship between the generation and clearance of free radicals, fatigue, and exercise injury. Recently, hydrogen was identified as a new selective antioxidant with potential beneficial applications in sports. The present study evaluated the effect of 2-month consumption of hydrogen-rich water on the gut flora in juvenile female soccer players from Suzhou. As demonstrated by enzyme linked immunosorbent assay and 16S rDNA sequence analysis of stool samples, the consumption of hydrogen-rich water for two months significantly reduced serum malondialdehyde, interleukin-1, interleukin-6, tumour necrosis factor-α levels; then significantly increased serum superoxide dismutase, total antioxidant capacity levels and haemoglobin levels of whole blood. Furthermore, the consumption of hydrogen-rich water improved the diversity and abundance of the gut flora in athletes. All examined indices, including the shannon, sobs, ace, and chao indices, were higher in the control group than those proposed to result from hydrogen-rich water consumption prior to the trial, but these indices were all reversed and were higher than those in the controls after the 2-month intervention. Nevertheless, there were some differences in the gut flora components of these two groups before the trial, whereas there were no significant changes in the gut flora composition during the trial period. Thus, the consumption of hydrogen-rich water for two months might play a role modulating in the gut flora of athletes based on its selective antioxidant and anti-inflammatory activities. The study protocol was approved by the ethics committee of the Suzhou Sports School (approved number: SSS-EC150903).

Salicylic acid derivatives and phenylspirodrimanes from the sponge-associated fungus Hansfordia sinuosae.

Three new salicylic acid derivatives (1-3) and a known one, 6-(3'-hydroxypropyl)-2-hydroxybenzoic acid (4), together with seven known phenylspirodrimanes (5-11), were isolated from the sponge-associated fungus Hansfordia sinuosae, collected from the South China Sea. HRESIMS, FT-IR Spectroscopy, and NMR techniques including COSY, HSQC, and HMBC were used to elucidate the structures of these compounds. The inhibitory effects of the isolated compounds (1-11) against HIV-1 virus were evaluated, and most of the phenylspirodrimanes (5, 8-11) showed varying degrees of anti-HIV activity.

[Clinical research of percutaneous K-wires fixation after manipulative reduction combining with gypsum or splint fixation for treatment of the Barton fractures of aged people].

OBJECTIVE: To investigate the feasibility of using percutaneous K-wires fixation after manipulative reduction combining with gypsum or splint fixation for treatment of the Barton fracture of aged people. METHODS: From June 2011 to May 2013, 91 patients with closed and fresh Barton fracture were analyzed retrospectively which information was complete. According to different methods these patients were divided into three groups: 33 patients in group A were treated by simplex fixation of gypsum or splint after manipulative reduction, including 20 males and 13 females with an average age of (63.27 ± 5.83) years old; 35 patients in group B were treated by percutaneous K-wires fixation after manipulative reduction combining with gypsum or splint fixation, including 23 males and 12 females with an average age of (64.25 ± 4.53) years old; 23 patients in group C were treated by open reduction and internal fixation including 15 males and 8 females with an average age of (64.04 ± 4.83) years old. RESULTS: All the patients were followed up for 10 to 16 months with an average of 12 months by the method of recheckging in outpatient clinic. According Dienst scoring system: in group A, the result was excellent in 15 cases, good in 7 cases, fair in 11 cases; in group B, excellent in 25 cases, good in 6 cases, fair in 4 cases; in group C, excellent in 16 cases, good in 5 cases, fair in 2 cases. The excellent and good rate of group C was better than that of group B and A, further more group B is better than group A. According to X- ray standard, in group A, 26 patients were acceptable, 7 patients were unacceptable; in group B,28 patients were acceptable, 7 patients were uacceptable; in group C, 19 patients were acceptable,4 patients were unacceptable; there were no statistical significant difference (P > 0.05). There were 18 patients with emerging recrispation in group A, 10 patients in group B, 6 patients in group C, the result of group B and C was better than that of group A, and there was no statistically significant between group B and C (P > 0.05). CONCLUSION: Using percutaneous K-wires fixation after manipulative reduction combining with gypsum or splint fixation for treatment of the Barton fracture of aged people is an effective method, it has advantages of micro-invasived, reliable fixation, less complication, not need to fix wrist joint and early functional exercise.

[Investigation of operative process in treating lumbar intervertebral disc protrusion in aged patients].

OBJECTIVE: To investigate the operative management and surgical techniques for lumber disc herniation (LDH) in aged patients (>or=65 years). METHODS: From 2005 to 2010,the data of 43 patients with LDH underwent surgical treatment were retrospectively analyzed. There were 25 males and 18 females,aged from 65 to 70 years old with an average of 67.6 years. The course of disease was from 6 weeks to 7 years with an average of 10.2 years. Fenestratiodn discectomy or extended fenestration discectomy and unilateral or bilateral fenestration were used according to the conditions of location,type of herniated macleos polposus and nerve root compression. Among the patients,the nerve root canal was enlarged,hyperplastic osteophyma and soft tissue were removed, bilateral articular process was reserved in order to maintain the stability of the lumbar segment. RESULTS: All the patients were followed up from 1.2 to 5.2 years. According to the criteria of HU you-gu, 25 cases got excellent results, 15 good, 2 fair and 1 poor. No infection or nerve injury was found. Nerve function of patients had a normal or near normal recovery. CONCLUSION: For the treatment of LDH in aged patents,it is key that reasonably choose the operative method, completely remove the hyperplasy of diseased region and enlarge the nerve root canal, thoroughly loose the nerve root.

[Diagnosis of medial collateral ligament injury by stress X-ray and MRI of knee joint].

OBJECTIVE: To study the application of stress X-ray of knee joint for the diagnosis ot medial collateral ligament injury. METHODS: From January 2008 to June 2011, 46 patients with medial collateral ligament injury were reviewed. Among the patients, 32 patients were male and 14 patients were female, ranging in age from 28 to 72 years, with an average of (49.46 +/- 22.54) years. Left knee joint injuries occurred in 22 patients, and 24 patients had injuries in right knee joint. Thirty-one patients were treated with surgical method, and 15 patients were treated with conservative method including 1 patient finally received operation after 3 months treatment with conservative method without effect. The injury side and normal side were observed by X-ray under stress and non-stress, as well as MRI. Operation was used to treat patients with medial gap markedly widen and the deep layer of medial collateral ligament injury in MRI. A line (line A) was drawn from medial condyle to lateral condyle of tibia platform. The line A was translated to the inner margin of condylus medialis femoris, which was line B. The perpendicular distance was measured, which was line C. The ration of space difference (R) was calculated by (space at stress force of injured side-space at non-stress force of injured side)/(space at stress force of normal side-space at non-stress force of normal side). The relationship between R and ligament injury type were investigated. RESULTS: There were 17 patients with injuries of superficial lamella, 21 patients with injuries of deep lamella. Eight patients had associated injuries of articular capsule and posterior cruciate ligament. When R value was between 1.51 to 5.24, the injury of superficial ligament was found in 15 patients, actual injuries were found in 17 patients. When R value between 5.28 and 13.85, the injuries of bathypelagic ligament were found in 19 patients, actual injuries were found in 21 patients. When R value was between 15.61 and 26.25, the associated injuries of articular capsule and posterior cruciate ligament were found in 7 patients, actual injuries were found in 8 patients. CONCLUSION: Using the specific value as the standard of measurement can provide the quantizatily fractionation of the medial collateral ligament injury.

[Diagnosis and treatment of tarsometatarsal joint complex injury].

OBJECTIVE: To explore the diagnosis and treatment of tarsometatarsal joint complex injury (TJC). METHODS: From January 2007 to January 2009,16 patients with tarsometatarsal joint complex injury were treated with open reduction and internal fixation. There were 12 males and 4 females, ranging in age from 21 to 45 years with an average of 34.1 years. Seven cases were left and 9 cases were right and all injuries caused by direct violence. Four cases caused by traffic accident 5 by fall from high and 7 by crush injury. Intercuneiform dislocation were in 11 cases, naviculocuneiform joint dislocation in 3 cases and cuboid fracture in 2 cases. All the cases were three column injuries. According to the situation of exploring and the stability, screw fixation was used for intertarsal joint, internal and middle column tarsometatarsal joint, the Kirschner wire fixation for external column and miniature plate fixation for comminuted fracture of metatarsal bones and compressible fracture of cuboid. The criteria of the AOFAS Foot and Ankle Surgery by the United States Association of ankle-rear foot functional scale was used to evaluate the clinical effect. RESULTS: All the patients were followed up,the duration ranged from 6 to 18 months(averaged 12.6 months). According to the score system of AOFAS,the total score was (74.6+/-10.4 ) points, including pain items of (29.3+/-5.9), the score of functional items of (32.4+/-5.6) points, and power lines of (12.9+/-2.6). All the incisions were primarily healed without infection, skin necrosis,fixture broken or loosen. Three cases received arthrodesis due to osteoarthritis. Four cases were followed up continually because they only had the radiologic osteoarthritis without pain. CONCLUSION: Anatomical reduction and stable fixation is the key point of the treatment of tarsometatarsal joint complex injury. Open reduction and internal fixation at the first stage is good for secondary arthrodesis.

[Treatment of double injuries of superior shoulder suspensory complex].

OBJECTIVE: To explore operative method for the treatment of double injuries of superior shoulder suspensory complex (SSSC). METHODS: From January 2008 to March 2010,11 patients wiht SSSC injuries were treated, including 9 males and 2 females with an average age of 38 years (ranged from 20 to 47 years). The patients were treated with 4 methods as follows: 4 patients with fractures of neck of scapula combined with homolateral fracture of clavicle were treated with reconstituted plates; 2 patients with fractures of coracoid process or disruption of coracoclavicular ligament combined with the fracture of extremitas acromialis claviculae or acromioclavicular dislocation were treated with clavicular hook plates and cannulated compression screws; 3 patients with injuries of basilar part of acromial process combined with the glenoid cavity and acromioclavicular articulation were treated with reconstuction plates and clavicular hook plates; 2 patients with fractures of acromial process combined with acromioclavicular dislocation and the fracture of lateral third of clavicle were treated with small "T" plates and clavicular hook plates. RESULTS: Among 11 patients, 9 patients were followed up with an average duration of 9.2 months (ranged from 6 to 12 months). All the fractures were healed without bone nonunion or failure of internal fixators. The average union time was 2.6 months. The profile of articulatio capitis humeri was normal and hibateral articulatio capitis humeri was symmetrical without crispation, descensus, adduct and adtorsion of articulatio capitis humeri or other abnormity. According to the Constant-Murley evaluation system, the score ranged from 69 to 100, with an average of 89.7, which included average pain score of 10 to 15, daily activities score of 14 to 20, myodynamia score of 15 to 25, territory score of 34 to 40. CONCLUSION: The double injuries of SSSC should be treated by types to recover the integrity and constancy of SSSC.

[Treatment of tarsometatarsal joint injury combined with metatarsal fracture by open reduction and internal fixation].

OBJECTIVE: To evaluate the therapy and the key points of the tarsometatarsal joint injury combined with metatarsal fracture. METHODS: From Jan. 2006 to Jul. 2008,19 patients with tarsometatarsal joint injury combined with metatarsal fracture were treated with opened reduction and internal fixation of Kirschner wire or screws, included 13 males and 6 females with an average age of 38.1 years ranging from 21 to 56 years. The classification of tarsometatarsal joint injury showed that there were 2 cases of inner column injury, 5 cases of inner and medial column injury, 3 cases of lateral and medial column injury, 9 cases of tri-column injury. There were 8 cases of shaft fracture, 7 of neck fracture, 19 of foundation fracture. RESULTS: All the incisions were first stage healed without skin necrosis. The healing time of fracture was 11.2 weeks on average. All the patients were followed-up for 6 to 17 months with an average of 12.8 months. According to the standard of AOFAS, the average score was (84.500 +/- 8.553), the results were excellent in 4 cases, good in 9 cases, fair in 3, and poor in 3. The regular daily life was recovered after 6.4 months, 3 patients suffer from mild osteoarthritis. CONCLUSION: No matter which fixed mode was used, the anatomical reduction was the most important to rebuild arches of the foot and recover medial longitudinal and lateral arch. Rebuilding arches of the foot guaranteed the integrity of the stress point scaffold and avoided the pain and limp. The anatomical reduction of tarsometatarsal joint and metatarsal was also important to rebuild the function of foot.

Platelet-derived growth factor enhances platelet recovery in a murine model of radiation-induced thrombocytopenia and reduces apoptosis in megakaryocytes via its receptors and the PI3-k/Akt pathway.

BACKGROUND: Platelet-derived growth factor is involved in the regulation of hematopoiesis. Imatinib mesylate, a platelet-derived growth factor receptor inhibitor, induces thrombocytopenia in a significant proportion of patients with chronic myeloid leukemia. Although our previous studies showed that platelet-derived growth factor enhances megakaryocytopoiesis in vitro, the in vivo effect of platelet-derived growth factor in a model of radiation-induced thrombocytopenia has not been reported. DESIGN AND METHODS: In this study, we investigated the effect of platelet-derived growth factor on hematopoietic stem/progenitor cells and platelet production using an irradiated-mouse model. We also explored the potential molecular mechanisms of platelet-derived growth factor on thrombopoiesis in M-07e cells. RESULTS: Platelet-derived growth factor, like thrombopoietin, significantly promoted the recovery of platelets and the formation of bone marrow colony-forming unit-megakaryocyte in irradiated mice. Histology confirmed the protective effect of platelet-derived growth factor, as shown by an increased number of hematopoietic stem/progenitor cells and a reduction of apoptosis. In a megakaryocytic apoptotic model, platelet-derived growth factor had a similar anti-apoptotic effect as thrombopoietin on megakaryocytes. We also demonstrated that platelet-derived growth factor activated the PI3-k/Akt signaling pathway, while addition of imatinib mesylate reduced p-Akt expression. CONCLUSIONS: Our findings show that platelet-derived growth factor enhances platelet recovery in mice with radiation-induced thrombocytopenia. This radioprotective effect is likely to be mediated via platelet-derived growth factor receptors with subsequent activation of the PI3-k/Akt pathway. We also provide a possible explanation that blockage of platelet-derived growth factor receptors may reduce thrombopoiesis and play a role in imatinib mesylate-induced thrombocytopenia.

[Error diagnosis and inappropriate treatment for Essex-Lopresti injury in 2 cases].

OBJECTIVE: To analyze the reason of error diagnosis and inappropriate treatment of radius head fractures complicating distal radioulnar joint dislocation (Essex-Lopresti injury) and to seek for the reasonable treatment. METHODS: From 2008 to 2009, 2 male patients of radius head fractures complicating distal radioulnar joint dislocation were treated, the age was 56 and 66 years old respectively. The symptom included elbow swelling and limitation of forearm rotation. X-ray showed comminuted fractures of capitulum radius. There were 1 case of Mason type III and 1 cases of type IV. Two patients were treated by resection of capitulum radius and plaster fixation after operation. RESULTS: Both of the 2 cases had limited rotation of forearm and the distal radioulnar joint pain. The X-ray showed that the distal radioulnar joint was separated obviously and the proximal radius was translocated. CONCLUSION: The early diagnosis is very important for the Essex-Lopresti injury. Rebuilding the longth of the radius and reduction fixating the distal radioulnar joint after fixated is an effective treatment while the interosseous membranes can't be repaired and rebuilded.