Case Report: A testicular torsion as an initial presentation of a patient with metastatic cecum signet-ring cell cancer.

Secondary neoplasms of the testes from solid tumors are rare and usually present as a painless mass. Metastatic cecum signet-ring cell cancer of the testis is extremely rare. The orchioncus usually shows hypervascularity on color Doppler ultrasound. The present study reports an unusual case of testicular secondary signet-ring cell carcinoma mimicking missed testicular torsion in a 55-year-old male patient with right scrotal swelling and intermittent pain for 10 days. As color Doppler ultrasound showed an avascular distribution of the enlarged right testis, missed testicular torsion was initially diagnosed. Right-sided orchiectomy was performed, and pathology of the resected testis revealed an intestinal-type adenocarcinoma with mucinous and signet-ring cell features. This pathological feature led to further endoscopic colorectal biopsy of the digestive tract, which revealed poorly differentiated adenocarcinoma of the cecum with signet ring cell features similar to those of testicular specimens. In conclusion, differential diagnosis should be considered for rare testicular neoplasms, as was seen in this rare occurrence of testicular torsion in a patient who initially presented with metastatic colorectal cancer. A correct preoperative diagnosis can change the management and outcome. This report shares our reasons for misdiagnosis and opinions on diagnosing and treating this kind of case.

Operative versus nonoperative treatment of isolated Mason type Ⅱ radial head fracture / 中华创伤骨科杂志

Objective:To compare the outcomes of isolated Mason type Ⅱ radial head fracture between operative and non-operative treatments.Methods:A retrospective study was conducted to analyze the data of patients who had been treated for isolated Mason type Ⅱ radial head fracture either operatively or nonoperatively at Department of Trauma and Orthopaedics, Beijing Jishuitan Hospital, Capital Medical University from January 2017 to October 2020. The patients were divided into a non-operative group and an operative group according to their treatment method. After 1:1 propensity score matching method was used to match the patients in the 2 groups, a total of 58 pairs of patients were successfully matched. In the operative group, there were 24 males and 34 females with a mean age of (40±14) years and a body mass index of (23.7±3.4) kg/m 2; in the non-operative group, there were 22 males and 36 females with a mean age of (42±13) years and a body mass index of (23.5±3.9) kg/m 2. Elbow flexion-extension, forearm rotation, Mayo elbow performance score (MEPS), Quick-disabilities of the arm, shoulder and hand (q-DASH) score and complications were compared between the 2 groups. Results:There was no significant difference in the baseline data between the 2 groups, indicating comparability ( P>0.05). All the patients were followed up for (24±9) months. At the last follow up in the operative and the non-operative groups, respectively, the elbow flexion-extension was 134° (132°, 136°) and 134°(131°, 136°), the forearm rotation 176° (174°, 179°) and 178° (175°, 179°), the MEPS 100 (100, 100) and 100 (100, 100), the q-DASH score 0 (0, 0) and 0 (0, 0), showing no significant differences between the 2 groups in the above items ( P>0.05). Elbow pain was reported respectively in 4 (6.9%) and 6 (10.3%) patients in the operative and non-operative groups, showing no significant difference between the 2 groups ( P>0.05). Conclusion:The outcomes of operative and non-operative treatments of isolated Mason type Ⅱ radial head fracture are comparable.

Compliance with enhanced recovery after surgery protocol in geriatric patients with fresh fracture / 中华创伤骨科杂志

Objective:To analyze the compliance with enhanced recovery after surgery (ERAS) protocol in geriatric patients with fresh fracture.Methods:A retrospective study was conducted on the data of the patients with fresh extremity fracture which had been included in the ERAS perioperative protocol database during May 2019 and January 2022 at Department of Orthopaedic Trauma, Beijing Jishuitan Hospital. The patients ≥65 years were selected as a study group which was matched by a control group of the patients < 65 years in sex, fracture type and date frame of hospitalization at a ratio of 1∶1. The 2 groups were compared in the compliance with the 14 ERAS core perioperative elements.Results:The study group and the control group each included 66 patients who were matched in sex and fracture type. 62.1% (41/66) of the patients in the study group had combined diseases, significantly more than that [16.7% (11/66)] in the control group( P<0.001). Altogether, the compliance with the 14 ERAS core perioperative elements was 78.6 (71.4, 85.7) % in both groups, showing no significant difference between them ( P>0.05). Respectively, the compliance with the postoperative oral intake in the study group (80.3%, 53/66) was significantly lower than that in the control group (92.4%, 61/66) ( P<0.05); the compliance with the other 13 elements showed no statistically significant difference between the 2 groups ( P>0.05). Conclusion:The ERAS perioperative protocol can be carried out smoothly in geriatric patients with fresh fracture whose compliance may be comparable to that of the none-elderly patients.

Preoperative imaging and intraoperative stress test for Weber type B ankle fracture without medial malleolus fracture / 中华创伤骨科杂志

Objective:To explore the characteristics and clinical values of preoperative imaging signs and intraoperative stress test in the surgery of the Weber type B fracture without medial malleolar fracture.Methods:The data of 52 patients were reviewed who had been treated at Orthopaedic Trauma Department, Beijing Jishuitan Hospital for Weber type B ankle fracture without medial malleolar fracture from January 2018 to December 2021.They were assigned into 2 groups depending on their results of intraoperative stress test. In the positive group of 21 cases showing a positive intraoperative stress test, there were 19 males and 2 females with an age of (34.4±10.2) years; in the negative group of 31 cases showing a negative intra operative stress test, there were 22 males and 9 females with an age of (39.5±14.8) years. The 2 groups were compared in terms of the medial clear space, tibiofibular clear space and vertical length of the fibular fracture on the preoperative X-ray film, as well as the relative size of the posterior malleolar fracture fragment on the preoperative CT. The imaging characteristics of intraoperative stress tests were also observed.Results:There was no significant difference between the 2 groups in the preoperative general data, showing comparability between groups ( P>0.05). The medial clear space (7.2±2.5) mm and the vertical length of the fibular fracture [49.2 (33.7, 58.7) mm] in the positive group were significantly larger than those in the negative group [(4.5±1.7) mm and 29.6 (24.7, 36.0) mm] ( P<0.05). There was no significant difference between the 2 groups in the lower tibiofibular space [(6.0±1.9) mm versus (5.2 ± 1.4) mm] or in the relative size of posterior malleolar fracture measured by CT [15.8% (6.9%, 19.1%) versus 12.7% (0%, 18.9%)] ( P>0.05). The intraoperative stress test imaging data of a total of 22 cases were collected from the 2 groups (11 cases from each of the 2 groups). During the stress test, only the medial clear space was widened with no widening of the inferior tibiofibular space was found in 7 cases (5 cases in the positive group and 2 cases in the negative group). Conclusions:A routine stress test is recommended for Weber B ankle fracture without medial malleolus fracture, because instability sometimes exists after fibular fixation. Patients with a wider medial clear space and a longer fibular fracture line on X-ray after injury are more likely to be afflicted by instability after fibular fixation. In the patients with a widened medial clear space but without a widened inferior tibiofibular clear space during an intraoperative stress test, it calls for further study whether it is necessary to fix the inferior tibiofibular joint.

Characterization of 20 cases of humeral head necrosis after complex proximal humeral fracture / 中华创伤骨科杂志

Objective:To characterize the humeral head necrosis after open reduction and anatomic locking plate fixation of complex proximal humeral fractures.Methods:A retrospective study was conducted of the 20 patients who had been treated for humeral head necrosis after surgery of complex proximal humeral fracture at Department of Traumatic Orthopaedics, Beijing Jishuitan Hospital from September 2012 to June 2020. They were 7 males and 13 females with an average age of 57.4 years (from 35 to 84 years). Analyzed were their fracture types, time for diagnosis of humeral head necrosis, length of the medial residual bone, thickness of the humeral head and shoulder function.Results:The 20 patients were followed up for 8 to 104 months (average, 48.3 months). According to the Neer classification, there were 8 three-part fractures and 12 four-part fractures; shoulder dislocation was complicated in 10 cases. According to the AO-OTA classification, there were 16 type C fractures and 4 type B fractures. The length of the medial residual bone averaged 4.8 mm (from 0 to 10.7 mm); the medial soft tissue hinge was damaged in 18 cases and the thickness of the humeral head averaged 20.6 mm (from 13.6 to 33.0 mm). All fractures got united at the first stage after an average time of 8.4 weeks (from 5 to 12 weeks). The time for diagnosis of humeral head necrosis averaged 16.5 months (from 8 to 24 months). At the final follow-up, the Constant-Murley score of the affected side averaged 53.4 (from 22 to 74) while that of the healthy side 85.5 (from 53 to 98), with a ratio of affected side to healthy side of 62.43% (from 27.95 to 82.70%).Conclusions:Necrosis of the humeral head was common after surgery for complex proximal humerus fractures, most of which were three- or four-part ones or combined with shoulder dislocation. In most of the patients, the medial soft tissue hinge was damaged and the length of the residual medial bone usually shorter than 8 mm. Necrosis of the humeral head happened late after surgery. The function of the affected shoulder was significantly lower than that of the healthy side.

Trans-subscapularis approach for treatment of Ideberg type Ⅰa scapular glenoid fractures / 中华创伤骨科杂志

Objective:To evaluate the trans-subscapularis approach in the treatment of Ideberg type Ⅰa scapular glenoid fractures.Methods:A retrospective analysis was conducted in the 16 patients with Ideberg type Ⅰa scapular glenoid fracture who had been treated via the trans-subscapularis approach at Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital from December, 2012 to August 2019. X-ray follow-ups were conducted at 2 weeks, 6 to 8 weeks, 3 months and 12 months, and CT follow-ups at 6 to 8 weeks after operation. The Constant-Murley score and visual analogue scale (VAS) were used at the last follow- up to evaluate the postoperative shoulder function and pain in the patients.Results:The 16 patients were followed up for 9 to 101 months (average, 41.2 months). All fractures achieved bony union after 6 to 8 months (average, 6.8 weeks). The Constant-Murley scores at the last follow-up ranged from 85 to 100 points; the lateral internal rotation scores averaged 8.3 points (from 6 to 10 points), showing the level of the T12 spinous process could be palpated by the back of the hand; the VAS scores averaged 0. No patients reported internal fixation failure, postoperative infection or other complications.Conclusion:The trans-subscapularis approach can be used to treat Ideberg type Ⅰa scapular glenoid fractures due to its satisfactory clinical effects.

Is there a correlation between miR-301a expression and neoadjuvant chemotherapy efficacy in breast cancer tissue?

Neoadjuvant chemotherapy (NAC) is the standard therapeutic regimen for locally advanced breast cancer. However, clinical physical examination and imaging results fail to accurately assess the treatment response, and postoperative pathological examination has a time lag in response to therapeutic effect which is not conducive to the timely adjustment of treatment strategies. A previous study has shown that miR-301a was associated with invasion and metastasis in breast cancer, and was found to be involved in endocrine therapy resistance; however, evidence regarding the correlation between miR-301a expression and NAC efficacy remains scarce. In this study, 101 patients with locally advanced breast cancer were included. All patients received anthracycline based chemotherapy. The expression level of miR-301a in pretreatment core needle biopsy tissues was determined by real-time polymerase chain reaction analysis. Relevant clinicopathological data were collected, and the correlation between miR-301a expression and NAC efficacy was assessed. Based on our data, miR-301a cannot be used to identify whether breast cancer benefits from NAC, and no correlation was observed between miR-301a expression and clinicopathological characteristics. In conclusion, miR-301a may not be a potential prognostic biomarker of NAC efficacy in breast cancer.

Treatment of scapular glenoid fractures via the modified Judet approach / 中华创伤骨科杂志

Objective:To analyze the treatment of scapular glenoid fractures via the modified Judet approach.Methods:A retrospective study was conducted of the 25 patients who had been treated for scapular glenoid fractures via the modified Judet approach and completely followed up at Department of Orthopaedic Trauma, Beijing Jishuitan Hospital from January 2014 to January 2020. They were 19 males and 6 females with an average age of 46 years (from 29 to 66 years). According to the Goss-Ideberg classification, 8 cases were diagnosed as type Ⅱ, 2 cases as type Ⅳ, 10 cases as type Ⅴ and 5 cases as type Ⅵ. 3D reconstruction of the CT scans by software Mimics 16.0 was made to confirm the diagnoses and classifications of the fractures. Articular step-off and displacement of the scapular glenoid were calculated and recorded. The functional outcomes were evaluated by Constant-Murley scoring system at 6 months postoperatively.Results:Preoperatively, the mean articular step-off was 5.8 mm (from 1.2 to 6.3 mm) and the mean displacement 7.7 mm (from 2.1 to 12.9 mm). All fractures obtained bony union within postoperative 6 months. The mean follow-up period was 58.8 months (from 7 to 92 months). The forward flexion was 158.6° (from 125° to 180°) and the external rotation 39.0° (from 30° to 45°) at 6 months postoperatively. The mean Constant-Murley score was 92.6 (from 75 to 100) at 6 months post-operatively; 19 cases were excellent (76%), 5 were good (20%) and one was fair (4%), giving an excellent to good rate of 96% (24/25).Conclusion:For scapular glenoid fractures of Goss-Ideberg types Ⅱ/Ⅳ/Ⅴ/Ⅵ, surgery via the modified Judet approach may promise satisfactory reduction and fixation and fine clinical outcomes.

Treatment of extra-articular scapular fractures with assistance of 3D reconstruction measurements with Mimics software / 中华创伤骨科杂志

Objective:To investigate a 3D method of radiological evaluation of extra-articular scapular fracture and the treatment outcomes.Methods:A total of 19 patients with extra-articular scapular fracture were operatively treated and completely followed up at Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital from January 2014 to January 2020. They were 17 males and 2 females with an average age of 41 years (from 24 to 65 years). The medial-lateral displacement, antero-posterior angulation and glenopolar angle were measured on images of 3D reconstruction of the fractured scapulae by Mimics software. 3D reconstructions of the intact scapulae were made as controls in the patients with proximal humerus fracture matched in time and age (17 males and 2 females with an average age of 41 years). Operations were carried out via the modified Judet approach in the experimental group. The treatment outcomes in the experimental group were evaluated by the Constant-Murley absolute value scoring at 6 months after operation.Results:All the patients in the experimental group obtained a mean follow-up of 48 months (from 11 to 73 months). All fractures in the experimental group acquired anatomical reduction and fixation intraoperatively and bony union within 6 months after operation. In the experimental group, the medial-lateral displacement averaged 17.9 mm and the antero-posterior angulation 26.9° before operation while the anteflexion lifting angle 162.2°, the lateral external rotation 41.6°, and the Constant-Murley absolute value scores 93.2 points at 6 months after operation. Pre-operatively, the glenopolar angles were 34.4°±6.3° and 40.6°±6.6° for the experimental and control groups respectively, showing a significant difference between the 2 groups ( P<0.05). At 6 months after operation, the glenopolar angle was 38.4°±5.0° for the experimental group, showing a significant difference between pre- and post-operation ( P<0.05). Conclusions:3D reconstruction measurements with Mimics software help accurate characterization of extra-articular scapular fracture and evaluation of surgical indications. Open reduction and internal fixation of scapular fractures via the modified Judet approach may promise a satisfactory union rate and functional outcomes.

Factors influencing postoperative early ambulation in patients with fresh fracture based on concept of enhanced recovery after surgery / 中华创伤骨科杂志

Objective:To analyze the factors which may influence postoperative early ambulation in patients with fresh fracture so as to further optimize the perioperative protocol based on the concept of enhanced recovery after surgery (ERAS).Methods:A retrospective analysis was conducted of the patients who had been treated for a single fresh fracture at the extremity, pelvis or acetabulum from May 2019 to July 2019. Collected were the data concerning basic features of patients, perioperative ERAS management and surgery, as well as early ambulation on the day of surgery or the first day after surgery. The patients were divided into an early ambulation group and a non-early ambulation group according to the time of ambulation. Statistical analyses were performed of the relationships between early ambulation and 20 potential factors concerning basic features of patients, perioperative ERAS management and surgery. Logistic correlation analysis was performed to identify risk factors for postoperative early ambulation.Results:A total of 306 patients were included, including 96 upper limb, 203 lower limb, 5 acetabular and 2 pelvic fractures. Of them, 150 ambulaed from bed on the day of surgery or the first day after surgery while 156 did not. Significant differences were observed between the 2 groups in fracture site, intake of carbohydrate liquids the night before surgery and the day of surgery, catheter indwelling, intraoperative liquid transfusion volume and postoperative complications ( P < 0.05). Logistic correlation analysis of the relationship between the above factors and postoperative early ambulation found that fracture site and intraoperative liquid transfusion volume were significantly correlated with postoperative early ambulation ( P < 0.05). Conclusions:About half of the patients with a single fresh fracture may ambulate early after surgery. Fracture site and intraoperative liquid transfusion volume may be significantly correlated with postoperative early ambulation.

Open reduction and internal fixation for old displaced fractures of humeral greater tuberosity / 中华创伤骨科杂志

Objective:To investigate the operative treatments of old displaced fractures of humeral greater tuberosity and their related factors.Methods:A retrospective study was conducted of the 16 patients who had received operative treatment at Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital for old displaced fractures of humeral greater tuberosity from November 2010 to March 2019 and whose complete follow-up data were available. They were 9 males and 7 females with an average age of 61 years(from 40 to 77 years). The original injury was accompanied by shoulder dislocation in 12 cases; the original displaced fracture of humeral greater tuberosity was not surgically treated in time in 8 cases; the primary surgical treatment did not lead to effective fracture reduction in 4 cases; the fracture of humeral greater tuberosity was displaced again after surgical treatment in 4 cases. Anterior displacement was observed in 2 cases, posterior displacement in 3 cases and superior displacement in 11 cases. The duration between the onset of displacement and the last operation averaged 5 months, and the displacement distance 16.5 mm. The Constant-Murley and visual analogue scale(VAS) scores were compared between preoperation and 6 months postoperation.Results:This group of patients obtained a mean follow-up of 55 months(from 16 to 118 months). Anatomical reduction of the greater tuberosity was achieved in 15 cases, leading to uneventful union. Mal-reduction occurred in one patient whose greater tuberosity was found displaced superiorly again by follow-up. For the 16 patients, the Constant-Murley absolute value scores were 37.0±11.7 and 91.0±9.9, and the flexion elevation ranges 33.0°±26.7° and 144.0°±38.5°, respectively for preoperation and 6 months postoperation, showing significant improvements between preoperation and 6 months postoperation( P<0.05). The VAS scores were 0.7±1.3 at 6 months postoperation, significantly improved than the preoperative value 4.5±1.0 ( P<0.05). Postoperatively, good shoulder function scores were not obtained by one patient who could still manage to fulfill daily life tasks. Conclusion:Open reduction and internal fixation can result in satisfactory functional outcomes in the treatment of old displaced fractures of the humeral greater tuberosity, depending on different features of fracture displacement.

Enhanced Recovery After Surgery used in close reduction of distal radius fracture in emergency traumatic patients: a prospective cohort study / 中华创伤骨科杂志

Objective To compare the therapeutic effects between the anesthetic and non-anesthetic closed reduction protocols for distal radius fractures based on the concept of Enhanced Recovery After Surgery (ERAS).Methods A prospective study was conducted in a cohort of 186 patients with distal radius fracture who had been admitted to the Department of Orthopaedic Trauma,Beijing Jishuitan Hospital from September 2018 to January 2019.The patients were divided into 2 groups depending on the choice by themselves.Of them,72 (intervention group) underwent the standardized closed reduction under brachial block anesthesia based on the concept of ERAS while the other 114 (control group) conventional closed reduction under no anesthesia.The 2 groups were compared in terms of emergency reduction times,swelling scores,reoperation rate,splint removal time,functional outcomes by the Patient-Rated Wrist Evaluation (PRWE) and radiographic outcomes by the Lidstr(o)m criteria.Results The patients in both groups were followed up for 6 months.The reduction times were fewer in the intervention group than in the control group (1.1 ± 0.1 versus 1.6 ±0.1,P ＜ 0.05).The reoperation rate was significautly lower in the intervention group than in the control group [2.8％ (2/72) versus 12.3％ (14/114),P ＜0.05].Reduction deteriorated the swelling condition.Compared with the control group,the swelling was significantly less in the intervention group (2.0 ± 0.1 versus 2.6 ±0.1,P ＜ 0.05).The splint removal time for the intervention group (5.3 ±0.2 weeks) was significantly shorter than that for the control group (6.9 ± 0.2 weeks) (P ＜ 0.05).The intervention group had significantly better PWRE scores than the control group (23.4 ± 1.0 versus 30.3 ± 1.1,P ＜ 0.05),but there was no significant difference between groups in the Lidstr(o)m evaluation (P ＞ 0.05).Conclusion Compared with conventional closed reduction,the closed reduction under anesthesia based on the ERAS concept is an effective method for the emergency treatment of distal radius fracture,because it may minimize the patients' pain experience,increase the rate of successful reduction,decrease the rate of reoperation,shorten the splint fixation time and gain better functional outcomes.

Case-control study on single locking plate and locking plate with suture anchors for the treatment of unstable distal clavicle fractures / 中国骨伤

OBJECTIVE@#To compare therapeutic effects of single locking plates and locking plates with suture anchors in treating type Neer IIb distal clavicle fractures.@*METHODS@#From January 2013 to January 2015, 40 distal clavicle fractures patients with Neer IIb were treated by retrospectively analyzed and divided into single locking plates (control group) and locking plates with suture anchors(observation group) according to methods of operation. There were 20 patients in control group treated by single locking plates, including 16 males and 4 females aged from 26 to 64 years old with an average of(40.60±12.64) years old; while there were 20 patients in observation group treated by locking plates with suture anchors, including 15 males and 5 females aged from 20 to 57 years old with an average of(37.30±10.56) years old. Length of incisions, operation time, blood loss, hospital stays, fracture healing observed by X-ray, position of internal fixation, and changes of coracoclavicular distance were compared, Constant-Murley score was used to evaluate shoulder joint function.@*RESULTS@#All patients were followed up from 22 to 42 months with an average of (30.08±6.72) months. There was no statistical significance in length of incisions, operation time, blood loss, hospital stays and fracture healing time (>0.05). Constant-Murley score in control group was 83.10±5.81, and lower than that of observation group (92.30±6.05)(<0.05) at final following-up. Coracoclavicular distance in control group (11.22±3.85) mm, was longer than that of observation group (8.71±2.14) mm(<0.05).@*CONCLUSIONS@#Compared with locking plates, locking plates with suture anchors for type Neer IIb distal clavicle fractures has better shoulder joint, shorter coracoclavicular distance. It showed coracoclavicular ligament is an effectiveness method for treating Neer IIb distal clavicle fractures.

Enhanced Recovery After Surgery used in close reduction of distal radius fracture in emergency traumatic patients: a prospective cohort study / 中华创伤骨科杂志

Objective@#To compare the therapeutic effects between the anesthetic and non-anesthetic closed reduction protocols for distal radius fractures based on the concept of Enhanced Recovery After Surgery (ERAS).@*Methods@#A prospective study was conducted in a cohort of 186 patients with distal radius fracture who had been admitted to the Department of Orthopaedic Trauma, Beijing Jishuitan Hospital from September 2018 to January 2019. The patients were divided into 2 groups depending on the choice by themselves. Of them, 72 (intervention group) underwent the standardized closed reduction under brachial block anesthesia based on the concept of ERAS while the other 114 (control group) conventional closed reduction under no anesthesia. The 2 groups were compared in terms of emergency reduction times, swelling scores, reoperation rate, splint removal time, functional outcomes by the Patient-Rated Wrist Evaluation (PRWE) and radiographic outcomes by the Lidström criteria.@*Results@#The patients in both groups were followed up for 6 months. The reduction times were fewer in the intervention group than in the control group (1.1±0.1 versus 1.6±0.1, P<0.05). The reoperation rate was significautly lower in the intervention group than in the control group [2.8%(2/72) versus 12.3%(14/114), P< 0.05]. Reduction deteriorated the swelling condition. Compared with the control group, the swelling was significantly less in the intervention group (2.0±0.1 versus 2.6±0.1, P<0.05). The splint removal time for the intervention group (5.3±0.2 weeks) was significantly shorter than that for the control group (6.9±0.2 weeks) (P<0.05). The intervention group had significantly better PWRE scores than the control group (23.4±1.0 versus 30.3±1.1, P<0.05), but there was no significant difference between groups in the Lidström evaluation (P>0.05).@*Conclusion@#Compared with conventional closed reduction, the closed reduction under anesthesia based on the ERAS concept is an effective method for the emergency treatment of distal radius fracture, because it may minimize the patients’ pain experience, increase the rate of successful reduction, decrease the rate of reoperation, shorten the splint fixation time and gain better functional outcomes.

Antibiotic resistance characteristic and genes analysis of a marine water sourced Klebsiella pneumoniae

Objective:Both antibiotic resistant bacteria (ARBs) and antibiotic resistant genes (ARGs) are considered as one of the most dangerous environmental pollutants in the 21st century by the WHO. This study aims to understand the ARGs of Klebsiella pneumoniae (K. pneumoniae) with multiple drug resistance bacterium from the marine water collected from a beach at Sanya Bay, and to explore the antibiotic resistance mechanism of the K. pneumoniae, providing a basis for exploring the transfer of drug resistance genes of beach, and preventing and controlling the health risk of entertainment population.Methods:The sample of marine water were collected and screened by Mcconkey plate. The drug sensitive test was detected by Merieux VITEK2, The DNA was extracted and one strain of 16srDNA was sequenced and identified as K. pneumoniae. Whole-genome resequencing was performed using Illumina HiseqXten platform, and the obtained sequences were compared with NCBI blasting. The reference bacterium were multi-resistant K. pneumoniae HS11286. Plasmids were extracted and the resistant genes were identified.Results:The ARGs encoding protein was 117/4801 (identity > 40%) and the carrying rate was 2.436 9%. The identity of following ARGs of OKPB, sul1, rpoB, ef-tu, phoP, sul2, AAC(6’)-ib-cr, QnrB, floR, aadA16 were more than 99%. The strain showed resistance to ampicillin, ticacillin/clavulanic acid and chloramphenicol, and was intermediate to ampicillin/sulbactam, compound sulfamethoxazole, ciprofloxacin, minocycline. Preliminary positioning showed that Qnrs, sul1, tetA, cat, QacE were carried on plasmid.Conclusion:The multiple drug resistant bacteria strain has a variety of different resistant phenotypes, some ARGs can be easily spread by plasmid. It probably will bring exposure risk to people for entertainment. Sensibility of some antibiotics were on the brink of resistance, It is necessary to tracking corresponding antibiotics pollution and strengthening monitoring of ARBs and mobile resistant elements of bacteria.

A preliminary investigation into rotator cuff injuries in patients with proximal humeral fracture / 中华创伤骨科杂志

Objective To investigate the incidence and associated factors of rotator cuff injuries in patients surgically treated for proximal humerus fracture.Methods A retrospective investigation was conducted in the patients over 40 years old who had been surgically treated for proximal humeral fracture from April 10th 2017 to December 1st 2017 at Department of Traumatic Orthopaedics,Beijing Jishuitan Hospital.Intraoperative direct visualization was used to collect their clinical data concerning rotator cuff injuries in combination with proximal humeral fracture.All the data were analyzed to find the incidence,gender ratio,age distribution and fracture type distribution concerning rotator cuff injuries.Results A total of 143 eligible patients were included in this investigation.Their average age was 61.95 years and their male-female ratio 1:2.3.The incidence was 46.2％ (66/143) for all the rotator cuff injuries in proximal humerus fracture and 23.1％ (33/143) just for rotator cuff tears.There were no significant differences in age,male to female ratio or distribution of Neer fracture type between patients with rotator cuff injury and those without rotator cuff injury (P ＞ 0.05).There was no significant difference in the age and or distribution of Neer fracture type between patients with rotator cuff tear and patients without rotator cuff tear (P ＞ 0.05).The proportion of females in patients with rotator cuff tears (84.8％,28/33) was significantly higher than that in patients with no rotator cuff tears (63.6％,21/33) (P ＜ 0.05).There was no significant difference between different age groups of the patients in incidence of combined rotator cuff injury (P ＞ 0.05).Conclusions Concomitant rotator cuff injuries are relatively common in patients over 40 years old with a proximal humerus fracture.About half of the injuries may be simple wear or wear plus degeneration while the other half rotator cuff tear happening mostly in female patients.The incidence of concomitant rotator cuff injury may increase with the age of the patients with a proximal humerus fracture.