Objective To discuss the complications following internal fixation of intra-articular calcaneal fractures and its prevention and treatment. Methods From January 1997 to July 2002, 59 sides of calcaneal fractures in 54 patients were treated with open reduction and Y-shaped plate fixation through lateral approach, most of them supplemented by autogenous bone grafting. According to Sanders classification, 20 sides were accounted for typeⅡ, 24 for type Ⅲ, 15 for type Ⅳ. During operation, lateral roentgenograms were made to assess Bler angle and Gissane angle, Broden view was made to evaluate congruency of the posterior facet. The wounds were drained underneath the lateral flap to prevent hematoma formation. Perioperative antibiotics were used routinely. All the cases were followed-up for an average of 17 months(range, 9 to 48 months). Results The clinical results were evaluated according to Maryland Foot Score, excellent results achieved in 30 cases, good in 21, fair in 6, poor in 2; excellent and good rate was 86.4%. Early complications were found in 4 cases(6.8%). Among them, 2 cases of wound necrosis were treated with suture after resection of necrotic tissue or covered with flap grafts, 1 case of wound infection recovered after dressing changes, 1 case of sural nerve injury recovered uncompletely without any special treatment. Late complications were found in 2 cases(3.4%) with obvious chronic pain, the patients were treated by subtalar arthrodesis and relieved from pain later. Conclusion The complications of internal fixation to fractures are related to anatomic features of calcaneus and their injury mechanism. Serious complications can be minimized in several ways as follows: optimal time for operation and preoperative design should be carefully considered, a full-thickness flap is recommended in avoidance of excessive distraction, bone grafting is needed to support intra-articular fracture fragments and to enhance the stability of internal fixation, the affected extremity should be immobilized by plaster and elevated, and perioperative use of antibiotics.The appropriate management should be taken in cases of complications.

0.05), except PYM-AMS of 1.130 mg/ml and PYM of 300 ?g/ml at 24 h.In the same group and at the same exposure time,higher dose of the corresponding agents showed higher growth inhibition ratio(P0.05).At the same doses 48 h exposure of PYM-AMS or PYM gave higher apoptosis rate than 24 h exposure(P

Objective: To evaluate the effect of pingyangmycin-albumin microspheres (PYM-AMS) on the modality of endothelial cells. Methods:In the in vitro study blood vessle endothelial cells of ECV 304 cell line were exposed to PYM-AMS(containing PYM at 150 ?g/ml),AMS and PYM(150 ?g/ml) for 24,48,72 and 96 h respectively. In the in vivo study,24 Japanese white rabbits were divided into 4 groups using randomized block design. PYM+9 g/L NaCl,PYM+soyabean oil, PYM-AMS+soyabean oil(PYM at 5 mg/ml) were injected into the central auricular arteries of the animals(0.26 ml/per ear), then these vessels were examined histologically 2, 7, 14, 21 days after injection respectively. The mophorlogy of the cells was observed by light microscope and electron microscope.Results:In vitro, a great part of cells were swollen and cell number decreased in PYM and PYM-AMS group. But there was no change in AMS group.In vivo, the endothelial cells had no significant changes in PYM+9 g/L NaCl group.In PYM+soyabean oil group, at the 2nd day, the endothelial cells were a little bit swollen. At the 7th day, some endothelial cells were dropped off. At the 21st day, a few of endothelial cells were proliferative. In PYM-AMS group, at the 2nd day, the endothelial cells were a little bit swollen and small vessels were embolized by PYM-AMS. At the 7th day, the endothelial cells were swollen. At the 14th day, the endothelial cells were proliferative and the wall of the central auricular artery had more layers. The lumen of the central artery became smaller, while the surface of PYM-AMS was absorbed. At the 21st day, the wall of the central auricular artery was proliferative and the artery became sclerostenosed. The PYM-AMS was obviously absorbed, while the wall of small vein was proliferative, too. Conclusion:PYM-AMS and PYM may injure blood vessel endothelial cells, the effect of PYM-AMS is more obvious than pingyangmycin.

On the basis of analyzing the transition and development trend of current medical and pharmaceutical mode,this article proposed that in the process of pharmacy talents training,not only biological,but also the construction of natural drugs knowledge should be stressed.In addition,the necessity of natural drugs knowledge construction as well as its practice and future blueprint in our university were illuminated intensively,in order to provide reference for the training of pharmacy talents in local colleges.

Objective To investigate the application value of enhanced recovery after surgery(ERAS) in laparoscopic pancreaticoduodenectomy (LPD).Methods The retrospective cohort study was adopted.The clinical data of 64 patients who underwent LPD from January 2014 to January 2016 in the Shangjin Hospital of West China Hospital of Sichuan University were collected.Of the 64 patients,41 patients managed with ERAS program between March 2015 and January 2016 were allocated into the ERAS group,23 patients managed with traditional perioperative treatment between January 2014 and Febuary 2015 were allocated into the traditional group.The following indexes were observed:(l) intraoperative status:operation time,volume of intraoperative blood loss,conversion to open surgery,pylorus preservation.(2) Postoperative status:the time to out-of-bed activity,time to postoperative flatus,time of drainage tube removal,postoperative complications (pancreatic leakage,bile leakage,hemorrhage,delayed gastric emptying,abdominal infection,cardiovascular complications),duration of postoperative hospital stay,death within the postoperative 30 days.(3) Follow-up status:incidence of complications after discharge and survival of patients.The follow-up including incidence of complications after discharge and survival of patients was conducted by outpatient examination and telephone interview up to March 2016.Measurement data with normal distribution were presented as (x) ± s and analyzed by t test.Count data were analyzed using the chi-square test or Fisher exact probability.Results (1) Intraoperative status:the operation time,volume of intraoperative blood loss,number of patients with conversion to open surgery and pylorus preservation were (377 ± 38) minutes,(164 ± 48) mL,1,40 in the ERAS group and (392 ± 53) minutes,(152 ±31)mL,2,21 in the traditional group,showing no statistically significant difference between the 2 groups (t =5.02,8.43,x2=1.29,1.29,P ＞ 0.05).(2) Postoperative status:the time to out-of-bed activity,time to postoperative flatus,time of drainage tube removal and duration of postoperative hospital stay were (1.7 ± 0.6)days,(2.5 ± 0.6) days,(5.3 ± 1.7) days,(9.1 ± 1.3) days in the ERAS group and (2.1 ± 0.9) days,(3.8 ±1.2) days,(8.2 ± 2.6) days,(11.9 ± 1.8) days in the traditional group,showing statistically significant differences between the 2 groups(t =-5.28,-7.01,-16.20,-10.67,P ＜ 0.05).The numbers of patients with pancreatic leakage in stage A,B and C,bile leakage,hemorrhage,delayed gastric emptying,abdominal inflection,cardiovascular complications and death in the postoperative 30 days were 8,0,0,0,1,3,0,1,1 in the ERAS group and 5,1,0,1,1,3,2,1,0 in the traditional group,respectively,showing no significant difference between the 2 groups (x2=0.37,1.81,0.18,0.57,3.68,0.18,P ＞0.05).(3) Follow-up status:the 64 patients were followed up for a median time of 11 months (range,1-25 months).During the follow-up,number of patients complicated with diabetes,local tumor recurrence,liver metastasis and death were 5,4,1,0in the ERAS group and 2,5,2,3 (2 died of tumor recurrence and 1 died of myocardial infarction) in the traditonal group.Conclusion Application of ERAS in the perioperative management of LPD is safe and effective,meanwhile,it can accelerate the recovery of patients who underwent LPD and shorten the duration of hospital stay.

OBJECTIVETo evaluate the anesthetic effects and safety of Gow-Gates technique of inferior alveolar nerve block in impacted mandibular third molar extraction.

METHODSA split-mouth study was designed. The bilateral impacted mandibular third molar of 32 participants were divided into Gow-Gates technique of inferior alveolar nerve block (Gow-Gates group) and conventional technique of inferior alveolar nerve block (conventional group) randomly with third molar extracted. The anesthetic effects and adverse events were recorded.

RESULTSAll the participants completed the research. The anesthetic success rate was 96.9% in Gow-Gates group and 90.6% in conventional group with no statistical difference ( P= 0.317); but when comparing the anesthesia grade, Gow-Gates group had a 96.9% of grade A and B, and conventional group had a rate of 78.1% (P = 0.034). And the Gow-Gates group had a much lower withdrawn bleeding than conventional group (P = 0.025). Two groups had no hematoma.

CONCLUSIONGow-Gates technique had a reliable anesthesia effects and safety in impacted mandibular third molar extraction and could be chosen as a candidate for the conventional inferior alveolar nerve block.

Anesthesia, Dental ; Anesthetics ; Female ; Humans ; Injections ; Mandible ; Mandibular Nerve ; Molar ; Molar, Third ; Nerve Block ; Tooth Extraction

OBJECTIVEThe purpose of this study was to investigate the indication and therapeutic effects of Pingyangmycin injection as a primary therapy of lymphangiomas in oral, maxillofacial and cervical region.

METHODSA total of 195 patients (106 males and 89 females) with lymphangiomas in oral and maxillofacial regions were treated in the affiliated dental hospital of Sichuan University from May 1990 to December 2000. The patients' ages ranged from 0.5 to 46 years. The tongue was the most commonly involved site, followed by the cheek and the neck. The 200 lymphangiomas (5 patients had 2 lymphangiomas in different sites) underwent the therapy of Pingyangmycin, which was injected as with 1 mg/ml in saline. The total dose of Pingyangmycin ranged from 5 mg to 70 mg and 5 to 58 times, 1 time per 2-4 weeks.

RESULTSThe curative rate of cystic-type lymphangiomas was the highest. Of the 51 cystic lymphangiomas, 110 capillary lymphangiomas, 18 cavernous lymphangiomas and 21 combinations of capillary and cavenous lymphangiomas, the curative rates were respectively 100% (51), 46.36% (51), 16.16% (3) and 19.05% (4), which showed a significant therapeutic effect, respectively. And 40(78.43%), 19(17.27%), 2(11.11%) and 0(0%) of them completely disappeared. There was no serious side effect with Pingyangmycin-injection treatment, such as pulmonary fibrosis.

CONCLUSIONThe treatment of injection of Pingyangmycin is a selective primary method of lymphangiomas, which can reduce the size of lymphangiomas, and make them completely disappeared.

Adolescent ; Adult ; Antibiotics, Antineoplastic ; administration & dosage ; Bleomycin ; administration & dosage ; analogs & derivatives ; Child ; Child, Preschool ; Dexamethasone ; administration & dosage ; Drug Administration Schedule ; Female ; Head and Neck Neoplasms ; drug therapy ; Humans ; Infant ; Injections, Intralesional ; Lymphangioma ; drug therapy ; Male ; Mouth Neoplasms ; drug therapy ; Tongue Neoplasms ; drug therapy

Objective:To analyze the influencing factors of the medical insurance balance of hospitalization expenses for gastric cancer surgery patients under DRG payment, for reference for promoting the reform of DRG payment in public hospitals and controlling hospitalization expenses reasonably.Methods:The gastric cancer patients enrolled in the gastroenterology department of a tertiary comprehensive hospital from January to July 2022 were selected as the research subjects. The indicators such as patient age, medical insurance balance, hospitalization expenses and their composition were extracted from the hospital information management system and the medical insurance settlement system a certain city. Descriptive analysis was conducted for all data, and stepwise multiple linear regression was used to analyze the influencing factors of patients′ medical insurance balance. Monte Carlo simulation method was used to simulate different combination scenarios of various influencing factors to analyze the probability of medical insurance balance.Results:A total of 205 patients were contained, including 117 in the medical insurance balance group and 88 in the loss group. The difference in hospitalization expenses and medical insurance balance between the two groups of patients were statistically significant ( P<0.05). The intervention of medical insurance specialists, correct DRG enrollment, parenteral nutrition preparation costs, anti infective drug costs, examination costs, and consumables costs were the influencing factors of patient medical insurance balance ( P<0.05). Through Monte Carlo simulation verification, patients with different cost parenteral nutrition preparations, or different anti infective drug schemes had the higher probability of medical insurance balance in the scenario where the medical insurance commissioner intervenes and the DRG enrollment was correct. Conclusions:The hospital adopted interventions from medical insurance specialists to ensure the correct DRG enrollment of patients, accurate use of parenteral nutrition and anti infective drugs, and reasonable control the cost of examinations and consumables, which could increase the probability of medical insurance balance for gastric cancer surgery patients. In the future, hospitals should further promote the procurement of drug consumables in bulk, reduce unnecessary examinations, develop standardized perioperative nutritional interventions and anti infection treatment pathways, ensure the accuracy of DRG enrollment, optimize clinical diagnosis and treatment pathways to improve the efficiency of medical insurance fund utilization and provide high-quality medical services for patients.

BACKGROUNDThis study was designed in an attempt to determine the influence of neoadjuvant chemotherapy on estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (Her-2), and Ki-67 expressions in patients with breast cancer.

METHODSPre- and post-neoadjuvant chemotherapy, paired-tumor specimens from 103 patients with breast cancer administrated with anthracycline or anthracycline combined taxane regimen were collected. Immunohistochemical staining for ER, PR, Her-2, and Ki-67 was performed by the DAKO EnVision method.

RESULTSAmong the 103 cases, five patients (4.9%) had a complete response (CR), 82 (79.6%) partial response (PR), 15 (14.6%) stable disease (SD), and one (0.9%) progressive disease (PD), yielding an overall response rate (CR + PR) of 84.5%. Nine patients achieved pathological CR. There was a significant decrease in the average index of Ki-67 postneoadjuvant chemotherapy, compared with that before chemotherapy (24.1% vs. 39.7%, P < 0.001). After neoadjuvant chemotherapy, the changes of Ki-67 in different subtypes of breast cancer were different (P < 0.001), and these changes correlated with response to neoadjuvant chemotherapy (P < 0.001). No significant changes in immunohistochemical expression were observed for ER, PR and Her-2.

CONCLUSIONSNeoadjuvant chemotherapy apparently reduced Ki-67 index in primary breast carcinomas, but profiles for ER, PR and Her-2 were not significantly different before and after neoadjuvant chemotherapy. The change of Ki-67 correlated with molecular subtypes and response to neoadjuvant chemotherapy, suggesting that Ki-67 index was a surrogate marker to predict the treatment response of neoadjuvant chemotherapy.

Adult ; Aged ; Anthracyclines ; therapeutic use ; Breast Neoplasms ; drug therapy ; metabolism ; therapy ; Bridged-Ring Compounds ; therapeutic use ; Female ; Humans ; Immunohistochemistry ; In Vitro Techniques ; Ki-67 Antigen ; metabolism ; Middle Aged ; Neoadjuvant Therapy ; Receptor, ErbB-2 ; metabolism ; Receptors, Estrogen ; metabolism ; Receptors, Progesterone ; metabolism ; Taxoids ; therapeutic use ; Young Adult

Objective: To research the expression levels of FEN1 and PCNA in carcinoma-associated fibroblasts (CAFs) and analyze their correlation. Methods: Fresh specimens of oral squamous cell carcinoma tissues and normal oral mucosal tissues excised during oral and maxillofacial plastic surgery were collected. Primary oral CAFs and normal fibroblasts (NFs) were obtained by tissue culture, identified by immunocytochemistry and divided into the CAF and NF groups. Western blot and quantitative real-time PCR were used to detect the protein and mRNA expression levels of both FEN1 and PCNA in the oral CAFs and NFs. The correlation between FEN1 and PCNA expression in oral CAFs was analyzed. Results: Oral CAFs and oral NFs were successfully cultured and identified from 12 samples. Both the protein and mRNA expression levels of FEN1 and PCNA were higher in the oral CAFs than NFs, but there were no significant differences (P > 0.05). In the oral CAFs, the linear correlation coefficient between FEN1 and PCNA was 0.677 (P = 0.016) at the mRNA level, indicating a strong positive correlation; however, at the protein level, no correlation was found (P > 0.05). Conclusion In primary cultured oral CAFs and NFs, there were no significant differences in the FEN1 and PCNA protein and mRNA expression levels. However, in the CAFs, the mRNA levels of FEN1 and PCNA had a strong positive correlation. The relationship and the regulatory mechanism of the two genes require further study.