Objective To evaluate effect of construction with dual plates via olecranon osteotomy approach in treatment of type C distal humeral fractures.Methods The study involved 19 patients with type C distal humeral fractures treated by olecranon osteotomy and double plate fixation between July 2008 and April 2010,including 11 males and 8 females at a mean age of 49.2 years (range,27-71 years).Fractures were causes by traffic accidents in 10 patients,tumble in seven and fall from height in two.According to Association for Osteosynthesis/Orthopaedic Trauma Association (AO/OTA) classification,there were nine patients with type C2 and 10 with type C3 fractures.Besides,two patients were complicated by ulnar nerve injuries and one by radial nerve injury.Results Primary wound healing was achieved in all patients after operation.All patients were followed up for average 15.9 months (range,12-20 months).X-ray films revealed that both fracture and olecranon osteotomy sites were healed in average 12 weeks (range,8-18 weeks).No fixation failure,myositis ossificans,malunion,delayed union or disunion occurred during the follow-up.Average Mayo elbow performance score (MEPS) was 94.8 points (range,75-100 points) at the last follow-up,which showed excellent results in 14 patients,good in three,and fair in two,with excellence rate of 90％.Conclusions Double plate fixation via olecranon osteotomy gains advantages of solid fixation and early functional exercise in treatment of comminuted intercondylar fractures of humerus.Moreover,postoperative outcome is satisfactory.

Objective To investigate the method of surgical treatment of acute intestinal obstruction caused by colorectal cancer,and affirm the feasibility and validity of the new way ofearly precolonic postoperative enteral nutritionafter operation of acute intestinal obstruction caused by colorectal cancer.Methods Retrospective analized the clinical data of 78 cases of acute intestinal obstruction caused by colorectal caner from September 2007 to September 2012 and the incidence of complications (incision infection,intra-abdominal abscess,anastomotic leakage,and pneumonia) was observed.Results Sixty-two patients received radical resection and primary anastomosis.All of them were cured and no death occurred.Two patients had complication of postoperative infection and none suffered from anastomotic or drainage leakage.Conclusion Radical resection and primary anastomosis using Intra-operative colonic lavage are safe and effective methods for patients with colorectal cancer associated with acute intestinal obstruction,and early precolonic postoperative enteral nutritioncould better eliminate perioperative malnourished patients more,reduce operation complication,prevent anastomotic leakage,and increase the success rate of the operation.

Objective To compare the clinical outcome of procedure for prolapse and hemorrhoids (PPH) and PPH + selective Milligan-Morgan hemorrhoidectomy(MMH) in surgical treatment of Ⅲ ～ Ⅳ stage hemorrhoids and research the best surgical procedures.Methods Retrospective analysis was made on the clinical data of 125 cases with Ⅲ ～ Ⅳ stage mixed hemorrhoids,they were non-randomized-controlled divided into PPH group (group 1) and PPH + selective MMH group(group 2),comparing the data of recurrence,complication and symptoms relief including anal prolapse,bleeding,anus fall feeling,wet anus and pruritus ani.Results While observing 3 years after operation,group 1 and group 2 both relieved symptoms of anal prolapse,bleeding,anus fall feeling,wet anus and pruritus ani.The relief rate of these symptoms in the two group were all high than 92%.There was one cases relapsed in the group 2 (the recurrence rate of 2%) was better than the group 1 (the recurrence rate of 13%) which were 8 case,there was a significant statistical significance (x2 =4.629,P ＜ 0.05) in the recurrence and clinical outcome.Conclusion Radical choose of PPH and selective MMH to treat Ⅲ ～ Ⅳ stage mixed hemorrhoids patients,which could relieve postoperative symptoms and acquire better long-term clinic outcomes.

Objective To evaluate the safety and efficacy of low-dose platelet glycoprotein Ⅱb/Ⅲa antagonist tirofiban on preventing reocclusion during mechanical thrombectomy (MT) for in situ thrombosis(IST).Methods It is a retrospective cohort study, and 112 patients treated with MT, from the Nanjing Prospective Stroke Registration, were enrolled from February 2014 to October 2014. During MT, if angiography after a successful recanalization(defined as Thrombolysis In Cerebral Infarction(TICI) 2b/3) showed residual stenosis at the site of occlusion, additional angiographies were made every 10 min for 30 min.Then, if angiography displayed reocclusion in the corresponding vessels, a repeat recanalization was operated, followed by a low dose intra-arterial tirofiban infusion. MRA or CT angiography (CTA) was implemented to identify intracranial atherosclerosis (ICAS) 5-7 days after the procedure. The patients with confirmed ICAS were enrolled in the IST group. The rest were enrolled in the non-in situ thrombosis (NIST) group.Results A total of 80 patients with acute cerebral infarction were enrolled in the study. IST rate was 32.5%(26/80).All IST patients were confirmed ICAS by follow-up vascular imaging. Instant reocclusion after successful recanalization was significantly more common in the IST group(57.7%(15/26) vs 3.7%(2/54);χ2=30.568, P=0.000) than in the NIST group.In the case of the efficacy and safety of low-dose intra-arterial tirofiban infusion, 82.6%(19/23) of the reocclusion patients eventually accomplished TICI 2b/3, the rest 17.4%(4/23) of the cases were intractable to the procedure and needed rescue stent implantation.The modified Rankin Scale scores in patients infusing tirofiban were superior to the unused patients in 90 days. There was no patient with symptomatic intracranial hemorrhage after the procedure. Conclusions Patients with IST have higher cerebrovascular reocclusion rate during MT. After MT, low-dose intra-arterial tirofiban infusion may prevent reocclusion, and the prognosis is better.

OBJECTIVETo study the correlation between adipocytokines levels and metabolic syndrome (MS) in patients with newly diagnosed type 2 diabetes mellitus (T2DM).

METHODSSixty-eight patients with newly diagnosed T2DM, including 51 cases with MS and 17 without MS, were examined for blood pressure (BP), fasting blood glucose (FBG), fasting insulin (FINS), insulin resistance index (IRI), waist to hip ratio (W/H), body mass index (BMI), and serum adipocytokine levels (IL-6, vaspin, and adiponectin).

RESULTSThe diabetic patients with MS had higher BMI, HbA1c, FBG, FINS, IRI, TG, TC, and SBP than those without MS. Serum IL-6 level was higher but adiponectin level was lower in patients with MS than in those without MS. There was no significant difference in vaspin level between the two groups. Adiponectin level was positively correlated with TG (r=-0.30, P=0.02) and inversely with BMI (r=-0.47, P=0.39) and HOMA-IR (r=-0.30, P=0.03); vaspin level was positively correlated with HOMA-IR (r=0.347, P=0.02) and inversely with HDL-L (r=-0.45, P=0.01); IL-6 level was positively correlated with LDL-L (r=0.18, P=0.25) and inversely with HDL-L (r=-0.45, P=0.01).

CONCLUSIONAdiponectin and IL-6 levels are closely related to MS, but the relationship between vaspin and MS needs further investigation.

Adipokines ; blood ; Adiponectin ; blood ; Adipose Tissue ; metabolism ; Adult ; Diabetes Mellitus, Type 2 ; blood ; complications ; Female ; Humans ; Interleukin-6 ; blood ; Male ; Metabolic Syndrome ; complications ; Middle Aged ; Serpins ; blood

Objective To study the correlation between adipocytokines levels and metabolic syndrome (MS) in patients with newly diagnosed type 2 diabetes mellitus (T2DM). Methods Sixty-eight patients with newly diagnosed T2DM, including 51 cases with MS and 17 without MS, were examined for blood pressure (BP), fasting blood glucose (FBG), fasting insulin (FINS), insulin resistance index (IRI), waist to hip ratio (W/H), body mass index (BMI), and serum dipocytokine levels (IL-6, vaspin, and adiponectin). Results The diabeitc patients with MS had higher BMI, HbA1c, FBG, FINS, IRI, TG, TC, and SBP than those without MS. Serum IL-6 level was higher but adiponectin level was lower in patients with MS than in those without MS. There was no significant difference in vispin level between the two groups. Adiponectin level was positively correlated with TG (r=-0.30, P=0.02) and inversely with BMI (r=-0.47, P=0.39) and HOMA-IR (r=-0.30, P=0.03); vispin level was positively correlated with HOMA-IR (r=0.347, P=0.02) and inversely with HDL-L (r=-0.45, P=0.01);IL-6 level was positively correlated with LDL-L (r=0.18, P=0.25) and inversely with HDL-L (r=-0.45, P=0.01). Conclusion Adiponectin and IL-6 levels are closely related to MS, but the relationship between vispin and MS needs further invesitgation.

Objective To study the correlation between adipocytokines levels and metabolic syndrome (MS) in patients with newly diagnosed type 2 diabetes mellitus (T2DM). Methods Sixty-eight patients with newly diagnosed T2DM, including 51 cases with MS and 17 without MS, were examined for blood pressure (BP), fasting blood glucose (FBG), fasting insulin (FINS), insulin resistance index (IRI), waist to hip ratio (W/H), body mass index (BMI), and serum dipocytokine levels (IL-6, vaspin, and adiponectin). Results The diabeitc patients with MS had higher BMI, HbA1c, FBG, FINS, IRI, TG, TC, and SBP than those without MS. Serum IL-6 level was higher but adiponectin level was lower in patients with MS than in those without MS. There was no significant difference in vispin level between the two groups. Adiponectin level was positively correlated with TG (r=-0.30, P=0.02) and inversely with BMI (r=-0.47, P=0.39) and HOMA-IR (r=-0.30, P=0.03); vispin level was positively correlated with HOMA-IR (r=0.347, P=0.02) and inversely with HDL-L (r=-0.45, P=0.01);IL-6 level was positively correlated with LDL-L (r=0.18, P=0.25) and inversely with HDL-L (r=-0.45, P=0.01). Conclusion Adiponectin and IL-6 levels are closely related to MS, but the relationship between vispin and MS needs further invesitgation.

To evaluate the therapeutic effectiveness and safety of a novel gastrointestinal occluder device for gastrobronchial fistula. Data of 5 patients diagnosed as having gastrobronchial fistula who received treatment by a novel gastrointestinal occluder device at the First Affiliated Hospital of Nanjing Medical University from July to August 2020 were retrospectively analyzed. The total operation time, occluding time, intraoperative and postoperative complications, postoperative hospital stay and patients′ satisfaction were reviewed. Regular follow-up was conducted, and the short-term curative effect of occluding was evaluated 1 month after operation.All patients were males with age of 58-69 years. The course of fistula ranged 3-16 months and the diameter ranged 0.3-1.0 cm. All 5 patients achieved technical success with operation time of 38-88 minutes and occluding time of 8-24 minutes. The postoperative hospital stay ranged 3-5 days and the patients′ satisfaction score was 10. No severe complications occurred during or after operation. One month after endoscopic therapy, fistula was completely occluded in 4 patients. One patient died due to severe pulmonary infection and multiple organ failure although the bucking symptom after drinking and eating recovered before. Endoscopic closure of gastrointestinal fistula by means of the novel gastrointestinal occluder device is safe and effective.

Objective:To evaluate the safety and clinical efficacy of the novel double disc-shaped gastrointestinal occluder (hereinafter referred to as occluder) in treatment of refractory tracheoesophageal fistula (TEF).Methods:From July 1, 2020 to January 31, 2021, 10 patients with refractory TEF treated with occluder at Department of Gastroenterology, the First Affiliated Hospital with Nanjing Medical University were collected. The patients′ clinical data such as gender, age, body mass index and fistula diameter were recorded. The success rate of operation, intraoperative and postoperative complications, operation time, postoperative hospital stay, efficacy of fistula closure and postoperative recovery were analyzed. The Karnofsky score and body mass index of patients 1 month and 3 months after operation were compared with those before operation for curative effect evaluation. Paired t test was used for statistical analysis. Results:Among the 10 TEF patients, there were 7 males and 3 females, the median age was 64.5 years old (ranged from 49.0 to 78.0 years old), the body mass index was (18.0±2.5) kg/m 2 and the diameter of the fistula was (1.2±0.6) cm. Occluder placement was successful in all patients. The operation time was (17.6±7.8) min (ranged from 7.0 to 30.0 min). Two cases had little bleeding during the operation, and there was no bleeding after the operation. The postoperative hospital stay was (5.9±4.0) d (ranged from 1.0 to 12.0 d). Among the 10 TEF patients, fistula of 5 patients were completely blocked, 4 cases were partially blocked and 1 case was ineffectively blocked, the effective rate of blocking was 9/10. One month follow-up after operation showed that the symptoms of choking and coughing during eating were significantly improved in 9 patients, and the symptoms of choking and coughing during eating were significantly improved in 1 patient after waist diameter of 12 mm occluder was replaced with the occluder of 15 mm. The 3-month follow-up after operation showed that the occluders were in the right place in 8 patients, the occluder was displaced in 1 patient and the occluder was removed and treated with enteral nutrition. One patient died due to the recurrence of esophageal cancer. The Karnofsky score of TEF patients 3 months after operation and the body mass index of TEF patients 1 month and 3 months after operation were higher than those before operation (70.0±34.0 vs. 46.0±10.7, (19.32±2.59) and (19.73±2.92) kg/m 2 vs. (18.03±2.50) kg/m 2), and the differences were statistically significant ( t=-3.09, -2.37 and -2.82, all P<0.05). Conclusions:Gastrointestinal occluder is safe and effective in the treatment of refractory TEF.

Objective:To investigate the correlation between the lipocalin-2 (LCN-2) level and white matter hyperintensities (WMHs) in patients with ischemic stroke.Methods:Consecutive patients with ischemic stroke admitted to the Department of Neurology, Jinling Hospital, Medical School of Nanjing University from September 2021 to November 2021 and whose duration from onset to hospitalization <14 d were prospectively enrolled. Enzyme-linked immunosorbent assay was used to detect the serum LCN-2. Fazekas scale was used to assess the severity of periventricular and subcortical WMHs. A total WMHs score ≥3 was defined as severe WMHs. Multivariate logistic regression analysis was used to determine the correlation between serum LCN-2 level and WMHs. Results:A total of 179 patients were enrolled, including 122 males (68.2%), aged 64.7±11.6 years. The median serum LCN-2 level was 387.1 g/L, and 86 patients (48.0%) had severe WMHs. Serum LCN-2 in the severe WMH group was significantly higher than that in the non-severe WMH group (505.3±342.4 g/L vs. 367.8±224.5 g/L; t=3.110, P=0.002). Multivariable logistic regression analysis showed that after adjusting for the relevant confounding factors, there was a significant correlation between higher serum LCN-2 and severe WMHs (odds ratio 2.32, 95% confidence interval 1.17-4.63; P=0.017) and higher total WMHs score (odds ratio 1.62, 95% confidence interval 1.12-2.35; P=0.011). Conclusion:Higher serum LCN-2 level is associated with severe WMHs in patients with ischemic stroke.