A self-prescribed recipe of drug for purging turbid, Resolving Dampness and Dispelling Phlegm was employed in the treatment group (N = 54) with combination of allopurinol, and compared its effect with that in the control group (N = 36) only with allopurinol. The total effective rate in the treatment group (92.59%) was significantly higher (P

Objective To observe the effect of Huazhuo-Jiedu-Huoxue Tongluo recipe on local inflammation of cerebral ischemia reperfusion injury in mice. Method Fifty Kunming Mice were randomly divided into five groups: model group, high-dose group of TCM, low-dose group of TCM, nimodiping group and sham operation group. Each group had 10 mice. Mice models of the right middle cerebral artery CIRI in the first four groups were established through thread embolism method. Physiological saline was given to the mice in the model group and sham operation group. Nimodipine solution was given to the mice in the Nimodipine group. High and low dose of Huazhuo-Jiedu-Huoxue-Tongluo Chinese medicine decoction were given to the mice in the high dose of TCM group and low dose of TCM group respectively after the models were successfully established. To assess the expression level of IL-6 and TNF-α by radioimmunoassay after the treatment. Results Compared with model group [(219.29±39.28) pg/ml, (1.325 ± 0.236) ng/ml] , the level of IL-6 and TNF-α of high dose of TCM group[(120.69±49.23)pg/ml, (1.086±0.178)ng/ml], low dose of TCM group[(173.97±49.03)pg/ml, (0.937 ± 0.105)ng/ml]and nimodipine group[(170.88± 47.06)pg/ml, (1.092±0.184) ng/ml]decrease (P<0.05). There is no significant difference between the high dose of TCM group and the sham operation group (P>0.05). Conclusion Huazhuo-Jiedu-Huoxue-Tongluo recipe can restrain the expression of inflammatory cytokines and reduce the infiltrating of leukocytes in mice with cerebral ischemia reperfusion injury.

BACKGROUND:In the treatment of tibial plateau fractures, because of the variety of fracture, the complexity of anatomical changes, X-ray films or three-dimensional CT scan limited by two-dimensional plane, increases the difficulty in preoperative plan and surgical treatment. The application of three-dimensional (3D) printing technology has attracted attention in the department of orthopedics. OBJECTIVE:To explore the auxiliary role of 3D printing technique in preoperative plan and treatment for tibial plateau fractures. METHODS:Thirty patients with tibial plateau comminuted fractures were enroled in this study and divided into two groups: experimental and control groups, with 15 patients in each group. In the experimental group, patients underwent 3D CT scan, which was stored in DICOM format, and processed by Mimics software. Data were converted into STL format, entered 3D printer, and a 1:1 entity size of the fracture model was made, in accordance with repair plan of 3D fracture model. Operation time and intraoperative blood loss were compared between the two groups. At 12 months after treatment, their outcomes were assessed using Rasmussen evaluation criteria. RESULTS AND CONCLUSION: The 3D printing fracture models of 1:1 ratio identified fracture type and made a repair program before surgery in the experimental group. Operation time and intraoperative blood loss were significantly less in the experimental group than in the control group (P < 0.05). After surgery, patients were folowed up for 12 to 18 months. The healing time was 3-5 months, averagely 4.3 months. At 12 months after treatment, the Rasmussen evaluation criteria results showed that the excelent and good rate was significantly higher in the experimental group than in the control group (P < 0.05). These results suggest that the fracture model of 3D can help to make the operation plan. The treatment of tibial plateau fractures is more precise, personalized and visual.

BACKGROUND:As a noticeable tissue engineering material of polyhy droxyalka noates family, poly (3-hydroxybutyrate-co-4-hydroxybutyrate)(P3HB4HB) exhibitsgood biocompatibility, adhesion and mechanicalproperties, presenting aextensive application future in tissue-engineered research.
OBJECTIVE:To investigate the biocompat ibilityin vitroand ectopic osteogenic differentiationin vivoof P3HB4HB and human bone marrow mesenchymal stem cels.
METHODS:Passage 5human bone marrow mesenchymal stem cels transplanted ontothe three-dimensional P3HB4HB scaffoldwereincubated with osteogenic induction medium (test group)or with no osteogenic induction(control group), respectively. After 5-day incubation, thecelgrowth was assessed by acridine orange staining and scanning electron microscopy; after14-day incubation, both kinds of cel-scaffold composites were subcutaneously implanted into the nude mice. At 16 weeks after implantation, the cel-scaffold composites were removed to observeectopic osteogenic differentiationin vivousing hematoxylin-eosin staining, von Kossa staining and colagen type I immunohistochemical staining.
RESULTS AND CONCLUSION:Acridine orange staining showed that cels adhered wel on the surface of the scaffold;under thescanning electron microscope, induced celsgrew wel on the P3HB4HB scaffold and produced abundant extracelular matrixes. In addition, at 16 weeks after implantation, there were osteoidtissues in the test group, positive for von Kossa staining as wel as colagen type I immunohistochemical staining;furthermore, hematoxylin-eosin staining showednumerous osteoblasts and bone lacunas. In contrast, no bone tissues appeared in the control group. To conclude, P3HB4HB is a suitable material for bone tissue engineering.

Tepoxalin is a potent inhibitor of both the cyclooxygenase and lipoxygenase pathways of the arachidonic acid cascade, as well as a potent anti-inflammatory and control-pain (postoperation, arthritis et. al.) agent. The new method about the use of novel synthesis reagents and the first using ionic liquid as reactive solvent to synthesize tepoxalin were presented in this paper. The ionic liquid can be easily recycled and reused for several runs efficiently. The analgesic activity of tepoxalin was detected by acetic acid test on mice. The analysis of variance showed that oral administration of tepoxalin could significantly inhibit the number of writhing response within 1 hour and prolong the latent time in a dose dependent manner as compared with CMC control group (P < 0.05). At the same time, tepoxalin had the same analgesic activity as diclofenac sodium.

Objective:To investigate the clinical effects of intermittent irrigation with povidone iodine for early postoperative infections of prosthetic joint.Methods:From September 2014 to September 2017, a total of 6 patients with early postoperative infections of prosthetic joint were analyzed retrospectively. They underwent one of three types of orthopedic surgery, namely femoral head replacement (FHR), total hip arthroplasty (THA) or total knee arthroplasty (TKA). These patients were treated with intermittent irrigation at the bedside instead of debridement. After extensive disinfection, the presence of pus and sinuses communicating with the prosthesis were detected with vascular forceps. Then, the specimens were taken for bacterial culture. Under the protection of the forceps, a needle was entered the joint cavity. Povidone iodine solution (50 g/L, 10 ml) was injected into the joint for irrigation. The intervention was repeated once every day. When the wound was fresh, no pus was observed with negative bacterial cultures for more than twice. The irrigation operation was stopped followed by dressing change until the wound heals. During the follow-up, six patients were observed for systemic and local infections, including body temperature, swelling, tenderness, fluctuations, exudation and sinus. At 1, 3, 6, 12 and 24 months after discharge, the routine blood tests, erythrocyte sedimentation rate, C-reactive protein, liver and kidney function were tested. X-rays of the affected joints were examined to record the signs of infection such as prosthesis subsidence, loosening, osteolysis, and periosteal reaction. Harris/KSS joint function score and visual analogue score (VAS) were used to evaluate the hip or knee joint function. The iatrogenic injuries and complications were also recorded.Results:The follow-up duration was 42.1±13.4 months (24-60 months). Each case has been irrigated for 12.7±5.7 times (6-18 times). At the last follow-up, all patients achieved satisfied incision healing. No swelling, exudation, systemic and local infection was observed without signs of infection such as osteolysis, loosening of prosthesis and periosteal reaction in radiographs. The VAS scores at 1, 3, 6, 12, 24 months after discharge were all lower than those at the preoperative (4.67±0.82) ( F=24.79, P<0.001). The Harris scores of the 5 hip patients at 1, 3, 6, 12, 24 months after discharge were 70.00±8.92, 76.40±7.23, 81.40±6.07, 82.80±4.87 and 83.20±5.07, respectively. No statistical difference was found between them ( P>0.05). However, they were all higher than the preoperative Harris score (22.40±12.74) ( F=43.74, P<0.001). In a patient with TKA, the knee function was significantly improved after discharge. Before surgery and 1, 3, 6, 12, 24 months after discharge, the KSS scores were 50, 75, 80, 88, 90 and 90 respectively. No iatrogenic injuries, serious complications such as deep vein thrombosis, pulmonary embolism, severe liver/kidney damage or deaths were observed. Conclusion:When debridement is contraindicated or refused by patients, intermittent irrigation with povidone iodine may be a treatment method for patients with early postoperative infections of prosthetic joint.

Objective:To investigate the clinical characteristics, diagnosis and treatment of dermatomyositis with kidney neoplasm.Methods:The data of two patients with dermatomyositis complicated with kidney neoplasm in Tongji Hospital from January to February 2022 were retrospectively analyzed. The first case was a 55-year-old female, who was admitted with the chief complaints of recurrent erythema of upper extremities for 2 months and facial erythema for 1 month. Physical examination: erythema can be seen on upper limbs and face, no tenderness or percussion pain in kidney area. Myositis enzyme profile test showed that anti-Mi-2 antibody and anti-SSA /Ro-52 antibody were positive. Contrast CT showed nodular uneven enhancement in the right kidney with a size of 50 mm×41 mm. The second case was a 58-year-old female, who was admitted with the chief complaints of kidney occupying for a month. Physical examination: flaky erythema on face, no tenderness or percussion pain in kidney area. Myositis enzyme profile test showed that anti-Ro-52 antibody and anti-MDA5 antibody were positive. Contrast CT showed a significantly uneven enhanced mass with a size of about 50 mm×41 mm on left kidney. Both patients were diagnosed with kidney neoplasm before surgery and underwent laparoscopic partial nephrectomy in Tongji Hospital.Results:Both patients received regular oral prednisone after surgery. The pathological presentation of case 1 was papillary renal cell carcinoma, the facial erythema subsided 1 month after surgery, and there was no tumor recurrence for 13 months. The pathological presentation of case 2 was clear cell renal cell carcinoma, facial erythema subsided 2 weeks after surgery, and there was no tumor recurrence for 12 months.Conclusions:The diagnosis of dermatomyositis should be combined with clinical manifestations and laboratory examination, and the possibility of malignant tumor should be excluded due to the high likelihood of concomitant malignancy. For patients with dermatomyositis with kidney neoplasm, the main treatment is still surgery, and supplemented with glucocorticoid therapy.

ObjectiveTo investigate the mechanism of Huazhuo Jiedu Huoxue Tongluo prescription in alleviating cerebral ischemia-reperfusion injury via regulating nerve cell autophagy based on c-Jun N-terminal kinase（JNK）signaling pathway . MethodSixty SD rats were randomly divided into 6 groups： sham group， middle cerebral artery occlusion/reperfusion （MCAO/R） group （model group）， Huazhuo Jiedu Huoxue Tongluo prescription group ［traditional Chinese medicine （TCM） group（25.0 g·kg^-1）］， JNK inhibitor SP600125 （SP） group（5 mg·kg^-1）， TCM+SP group and JNK agonist Anisomycin （Ani） group（15 mg·kg^-1）. After 24 h of modeling， TCM group and TCM+SP group were given TCM decoction （ig） for 3 consecutive days， and the other groups were given equal volume of normal saline （ig）. Neurological deficit was evaluated by neurological function score and cerebral infarct volume was determined by 2，3，5-triphenyltetrazole chloride （TTC） staining. Hematoxylin-eosin （HE） staining and Nissl staining were used to observe the structural changes of brain tissue and the damage of neurons， respectively. Terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling assay （TUNEL） was performed to detect cell apoptosis. The ultrastructure of autophagosomes was observed by transmission electron microscope. Western blot was employed to detect the protein expressions of microtubule-associated protein 1 light chain 3A/B （LC3A/B）， autophagy related 5 （Atg5）， the ortholog of yeast Atg6 （Beclin1）， p62， B-cell lymphoma 2 （Bcl-2）， JNK， phosphorylated （p）-JNK and c-Jun in brain tissue. The mRNA expressions of LC3A/B， Beclin1， p62， Atg5， Bcl-2， JNK and c-Jun were detected by Real-time fluorescence quantitative polymerase chain reaction （Real-time PCR）. ResultCompared with the sham group， the model group had elevated neurological deficit score （P<0.05）， enlarged cerebral infarct volume （P<0.05）and typical infarction manifestations formed in hippocampal region and its surrounding brain tissue. In addition， there were a large number of neuronal cell degeneration， necrosis， liquefaction， nucleus pyknosis and deep staining， and inflammatory cell infiltration in the cortex in the model group， and severe swelling of mitochondria， lysosomes， autophagosomes and autophagolysosomes were clearly seen under electron microscope. TUNEL positive cells were increased （P<0.05）， and cell apoptosis was severe. The nuclear membrane and nucleolus of neurons in brain tissue were blurred with discontinuous processes， and Nissl bodies in cytoplasm were stained light with reduced number. Western blot revealed that the model group had up-regulated protein expressions of LC3A/B， Beclin1， Atg5， JNK， p-JNK and c-Jun in brain tissue （P<0.05）， while down-regulated protein expressions of p62 and Bcl-2 （P<0.05）as compared with the sham group. Real-time PCR indicated that the mRNA expressions of LC3A/B， Beclin1， Atg5， JNK and c-Jun in the model group were higher （P<0.05） while the mRNA expressions of p62 and Bcl-2 were lower （P<0.05） than those in the sham group. Compared with the conditions in model group， the neurological deficit scores of TCM， SP and TCM+SP groups were lowered （P<0.05）， and the cerebral infarct volume was reduced （P<0.05）， with improved pathological status of brain tissue， especially in the TCM group. Furthermore， there were abundant and basically normal mitochondrial cristae， slightly dilated endoplasmic reticulum， slightly swollen golgi apparatus， slightly fused nuclear membrane， and few visible lysosomes， autophagosomes and autophagolysosomes. TUNEL positive cells were decreased （P<0.05）， displaying reduced apoptosis， especially in the TCM group. The nucleolus and nuclear membrane of neurons in brain tissue were discernible， and Nissl bodies in cytoplasm was reduced to a certain degree as compared with those in the model group. Western blot showed a decrease in the protein expressions of LC3A/B， Beclin1， Atg5， JNK， p-JNK and c-Jun in the TCM group ，the SP group，and the TCM+SP group（P<0.05），while an increase in the protein expressions of p62 in the TCM group and SP group（P<0.05），and an increase in the protein expressions of Bcl-2 in the TCM group and TCM+SP group. By Real-time PCR， the mRNA expressions of LC3A， LC3B， Beclin1， Atg5， JNK and c-Jun had a down-regulation（P<0.05） while the mRNA expression of p62 a up-regulation in the TCM group ，the SP group，and the TCM+SP group（P<0.05），and the mRNA expression of Bcl-2 a up-regulation in the TCM group and the TCM+SP group（P<0.05）.Scores of the Ani group were raised （P<0.05）， and infarct volume was increased significantly， with aggravated neuronal cell necrosis and obvious inflammatory infiltration. Moreover， there were neuronal nuclear membrane fusion with abnormal protrusion， increased heterochromatin aggregation in edge， severe mitochondrial swelling， endoplasmic reticulum expansion， increased lysosomes， increased intracytoplasmic vesicles， and visible autophagosomes and autophagolysosomes. TUNEL positive cells were increased （P<0.05）， representing severe apoptosis. The number of Nissl bodies dropped with light staining， and the nucleolus and nuclear membrane were blurred. Real-time PCR found that the mNRA expressions of Atg5， c-Jun， JNK were up-regulated （P<0.05），while Beclin1， p62， Bcl-2 were were down-regulated in the Ani group （P<0.05）. Compared with the TCM group and SP group，the protein expressions of LC3A/B， Beclin1， Atg5， JNK， p-JNK， c-Jun were decreased，and p62， Bcl-2 were increased in the Ani group（P<0.05）. Compared with the TCM group，the mRNA expressions of JNK mRNA had a down-regulation in the SP group and TCM+SP group，while LC3A， LC3B， Atg5， c-Jun， JNK had an up-regulation（P<0.05） and Bcl-2 had a down-regulation in the Ani group（P<0.05）. Compared with the SP group，the mRNA expressions of Atg5， c-Jun， JNK had an up-regulation（P<0.05）， and Beclin1， p62， Bcl-2 had a down-regulation in the Ani group（P<0.05）. ConclusionHuazhuo Jiedu Huoxue Tongluo prescription significantly up-regulates the protein and mRNA expressions of LC3A/B， Beclin1， Atg5， JNK， p-JNK and c-Jun， and down-regulates the protein and mRNA expressions of p62 and Bcl-2， suggesting that the prescription can inhibit autophagy through JNK signaling pathway to reduce ischemia/reperfusion injury in rats.

Objective: To investigate efficacy of operation and non-operation treatment for hip fractures patients complicated with pulmonary embolism. Methods: A retrospective case control study was conducted to analyze the clinical data of 18 hip fracture patients complicated with pulmonary embolism admitted to Dongyang People's Hospital from May 2017 to January 2019. There were 11 males and seven females, aged 59 to 96 years[(80.0±9.3)years]. There were 10 patients with intertrochanteric fractures, one with femoral subtrochanteric fracture and seven with femoral neck fractures. After diagnosis of pulmonary embolism, the patients were given anticoagulant therapy with low molecular weight heparin for at least one week. The re-examination showed that pulmonary embolism absorption improved and D-dimer did not increase. Eleven patients chose surgical treatment (operation group) with intramedullary nail internal fixation or artificial hip replacement. Seven patients chose non-surgical treatment (non-operation group) with skin traction. The Harris score of hip function was compared between the two groups. Visual analogue scale (VAS) was used to evaluate hip joint pain. At the last follow-up, fracture healing, prognosis of pulmonary embolism and mortality within 3 months were recorded. Results: All the patients were followed up for 3-22 months [(11.2±6.0)months]. At last follow-up, the Harris score was (92.1±2.2)points in the operation group and (28.8±18.8)points in the non-operation group (P<0.01); the VAS was 0 point (0-1 point) in the operation group and 3 points (1-3 points) in the non-operation group (P<0.01). At the last follow-up in the operation group, five patients obtained fracture healing after internal fixation, and among the six patients receiving artificial joint replacement, five patients recovered well except for one deceased patient. At the last follow-up, pulmonary embolism was absorbed and no recurrence of pulmonary embolism was found. None of the patients died within 3 months in operation group, while 14% of the patients (1/7) in the non-operation group died within 3 months. Conclusions For hip fracture patients complicated with pulmonary embolism, compared with non-operation treatment, operation treatment is more beneficial to restore hip function and relieve pain, with lower mortality rate within 3 months. Operation treatment is feasible for patients who showed improved absorption of pulmonary embolism and no secondary increase of D-dimer after one to two weeks of full anticoagulation treatment before operation.

Uniportal video-assisted thoracic surgery (UniVATS) is a significant approach of mini-invasive surgery for lung cancer. UniVATS was first used for treatment of lung cancer in 2010. The European consensus and the Chinese consensus were published in 2019 and 2020 respectively. The latest Chinese consensus included the definition of UniVATS, indications for lung cancer treatment, safety and feasibility, surgical skills, learning curve, short-term and long-term results, providing suggestions for the standardization of uniportal video-assisted thoracic surgery, which are essential to improve the quality of surgery and reduce the incidence of related complications. The Chinese consensus also summarized the current status of subxiphoid UniVATS and non-intubated UniVATS for lung cancer. Considering the technical difficulties and challenges, the application of both technologies in clinical treatment has certain limitation. This article aims to give an interpretation of the results of the Chinese consensus and the similarities and to compare the differences with the European consensus, and to provide a reference for the majority of thoracic surgery colleagues.