[Objective]To analysis the factors influencing the results and complications of displaced intra-articular calcaneal fractures treated with open reduction and internal fixation or sledging.[Method]Twenty-seven cases,29 displaced intra-articular calcaneal fractures treated with open reduction and internal fixation or sledging were reviewed and followed with 7～60 months.The postoperative results were evaluated with AOFAS.[Result]The scores were between 53 and 100 with average 87.2,with good results.The functional results of Sanders Ⅲ and Ⅳ fractures were worse than type Ⅱ fracures.[Conclusion]The patients with displaced intra-articular calcaneal fractures should be treated with operation.With less invasive manipulation,extensive lateral L incision hasn't more relation to infection.The degree of initial injury and the operative quality are important factors influencing prognosis.

Objective To study the imaging of arteriovenous malformation(AVM)and cerebral cavernous angiomas(CCA)by 3D-TOF MRA and SWI.Methods The clinical manifestations and MR imaging characteristics of 44 cases with intracranial vascular malformations were retrospectively analyzed.The MRA imaging and SWI imaging of 26 CCA cases and 18 AVM cases were compared.Results The location,size,input.artery and output vein of arteriovenous fistula were clearly showed by 3D-TOF MRA.3D-TOF-MRA did not show the artery of hemangioma.The imaging of SWI can clear display the number and increase of cavernous hemangioma,comparing with the conventional sequence.Moreover,SWI was effective to show the tortuous veins of arteriovenous malformation.However,it was not able to directly show the overview of abnormal blood vessels and big arteries such as input artery.Conclusion 3D-TOF MRA technologies is powerful to show the arteriovenous malformation with high flow velocity and low resistance(Such as AVM),while SWI has advantages in showing the cavernous hemangioma with low flow velocity and small diameters.Joining 3D-TOF-MRA and SWI techniques will improve the detection of cerebral vascular malformations and reduce the misdiagnosis and missed diagnosis.

Objective To explore the value of multiple-mouse MRI in evaluating the therapeutic effect of endostatin for transplantation tumor models of colorectal carcinoma in mice.Methods 24 subcutaneously transplantation tumor’s models of colorectal carcinoma (CT-26) in mice were established, 1 week later, 16 tumor-bearing mice were sieved out and divided randomly into two groups: endostatin (ES) group and normal saline (NS) group, treated with intraperitoneal injection of endostatin 6 mg/kg?d 0.2 ml and equal volume of saline respectively for 14 days. Subsequently, MMMRI was performed, and then the mice were killed immediately and the tumors were cut into sections which were stained with hematoxylin and eosin (H&E). Results Subcutaneous fat layer in NS group presented thinner or disappeared on T1WI,while subcutaneous fat layer in ES group presented thicker. The tumors presented inhomogeneous high signal and intratumoral stippled necrosis on T2WI. The tumor’s volumes measured by MRI and pathology were(2723.26?1136.91) mm3 and (3505.76?1350.12) mm3 respectively,there was no difference between these two measures. And there was correlation between MRI results and pathological results. There was no difference of absolute signal intensity between ES group and NS group on T1WI and T2WI. The signal intensity ratio of ES group (3.19?0.28) was higher than which of NS group (2.60?0.47) on T2WI, and there was no difference on T1WI. Conclusion The therapeutic effect for endostatin on transplantation tumor models of colorectal carcinoma in mice can be displayed distinctly in MMMR image, and the inhibition rate of results can be displayed exactly and noninvasively.

Objective To study the impact of respiratory frequency and amplitude of patients with the thoracic or abdomen tumor on 4DCT' s reconstructed image.Methods 75 thoracic or abdomen tumor patients who performed a scanning with belly belt-type respiratory gating on 4DCT between November 2012 to March 2013 in our hospital were retrieved.Reviewed their respiratory frequency,amplitude and fault distance of 4DCT' s reconstructed image and analyzed the correlation fault distance of the reconstructed image.The correlation analysis was used by bivariate Spearman method.Results Among these reconstructed images,fault distance more than 6 mm could be seen in 11 cases,fault distance ranging from 3 mm to 6 mm could be found in 46 cases,and distance less than 3 mm could be detected in 18 case.Respiratory frequency correlated significantly with the amplitude (rs =0.369,P =0.000);the respiratory rate had a tight association with the fault distance of the reconstructed image (r,=0.273,P=0.018);and respiratory amplitude was associated obviously with the fault distance of the reconstructed image (r,=0.696,P=0.000).Conclusions Both 4DCT reconstructed image and respiratory amplitude are significantly correlated to the continuity of the respiratory frequency.The smaller the respiratory frequence and amplitude change are,the better continuity will be.

Objective Through the design of comprehensive experiments, the precise medical philo-sophy was put into the medical molecular biology experimental teaching, and to explore its effect. Methods Eight-year medical students of Grade 2012 and Grade 2013 in the Fourth Military Medical University were chosen as the teaching subjects. Experimental group consisted of 36 students of Grade 2013, while control group consisted of 30 students of Grade 2012. Precision medicine-based learning was applied in experimental group while traditional learning method was adopted by the control group. At the end of the course, students of two groups were implemented theoretical and experimental skills assessment; through questionnaire students were required to evaluate the effect of teaching methods and the number of two groups of students who asked questions after class greater than or equal to 1 times was counted to evaluate the students' learning enthusiasm. SPSS 15.0 software was used to make t test and Chi-square analysis for the data of the students. Results The assessment results showed that the experimental group was better than control group, especially in the section of comprehensive experimental design [(16.7 ± 2.04) vs. (13.9 ± 2.87), P=0.000]. The results from questionnaire showed that the satisfaction degree of experimental group was also higher than that of control group in many respects, including learning interests, innovation capability, knowledge mastery, cognition of precision medicine and clinical research, satisfaction with the teaching method (P<0.05). And students' learning enthusiasm and the proportion of the number of students asking questions in the experimental group were higher than the control group (P=0.000). Conclusions Precision medicine-based learning not only changes the situation of slavish imitation and passive acceptance in traditional learning, but also arouses students' interest in study and helps students to cultivate clinical thinking, which is com-mensurate to the characteristics of precision-medicine era.

Objective To evaluate the surgical treatment,effect and follow-up for renal cell carcinoma with tumor thrombus (T T) in inferior vena cava (IVC) and right atrium (RA).Methods Three cases of renal cell carcinoma with TT in IVC and RA diagnosed by Doppler ultrasonography,CT,MRI and transesophageal echocardiography were included in this retrospective analysis from January 2014 to March 2015 in our hospital.They were all male patients,aged from 50-64 years,and all patients presented painless gross hematuria.All patients underwent radical nephrectomy,inferior caval venous and atrial thrombectomy under general anesthesia,using abdomen inverted Y shaped incision and median sternal incision.Firstly,we dissected and ligated renal artery,then the vena cava was dissected;then hepatobiliary surgeons help to dissect the liver that can expose suprahepatic vena cava and inferior vena cava,and hepatic artery,hepatic portal vein;cardiothoracic surgeons help to perform sternotomy and establish cardiopulmonary bypass.Finally,TT in renal vein and IVC were extracted.Results All patients underwent radical nephrectomy,caval and atrial thrombectomy successfully.The operation time was 480-589 min,the extracorporeal circulation time was 40-110 min,the intraoperative blood loss was 1 200-4 400 ml,and the blood transfusion amount was 1 800-3 200 ml.Of the 3 patients,1 patient died on the 17th day of sepsis,respiratory failure,renal failure and coagulation disorders.One patient developed adrenal gland,lung and brain metastases in 5 months after surgery and died in 7 months after surgery.The remaining one is alive (follow-up:12 months) and without evidence of tumor recurrence or metastases.Conclusion For patients with renal cell carcinoma and TT in IVC and RA,although the overall prognosis is poor,radical nephrectomy plus caval and atrial thrombectomy is the only safe and effective therapeutic method.

Objectives To study the performance of different microbial automated inoculation systems and to evaluate the performance of the Probact microbial automated inoculation and incubation system ( Probact system) and its applications in clinical microbiology laboratory.Methods A total of 160 clinical specimens, including respiratory secretions ( n=61 ) , urine ( n=49 ) , and feces ( n=50 ) , that were submitted to the Clinical Microbiology Laboratory in Peking Union Medical College Hospital of Chinese Academy of Medical Sciences from February 2015 to April 2015 were evaluated.These specimens were processed with conventional manual method, the Probact automated inoculation system, and PREVI Isola Inoculator.The quantity of bacterial species recovery, number of effectively isolated colonies, total number of colonies recovery per plate, and time of processing the 160 specimens by the three methods were evaluated. Wilcoxon signed-rank test and Kruskal-Wallis rank sum test were used for statistical analysis.Results The Probact system had significantly higher quantity of bacterial species recovery (respiratory specimens 3.41 ±1.40, urine 1.92 ±0.86, and feces 1.16 ±0.79) than those by the Isola Inoculator (respiratory specimens 3.75 ±1.29, urine 2.24 ±0.97, and feces 1.92 ±0.72), (P=0.006, 0.011, <0.001).Compared to the manual method, Probact performed less quantity of bacterial species recovery for respiratory specimens(3.85 ±1.38), but higher in feces(0.80 ±0.81)( P<0.001).There is no significant differences for urine ( 1.84 ±1.23 ) ( P=0.266 ) .As for number of isolated colony, the Probact system ( respiratory specimens 12.16 ±7.72, urine 2.71 ±4.24, and feces 5.40 ±5.04 ) had significant smaller numbers than that of Isola Inoculator (respiratory specimens 16.56 ±5.76, urine 4.35 ± 4.89, and feces 8.40 ±3.70) (P<0.001,0.007,0.003).However, both system had larger numbers of isolated colonies than those by the manual method (respiratory specimens 11.30 ±8.42, urine 2.67 ±4.34, and feces 1.90 ±3.90) and the difference was significant for fecal specimens(P<0.001).Regarding the total number of colonies recovery, larger number was found by Isola Inoculator than that by the Probact system for fecal specimens, however, there were no significant differences for respiratory or urine specimens (P=0.524,0.738).Compared with manual method, the Probact system had significantly more numbers of colonies recovery for respiratory and fecal specimens ( P<0.001 ) . The total time for processing 160 specimens was shortest for manual method (281 min), followed by Probact system (419 min) and Isola Inoculator (495 min) .Conclusions The performance of the Probact system is better than the manual method but no superior to the Isola Inoculator.The Probact system can meet the clinical need in terms of full automation and standardization of specimen inoculation and prevention of bias of processing by laboratory staffs using manual method.

To search for potent drugs against non-small-cell lung cancer(NSCLC),a series of hybrids(9a-9e, 10a-10e and 11a-11e﹚ from anilinopyrimidines and diazeniumdiolates were designed and synthesized.The MTT assay was employed to evaluate their antiproliferative activity against H1975 cells harboring epithelial growth factor receptor(EGFR)L858R/T790M mutation.The results showed that compounds 9a-9e displayed remarkable inhibitory activity on H1975 cells.Among these compounds, the most potent was compound 9b(IC50=0.65 μmol/L),which was superior to the positive control gefitinib.Additionally,molecular docking study indicated that 9b could bind with EGFR T790M by forming hydrogen bond, electrostatic interactions, et al, suggesting that compound 9b may be a potential anti-NSCLC agent for further investigation.

Objective:To investigate the efficacy of dual plate fixation in the treatment of proximal humeral fracture with comminuted calcar.Methods:From July 2018 to April 2020, 25 patients (7 males and 18 females) were treated operatively for proximal humeral fractures with calcar comminution using anterior plate and lateral Philos plate. The data of patients who were followed up for more than 12 months was retrospectively analyzed. The mean age was 58.3 years (range 33-79 years). There were 13 right sides (all principal sides) and 12 left sides (all non-principal sides). The causes of injuries included: falling on flat ground (12 cases), traffic accidents (11 cases) and falling from height (2 cases). According to Neer classification, there were 7 cases of two-part fractures, 16 cases of three-part fractures and 2 cases of four-part fractures. A number of parameters including patient demographics, mechanism of injury, operative time, time to union, the range of shoulder motion, visual analogue scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley shoulder joint score, neck-shaft angle and the complications were recorded.Results:All of 25 patients were operated and followed up for 24.7 months (range 14 to 36 months). The operation time was 124.3 min (75-185 min), and the blood loss was 178.4 ml (100-350 ml). All patients had healed fractures at the last follow-up, and the neck-shaft angle was 132.88°±8.11° immediately after surgery, and 132.68°±8.36° at the last follow-up. All 25 patients healed completely in 4.7 months (range 3-5 months). Range of shoulder joint motion were forward flexion 161.20°±13.01° (range 140°-180°), external rotation 37.60°±7.65° (range 20°-45°), and internal rotation T 4-L 4 levels. VAS score was 0.36±0.81 points (range 0-3 points), while ASES score was 87.32±8.78 points (range 57.7-100 points) and Constant-Murley score was 89.40±8.37 points (range 60 to 100 points). Overall satisfaction score (Constant-Murley score) was excellent in 23 cases, and good in 2 cases. No obvious complications occurred. Conclusion:The combination of anterior plate and lateral Philos plate in the treatment of proximal humerus fractures with comminuted calcar can achieve stable fixation and satisfactory postoperative results.

Objective:To investigate the risk factors for liver cancer after splenectomy in patients with cirrhosis.Methods:The clinical data of 150 patients diagnosed with hepatitis B associated cirrhosis, portal hypertension, and hypersplenism who underwent splenectomy at Shaanxi Provincial People's Hospital and the First Affiliated Hospital of Xi'an Jiaotong University from March 2000 to November 2012 were retrospectively analyzed. There were a total of 150 patients included, 114 males and 36 females, aged (44±10) years old. General information, intraoperative conditions, and postoperative complications of the patients were documented. The postoperative progress of patients was monitored by telephone or outpatient follow-up. Based on the follow-up results regarding liver cancer presence, all patients were categorized into two groups: liver cancer group ( n=42) and non-liver cancer group ( n=108). Multivariate analysis was employed to identify factors influencing the liver cancer occurrence after splenectomy. Kaplan-Meier survival analysis along with log-rank test was utilized to assess overall survival and survival rate comparison. Results:Compared to the non-liver cancer group, the liver cancer group exhibited an increased prevalence of hypertension, direct bilirubin levels, prothrombin time, maximum spleen diameter, and postoperative thrombosis (all P<0.05). However, there was a significant reduction in the number of patients receiving long-term regular antiviral therapy and postoperative bleeding (all P<0.05). The multivariate analysis revealed that preoperative hypertension ( OR=6.310, 95% CI: 1.729-23.024, P=0.005), spleen diameter exceeding 12 cm ( OR=5.338, 95% CI: 1.234-23.094, P=0.025), and occurrence of postoperative thrombosis ( OR=8.652, 95% CI: 2.700-27.729, P<0.001) in patients with hepatitis B-related liver cirrhosis and portal hypertension were associated with an increased risk of developing liver cancer following splenectomy. Patients who receive long-term regular antiviral treatment after surgery ( OR=0.143, 95% CI: 0.038-0.545, P=0.004) have a lower risk of developing liver cancer. There was no statistically significant difference observed in the cumulative survival rate between the liver cancer group and the non-liver cancer group ( χ2=1.74, P=0.187). Conclusion:Preoperative hypertension, spleen diameter exceeding 12 cm, and postoperative thrombosis are independent risk factors for liver cancer in patients with hepatitis B-related cirrhosis and portal hypertension after splenectomy. Additionally, postoperative long-term antiviral therapy serves as an independent protective factor.