Objective To evaluate the value of the abdominal computed tomography (CT) in diagnosing mesenteric injury. Methods Fourteen patients with mesenteric injury proven by surgery were selected as the study objects. A retrospective analysis was done on the clinical medical records and CT examination results including free intra-peritoneal fluid collection, infiltration of mesenteric fat, intra-mesenteric hematoma, extravasation of contrast media and thickening and enhancement of bowel wall. Meanwhile, in combination with surgical findings, the sensitivity of CT in diagnosis of mesenteric injury was determined. Results CT images showed free peritoneal fluid or hemoperitoneum and infiltration of mesenteric fat in all 14 patients, of which 12 had intra-mesenteric hematoma, two showed thickening and enhancement of bowel wall and one did extravasation of contrast material. CT findings accorded with surgical results. Conclusion CT is sensitive in diagnosis of mesenteric injury and helpful for identification of the injury site.

Objective To explore the CT classification of lacerating lung injury in blunt thoracic trauma and its clinical significance. Methods A total of 63 patients with lung lacerating injury were classified using CT features as simple type injury (complete visceral pleura, with no pneumothorax or he-mopneumothorax) and complex type injury (accompanied by visceral pleura rupture, pneumothorax or he-mopneumothorax). A retrospective analysis was done on CT manifestations and clinical data. Results Of 63 patients, 35 patients (56%) had simple type of lacerating lung injury with complete visceral pleu-ra, most of which were focal pulmonary pseudocyst lesions present in the edge of lungs and could be dis-persed quickly after conservative therapy without complications. Mean hospital stay was 16 days. Of pa-tients with complex type of lacerating lung injury, 28 patients (44.4%) were accompanied by visceral pleura rupture with larger extent of pulmonary injury, 20 (71%) by lung eontnsion, 15 (54%) by ate-lectasis or pulmonary atelectasis and three (11%) by local pulmonary infection. Thoracic puncture or closed drainage was performed in 19 patients (69%) and thoracotomy in one (4%), with mean hospital stay of 58 days. Conclusions According to CT manifestations on whether there exists visceral pleura rupture or not, the lacerating lung injury is classified as simple type injury and complex type injury. CT classification of lacerating lung injury may be helpful in selecting clinical treatment protocols and predic-ting early prognosis.

Objective To compare complications of ureteroneocystostomy and end-to-end ureteroureterostomy after kidney transplantation. Methods Eighty allograft renal transplantation patients between January 2005 and October 2008 were divided into two groups according to urinary tract reconstruction approach: ureteroneocystostomy group (40 cases) and ureteroureterostomy group (40 cases). Complications including leakage of urine,vesicoureteral reflux,obstruction of ureter and urinary tract infection were recorded.Results In ureteroneocystostomy group and ureteroureterostomy group,the patients were followed up for 13 - 46 (24.5 ± 8.9), 13 - 46 (26.0 ± 7.2) months postoperatively, urinary complications were recorded for 10 eases (25.0%, 10/40) and 4 cases (10.0%, 4/40)(P > 0.05), incidence of leakage of urine were 2.5%(1/40)and 5.0%(2/40) (P > 0.05), vesicoureteral reflux were 10.0% (4/40) and 0 (P ＜ 0.05), obstruction of ureter were 0 and 5.0% (2/40) (P > 0.05), and urinary tract infection were 12.5% (5/40) and 0 (P < 0.05).Conclusions Compared with ureteroneoc ystostomy, ureteroureterostomy can reduce the incidence of vesicoureteral reflux and urinary tract infection,it can be regarded as the first choice for urinary tract reconstruction after kidney transplant recipients.

Objective To explore the therapeutic efficacy of arthroscopy-assisted minimally invasive treatment for posterior tibial plateau fractures.Methods From July 2010 to June 2014,10 posterior tibial plateau fractures were treated at our department by arthroscopy-assisted minimally invasive treatment with percutaneous lag screws.They were 8 men and 2 women,with a median age of 31 years (from 18 to 52 years).All the fractures were closed and fresh,including 3 posteromedial tibial plateau ones,5 posterolateral tibial plateau ones,and 2 posteromedial and posterolateral tibial plateau ones.They were followed up periodically by radiological examinations.At the final follow-up,their knee functions were evaluated by Rasmussen scoring system,and their pain was evaluated by the visual analogue scale(VAS).Subjective factors included swelling,stairs climbing,joint stability,job participation and satisfaction with recovery.Results The follow-ups averaged 18 months (from 12 to 24 months).All fractures healed within 3 months postoperatively,with no infection or serious complications like implant failure.At 12 months postoperation,the mean Rasmussen score was 26 points (from 19 to 30 points).Eight cases were rated as excellent,one as good,and one as fair.Their mean VAS score was 1.2 points (from 0 to 4 points).Conclusion Arthroscopy-assisted minimally invasive management of posterior tibial plateau fractures with cannulated screw fixation is feasible,because it results in limited invasion,satisfactory reduction,reliable fixation,quick functional recovery and a low rate of complications.

Along with deepened understanding of rotator cuff injury in clinic as well as rapid progress in diagnostic techniques and arthroscopic surgery,increasingly more cases of rotator cuff injury have been reported,making diagnosis and treatment of the injury a hot topic in sports medicine.Although surgical techniques for rotator cuff repair are constantly improved,nonunion and retear after repair are still very common.As there has been no consensus on diagnosis and treatment of massive rotator cuff,more discussion and study on the topic are necessary.

Colorectal cancer is the third high-incidence of malignant tumors in the world, and also a kind of tumor with good biological behavior and good efficacy. Colorectal cancer heterogeneity is a very important trait of its biological behavior, which can be reflected in many different aspects, including tumor type, pathogenesis, molecular phenotyping and time-space heterogeneity. Different pathogenesis produces different tumor phenotypes, which are generated in the process of natural evolution and intervention. Various phenotypes show the difference among different individuals of colorectal cancer, in terms of clinical characteristics, treatment response and prognosis. Understanding the heterogeneity of colorectal cancer has important clinical value for individualized treatment.

Colorectal cancer is one of the most common malignant tumors in the world, threatening human health. The treatment strategy of stage II and stage III colorectal cancer has changed from surgery alone to multidisciplinary mode emphasizing perioperative treatment. The indication of adjuvant chemotherapy for stage II colon cancer is still defined by high-risk factors, but only microsatellite status and BRAF gene mutation can help predict efficacy of chemotherapy. Combined chemotherapy is the main adjuvant therapy for stage III colon cancer. The recommended course of adjuvant chemotherapy is 6 months. Based on the results of the IDEA study, the three-month CapeOX regimen (oxaliplatin and capecitabine) is recommended for the treatment of patients with T1-3 and N1 tumors. Neoadjuvant chemotherapy for locally advanced colon cancer is still in the exploratory stage of clinical trials. The difference between the treatment of rectal cancer and colon cancer lies in the application of radiotherapy. Chemoradiotherapy combined with TME (total mesorectal excision) surgery and adjuvant chemotherapy has become the standard treatment for locally advanced rectal cancer. Nowadays, the research hotspots in neoadjuvant therapy of rectal cancer include neoadjuvant chemotherapy and total neoadjuvant therapy (TNT). This article will review the progress of perioperative treatment for colorectal cancer.

OBJECTIVETo investigate the differences of clinical characteristics and molecular features among colorectal cancer subsides and provide evidence for colorectal cancer protection, diagnosis and treatment.

METHODSAll of 4 316 colorectal patients from Shanghai cancer center were selected for clinical character analysis, among which, 2 224 subjects for molecular feature analysis. Clinic pathological characteristics like age, gender, tumor types, histological types, differentiation and T-stage, as well as molecular features like hMLH1, hMSH2, CD44, p21, p53, COX2,E-cadherin, Her2 and Ki-67, were involved into this research.

RESULTSIt showed that compared with left-sided colon and rectal cancers, right-sided cancers occurred more in women (46.0% (541/1 176); 39.2% (424/1 083); 41.2% (848/2 057), respectively, χ² = 11.85, P < 0.01), had more mucinous or signet-ring carcinoma (12.0% (128/1 064), 5.8% (56/960), 4.0% (75/1 859), respectively, χ² = 31.27, P < 0.01), poor differentiated carcinoma (32.1% (343/1 069), 19.5% (201/1 033), 19.3% (380/1 967), respectively, χ² = 72.66, P < 0.01) , and advanced T stage (87.9% (992/1 129), 83.2% (869/1 045), 72.2% (1 486/2 057), respectively, χ² = 121.44, P < 0.01). Meanwhile, the rates of hMLH1 were higher in right-sided colon cancers when compared with rectal cancers (13.4% (59/439) vs 8.5% (88/1 035), OR (95%CI): 1.67 (1.18-2.37)), as well as the rates of hMSH2 negative expression (4.9% (22/452) vs 2.4% (26/1 083), OR (95% CI): 2.08(1.17-3.71)). The rates of p53 positive expression were higher in right-sided colon cancers when compared with rectal cancers (76.2% (321/421) vs 68.4%, (776/1 134), OR (95% CI): 0.68 (0.52-0.87)). Compared with right-sided colon cancers, the rates of Her2 positive expression were higher in rectal cancers (19.3% (176/913) vs 13.2% (45/340), OR (95% CI): 1.57 (1.10-2.23)) , as well as the rates of Ki-67 expression which was positive in more than 50% cells (73.6% (840/1 141) vs 65.6% (299/456), OR (95% CI): 0.68 (0.54-0.86)).

CONCLUSIONThere are specific characteristics in right-sided colon cancers. The difference of molecular features between right-sided colon and rectal cancers are more significant.

Adenocarcinoma, Mucinous ; Cadherins ; Carcinoma ; Carcinoma, Signet Ring Cell ; China ; Colonic Neoplasms ; Colorectal Neoplasms ; Female ; Humans ; Neoplasm Grading ; Neoplasm Staging ; Rectal Neoplasms ; Sex Factors

Objective:To investigate the therapeutic efficacy of Ilizarov bone shortening-lengthening technique for tibial defects of bone and soft tissue without vascular injury.Methods:A retrospective analysis was made of the 28 patients who had been treated by Ilizarov bone shortening-lengthening technique at Department of Orthopaedics, Wuxi No.9 People's Hospital from January 2007 to October 2017 for tibial de-fects of bone and soft tissue without vascular injury.They were 20 males and 8 females, aged from 18 to 69 years (average, 36.4 years).By the Gustillo classification, 5 cases belonged to type Ⅱ, 6 to type ⅢA and 17 to type ⅢB.Infection was complicated in 17 cases.After debridement or epluchage, the area of skin defects ranged from 4 cm × 3 cm to 16 cm × 5 cm and the length of bone defects from 4.5 to 11.0 cm (average, 6.9 cm).The wound healing, bone healing, functionary recovery of lower extremity and complications were observed postoperatively.Bone healing and functional recovery of lower extremity were evaluated according to the grading of Association for the Study and Application of the Method of Ilizarov (ASAMI).The complications associated with Ilizarov technique were assessed according to the Paley criteria.Results:The follow-up for all the patients lasted from 12 to 45 months (average, 20.5 months).The healing time for wounds ranged from 13 to 35 days (average, 21.9 days), the healing time for lengthened bone from 6 to 12 months (average, 8.9 months), and the healing time for bone defects at the dock sites from 6 to 11 months (8.3 months).According to the ASAMI grading, the bone healing was excellent in 21 cases and good in 7, giving an excellent to good rate of 100%(28/28) while the functionary recovery of lower extremity was excellent in 10 cases, good in 15, fair in 2 and poor in one, giving an excellent to good rate of 89.3%(25/28).The incidence was 14.3%(4/28) for major complications after Ilizarov surgery, 57.1%(16/28) for minor complications, 60.7%(17/28) for overall complications, and 1.7 times for each case.Conclusion:In the treatment of tibial defects of bone and soft tissue without vascular injury, Ilizarov bone shortening-lengthening technique can deal with the difficulties in repair of soft tissue defects, characterized by simplified wound closure, fast and improved bone healing at the dock sites, reduced complications and satisfactory functionary recovery of lower extremity.

Objective:To characterize the radial head fracture combined with capitulum cartilage injury (CCI).Methods:The data of 110 patients were analyzed retrospectively who had been treated for radial head fracture at Department of Orthopaedics, The Ninth People's Hospital of Wuxi from January 2011 to May 2020. They were 62 males and 48 females, aged from 17 to 74 years (average, 44.10 years). According to the finding of intraoperative exploration whether CCI was complicated or not, they were assigned into a CCI group and a CCI-free group. The diagnosis, location, size, type, operation method and postoperative recovery of CCI were observed in CCI group. The 2 groups were compared in terms of preoperative general data, range of forearm motion before and after operation and functional recovery of the limb by Mayo elbow performance score (MEPS).Results:CCI was complicated in 25 cases (type Ⅰ in 7 ones, type Ⅱ in 12 ones and type Ⅲ in 6 ones), involving all Mason types of radial head fracture, and located at the lateral capitellum in 13 cases, at the posterolateral capitellum in 9 cases and at the anterolateral capitellum in 3 cases. CCI was diagnosed before operation in 13 cases by physical examination after local anesthesia and imaging examination with a rate of 48% (12/25) for missed diagnosis. The preoperative flexion and extension (61.8°±13.7°) and rotation (60.0°±24.2°) in CCI group were significantly less than those in CCI-free group (77.7°±23.0° and 79.9°±21.9°) ( P<0.05); the Mason types of radial head fracture in CCI group were significantly more serious than those in CCI-free group ( P<0.05). There was no significant difference between the 2 groups in age, gender, combined injury, treatment of radial head fracture, follow-up time, range of forearm motion at the last follow-up or MEPS score ( P>0.05). Conclusions:CCI was complicated in 22.73%(25/110) of the radial head fractures in this cohort and found in all Mason types of radial head fracture, and mostly located at the lateral and posterolateral capitellum. CCI is likely to be missed by imaging examination. In patients with mild radial head fracture and suspected CCI, positive physical examination after local anesthesia is valuable for diagnosis of CCI complication and operative indication. Care should be taken to detect CCI complication by intraoperative exploration in surgery of radial head fracture.