Malunion is one of common complications after distal radius fractures.It is indicated that malunion plays an important role in fracture recovery in many studies.This article sums up the research data,from aspects of both biomechanical analysis and follows-up of clinical cases,of domestic and foreign scholars in recent years,and reviews the influences of malunion on wrist joint functional outcome.

Prognosis factors of Ⅲ A (N2) phase non-small cell lung cancer are various.The histological molecular markers are mainly about multi-resistant gene,growth factors,mucin 4,insulin-like growth factor-2,Ki-67,PTEN and so on.Different expressions of these genes may divide the N2 non-small-cell lung cancer into different molecular subtypes,which is more effective to guide clinical therapy.

0.05). Serum sCD44v6 levels in patients with OSCC decreased after treatment (P

Objective:To conduct a systematic review on the implementation effects of National Essential Medi-cine System ( NEMS) since the new health care reform and provide some suggestions to further improve the NEMS. Methods:Databases and relevant international organization reports were searched to collect studies related to the im-plementation of NEMS in China. The database search occurred from January 2009 to December 2014. Results:A to-tal of 1 292 studies were finally included, encompassing 1,277 Chinese papers, 12 English papers, and 3 WHO/HAI reports. A lot of researches have been done on NEMS, but the techniques of NEMS evaluation are not perfect. The sample representativeness is poor, and the longitudinal follow-up studies of the microscopic view is insufficient. . Evi-dence-based evaluation research using big data has just started. Conclusions: The research on NEMS should be strengthened. The NEMS evaluation should not only be based on national conditions, but it should also be in combi-nation with an international, multidimensional evaluation framework in terms of availability, affordability and rational drug use, so as to provide evidences to perfect the NEMS.

Objective To observe the levels of serum VEGF in different molecular subtypes of breast cancer and explore its relationship with response to neoadjuvant chemotherapy. Methods Levels of serum VEGF in 110 cases with breast cancer underwent neoadjuvant chemotherapy were detected by ELISA prior to and after 3 cycles of neoadjuvant chemotherapy. Clinical response to neoadjuvant chemotherapy was evaluated by physical examination and ultrasonography. Results Levels of serum VEGF were significantly increased in breast cancer patients with≥4 lymph node metastasis than those with < 4 lymph node[(307.31 ± 101.42) pg/mL vs. (170.16 ± 73.07) pg/mL,P = 0.017]. Patients with positive HER-2 status had significantly higher levels of serum VEGF than those with HER-2 negative status [(235.15 ± 88.42 ) pg/mL vs. (179.82 ± 69.90) pg/mL, P = 0.024]. No significant difference was observed among age , menopausal status and hormone status. In patients with neoadjuvant chemotherapy of cCR and Cpr,the mean levels of serum VEGF were (205.75 ± 78.12) pg/mL and (226.04 ± 89.04) pg/mL, respectively. After 3 cycles of chemotherapy, levels of serum VEGF decreased to (145.15 ± 67.08) pg/mL and (161.27 ± 93.57) pg/mL. There was significant difference between two groups (P=0.009,0.014). In patients with SD or PD response, no significant difference was observed between levels of serum VEGF before and after chemotherapy (P = 0.577). Conclusions Levels of serum VEGF in breast cancer correlate with lymph nodes metastasis and HER-2 status and may decrease after neoadjuvant chemotherapy. However,whether or not the levels of serum VEGF can be used as a biomarker for response to neoadjuvant chemotherapy needs more further studies.

Objective: To explore the relationships among social support, depression, anxiety and suicide ideation among middle school students in rural areas of south Sichuan Province so as to provide a scientific basis for promoting middle school students’ mental health and reducing suicide ideation. Methods: A sum of 2 217 students of grade 7 and 10 from 2 township middle schools in mountainous areas of Zizhong County, Sichuan Province, were investigated by means of typical sampling and cluster random sampling. Social Support Rating Scale (SSRS), Self-rating Scale for Depression (SDS), Self-rating Anxiety Scale (SAS) and Self-compiled adolescent health questionnaire were used to measure suicidal ideation, and structural equation model was used for statistical analysis. Results: The depression score of middle school students was (13.51±12.57), and the self-rating scale for Depression score of girls was (14.61±12.67), higher than that of boys (12.24±12.34). The SSRS score of Social Support Rating Scale of junior high school students was (35.49±5.88), which was higher than that of senior high school students (34.70±5.43), and the differences were of statistical significance(t=4.46, 2.67, P<0.05). The results of structural equation model showed that depression and anxiety directly affected suicidal ideation, and the standardized effects were respectively 0.11 (95%CI=0.06-0.16) and 0.09(95%CI=0.05-0.14). Depression and anxiety were the intermediate variables in the relationship between social support and suicidal ideation, and the mediating effects were respectively -0.46(95%CI=-0.51--0.41) and -0.21(95%CI=-0.27--0.16). Studying period could play a mediating role in the indirect effect made by social support on suicide ideation through anxiety. Conclusion Anxiety and depression have significant mediating effect on the relationship between social support and suicidal ideation among middle school students in rural areas of south Sichuan province. Anxiety and depression intervention are important measures to reduce suicide ideation among low social supporters.

Objective:To evaluate the knowledge, attitudes and practices ( KAP) on National Essential Medi-cine System among pharmacists from secondary public hospitals in Shaanxi province. Methods: The quantitative re-search of KAP questionnaire is used, and the content of questionnaire includes personal information, knowledge, atti-tudes and practices. Results: A total of 520 copies of questionnaires were distributed and 82. 3% were effective. Respondents’ overall knowledge and attitudes are at the middle level;the main way to obtain knowledge is via training and meeting;respondents’ education level and frequency of participating in training have a significant impact on their level of knowledge;the degree of attention paid by hospitals has yet to be strengthened; and respondents are mostly concerned about the supply and distribution of essential drugs. Conclusion: In order to improve the awareness and recognition levels of pharmacists on the implementation of National Essential Medicine System in secondary public hospitals, the government should take the relevant measures, including introducing the high educated persons into secondary public hospitals, organizing related training programs and standardizing the daily monitoring of essential drugs in secondary public hospitals, etc.

Objective:To characterize the 3-D morphology of lateral malleolar fractures of Danis-Weber type B, especially the distribution of fracture apexes, for formulation of 3-D maps of fracture lines which may facilitate the treatment of the fractures.Methods:A retrospective study was conducted to analyze the CT tomography data of 114 patients who had been operatively treated for lateral malleolar fractures of Danis-Weber type B at Department of Orthopaedic Surgery, Yangpu Hospital from January 2017 to May 2022. There were 46 males and 68 females with a mean age of 61.5 (51.8, 68.0) years. The morphology of distal bone blocks was measured and positions of fracture apexes were observed on 3-D CT reconstruction. According to the positions of apex, the fractures were divided into 4 types: type Ⅰ with the apex located on the lateral ridge, type Ⅱ with the apex located on the posterolateral side, type Ⅲ with the apex located on the posterior ridge, and type Ⅳ with the apex located on the medial side. CT images of all fractures were superimposed on a standard template to create 3-D fracture line maps.Results:In this cohort, there were 7 cases of type Ⅰ (6.1%, 7/114), 65 cases of type Ⅱ(57.0%, 65/114), 39 cases of type Ⅲ (34.2%, 39/114) and 3 cases of type Ⅳ (2.6%, 3/114). In 49 cases (43.0%, 49/114), the fracture apex was not located on the posterolateral fibula (so that a conventional posterolateral steel plate cannot compress the apex). In fracture morphology of the 114 patients, the anterior fracture height, posterior fracture height, vertical fracture length, inclination angle, spiral angle, and apex spiral angle were, respectively, (-6.22±4.62) mm, (27.23±12.32) mm, (33.45±11.89) mm, 56.9°±9.6°, 269.8°±37.1°, and 156.2°±24.0°. The anterior fracture height, posterior fracture height, vertical fracture length, inclination angle, spiral angle, and apex spiral angle in type Ⅲ were all significantly larger than those in type Ⅱ ( P<0.05). The 3-D fracture line maps indicated that the lines of type Ⅲ fracture were steeper than those of type Ⅱ fracture. Conclusions:Since the apexes are not located on the posterolateral fibula in nearly half of the Danis-Weber type B lateral malleolar fractures, a conventional posterolateral steel plate cannot provide an effective anti-glide role. The higher a fracture line, the closer the fracture apex is to the posteriomedial fibula (posterior ridge and medial side). Fractures of type Ⅲ and type Ⅲ often indicate greater injury violence and more accompanying injuries.

OBJECTIVETo determine if locally administered bone morphogenetic protein-2 (BMP-2) and osteoprotegerin (OPG) improved osteogenesis and new bone formation by trans-sutural distraction osteogenesis.

METHODSTwenty four dogs were divided into three groups randomly and received new internal trans-sutural distraction osteogenesis treatment. Five days after operation, infusion apparatus with double-tube was inserted to submucosa near the distracted zone to deliver controlled release agent of recombinant human bone morphogenetic protein-2/poly (lactic-co-glycolic acid)/fibrin sealant (rhBMP-2/PLGA/FS) in group A and group C. Recombinant human osteoprotegerin/fibrin sealant (rhOPG/ FS) was injected three weeks later in group B and group C. Histology staining and bone histomorphometry were used to measure the changes of maxillary bone sutura after distraction for 1, 2, 4 and 6 weeks.

RESULTSNew bone formation observed in distracted zone showed a significant increase in group A and C. Transmission electron microscope showed the osteoblast and osteocyte were active with dilated rough endoplasmic reticulum and a large number of chondriosomes and Golgi complex. After distraction for 6 weeks, indexes of osteoblast of group A, B, and C were 38.5 +/- 7.7, 35.7 +/- 6.5, and 41.7 +/- 11.0, indexes of osteoclast (Ioc) were 5.9 +/- 1.0, 1.2 +/- 0.3, and 2.8 +/- 0.4, bone trabecula thicknesses were (38.36 +/- 13.28), (66.20 +/- 9.16), and (51.85 +/- 9.92) microm respectively. Increased bone density and decreased Ioc were found in group B and C.

CONCLUSIONThe new elastic distractor is effective in inducing new bone formation. BMP-2 and OPG combination acts synergistically, and leads to significant enhancement of bone formation and remodeling.

Animals ; Bone Density ; Bone Morphogenetic Protein 2 ; Dogs ; Humans ; Lactic Acid ; Maxilla ; Osteoblasts ; Osteogenesis ; Osteogenesis, Distraction ; Osteoprotegerin ; Polyesters ; Polyglycolic Acid ; Polymers ; Recombinant Proteins ; Transforming Growth Factor beta

With accelerated aging process of the population, femoral intertrochanteric fractures have gradually become another major social health problem in China. Internal fixation is still the gold standard treatment for the fractures. Fracture reduction is the first step of the treatment and also the first element that affects the treatment efficacy. It is still controversial in clinical practice how to evaluate the quality of fracture reduction during internal fixation of the fractures. This article systematically expounds and analyzes the 7 systems of judging criteria for the reduction of intertrochanteric fractures from the aspects of fracture alignment, fracture apposition, difference in judgment criteria, and difference in imaging methods, in order to provide a reference for reaching consensus and improving curative effects.