[Objective]To discuss the value and methods of severe hindfoot reconstruction in the treatment of hindfoot injures.[Method]Six cases with severe hindfoot injures were treated with hindfoot reconstruction.Among them, 4 patients were males and 2 females. Five cases were fallen from high places and 1 case by traffic accident. All cases associated with talus and calcancus comminuted fractures of type Ⅳ according to Sanders classification and calcaneocuboid, talocalcaneal and talonaviculare joint disorders.Four cases were associated with anterior and medial or plantar skin laceration,2 of anterior and medial skin laceration and 2 of plantar skin laceration. Among them, 1 were of anterior and medial skin avulsion wound and skin necrosis defect.1 were of plantar skin laceration and skin necrosis and bone exposure.[Result]Two cases' incisions without skin laceration were healed up. Among 4 cases incisions with skin laceration, 3 were primarily healed. One was Ⅱ-period healed. Two cases' skin laceration were healed by 1st incisions and 2 skin defects were healed by skin transplantation in 6 and 10 weeks after operation. The postoperative functional evaluation by AOFAS revealed excellent result in 1 foot, good in 3, fair in 2.[Conclusion]Hindfoot reconstruction is an effective method for severe hindfoot injures with the advantages of resoring function and outer aspect hindfoot satisfactorily.

Objective To compare the therapeutic effect and complication of immediate and selective interlocked intramedullary nailing in treatment of open tibial shaft fractures. Methods A total of 123 open tibial shaft fractures of 102 cases were treated with immediate fixation with interlocked intramedullary nailing after debridement (Group A) and with selective fixation with interlocking intramedullary nailing after debridement and closing the wound (Group B). Results The follow up for more than half a year showed that all fractures were healed, with excellent joint function of knee and ankle. Of all, 12 cases with skin necrosis and defect but without deep infection were healed after pedicle flap reconstruction. The result of Group A was much better than that of Group B in regard of total operation time, hospital stay, cost, amount of antibiotics used and partial weight bearing. No statistical difference in therapeutic effects and complications was found between two group. Conclusion Infection is not the contra-indication of interlocked intramedullary nailing in open tibial fractures. Immediate operation can be done after thorough debridement.

Objective The aim of this study is investigate the relationship between ACE gene I/D polymorphism and cerebral stroke.Methods 131 patients with cerebral stroke were recruited. The control group includes 50 age-match health cases.The I/D polymorphism of ACE gene was analyzed with PCR amplification.To avoid the mistyping, we used an insertion-specific prime.Results DD genotype shows clear differences among control, infarction and hemorrhage groups(?~2=13.87,P=0.008)。 The frequencies of DD genotype in the patients with cerebral stroke was higher than normal controls(?~2=9.21,P=0.002;?~2=8.76, P=0.003). The D allele also exhibits among control, infarction and hemorrhage groups(?~2=14.23,P=0.005)。 The frequencies of D allele in the patients with cerebral stroke was higher than normal controls(?~ 2 = 11.17,P=0.001;?~2 = 10.87,P= 0.001).Conclusions There was a positive association between the D allele of the ACE polymorphism and cerebral stroke.

Objective:To compare the clinical curative effect of traditional Chinese medicine packet and diclofenac sodium treatment on knee osteoarthritis (KOA) . Methods:A total of 88 patients with KOA according to random number table were randomly divided into treatment group and control group. Treatment group was treated with traditional Chinese medicine packet,the control group recened diclofenac sodium conventional treatment. Traditional Chinese medicine new medicine clinical research guiding principles and Womac standard was used to identify treatment efficacy. Results:Two groups of patients after treatment, the illness were eased. Treatment group clinical control in 5 cases,24 cases were markedly effective,effective 13 cases,2 had no effect,the total effective rate was 95.45%. Control group clinical control in 2 cases, 11 cases were markedly effective, effective 24 cases, 7 had no effect, the total effective rate was 84.09%. WOMAC scores in both groups were significantly lower than that before the treatment, and the curative effect of treatment group was more significant (P<0.05) . Conclusion:KOA patients treated with traditional Chinese medicine packet has good curative effect is worthy of clinical promotion.

Objective To prepare a recombinant pneumococcal surface protein A clade 4 ( PspA4) and to analyze its immunogenicity.Methods The gene encoding PspA4 protein was synthesized and inserted into pET-20b to construct the recombinant expression plasmid.The transformed E.coli strains carrying expression plasmid were induced to express PspA4 protein.ELISA was performed to analyze the ti-ters of PspA4-specific IgG in a mouse model.Results The recombinant PspA4 protein of high purity ( 90%) was successfully prepared.The titers of PspA4-specific antibody in mice received PspA4 immuniza-tion were 106 times higher than those of the blank control group, suggesting that the expressed PspA4 protein had the advantage of high immunogenicity.Conclusion This study suggested that the PspA4 protein might be used as one of the candidate protein for the development of pneumovax and laid a foundation for further in-vestigation on pneumococcal protein based vaccine.

BACKGROUND:Poor incision healing and infection often occur in elderly patients with lateral malleolar fractures after traditional lateral plate fixation.With the application of engineering software in medicine,a new type of plate placed posterolateral can be designed to solve the above-described problems. OBJECTIVE:To design a new type of posterior lateral low-profile steel plate with the aid of medical bioengineering software,based on the 3D CT data of the distance between the top of the lateral ankle fracture line to the anterior starting point(ACD),the distance between the top of the fracture line to the tip of the lateral ankle(CTD),the distance between the top of the fracture line to the posterior edge of the fracture line(PCD)and the angle between the anterior and posterior lateral sides of the distal fibula(CA). METHODS:Thirty cases of unstable lateral malleolar fracture and normal ankle were taken for CT scanning and three-dimensional reconstruction.The ACD,CTD,and PCD values in patients with lateral malleolar fracture were measured by 3-matic software,and the characteristics of lateral malleolar fracture line were plotted and described.The mimics software was used to measure the value of CA in the normal ankle joint.Based on the data measured above,3-matic software and solidworks software were used to design the low-profile steel plate and the thickness of the steel plate and the direction of the nail path were constructed.In Geomagic Studio software,fine surface,automatic surface,and fitting surface were used to generate the prototype of the low-profile steel plate,and then 3D printing was performed.After making a posterolateral incision of the lateral malleolus,the peroneus longus and brevis tendons were removed,and the prototype of the 3D-printed steel plate was placed behind the fibula to test its size and fit to the bone surface. RESULTS AND CONCLUSION:(1)The mean of ACD was(2.97±0.03)cm,and the variation was 5.23.The mean of PCD was(3.17±0.11)cm,and the variation was 17.60.The mean of CTD was(4.52±0.07)cm,and the variation was 8.60.(2)The fracture line of the lateral malleolus was drawn with an inverted"V"shape.The mean of CA between anterior and posterior lateral surfaces of the distal fibula was(103.20±1.94)°.At the midpoint section of the upper and lower vertices of the anterior edge of the distal fibula,the angle of the anterior and posterior lateral sides(CA)of the distal fibula was(78.50±1.78)°.(3)By using 3-matic,Solidworks,and Geomagic Studio software,a new type of posterior lateral low-profile steel could be successfully designed.Three to four holes were reserved for the screw holes at the proximal end of the plate with screw directions from back to front,and three screw holes were reserved on the inner and outer sides at the far end.The direction of the inner three holes could be from back to front,and the outer three screw holes needed to be biased towards the inner side,with an angle of 9.72°-13.28°.(4)It is indicated that the variability of the ACD position on the anterior lateral fracture line of the lateral malleolus is relatively small,while the variability of the posterior lateral PCD position is relatively large.The angle between the anterolateral and posterolateral sides of the lateral ankle fracture block shows a decreasing trend,with a smaller variation in the proximal angle and a larger variation in the distal angle.Based on three-dimensional CT reconstruction data of the external ankle,with the help of computer bioengineering software and the use of reverse design concept,a new type of low-profile lateral malleolus steel plate with a good fit can be quickly and conveniently designed to provide a valuable reference for the design of internal fixation devices.

Objective: To study the miR-28-3p expression in triple negative breast cancer (TNBC) tissues and cell lines, and explore its effect on the malignant biological behaviors of MDA-MB-468 cells. Methods： ：Tumor tissues and matched para-cancerous tissues were collected from 83 TNBC patients, who underwent tumor resection and pathological confirmation in the Fourth Hospital of Hebei Medical University between Jan. 2013 and Jan. 2014. TNBC cell lines (MDA-MB-468, HCC-1937, MDA-MB-231, MDA-MB436, MDA-MB-453) and human normal breast epithelial cell line MCF10A were also used in this study. qPCR was used to detect the expression of miR-28-3p in above mentioned tissues and cell lines. The correlation between miR-28-3p expression and clinical parameters was analyzed.After transfection with miR-28-3p inhibitor, the proliferation, apoptosis, invasion and migration ability of MDA-MB468 cells were detected with CCK-8, Flow cytometry, Transwell and Wound-healing experiment, respectively. And Western blotting was used to examine the protein expression of bridging integrator-1 (BIN1) in MDA-MB-468 cells. Bioinformatics BIN1 tool waere used to predict the target gene of miR-28-3p. Luciferase reporter gene assay was performed to validate the regulatory effect of miR-28-3p on BIN1. Results: The expression of miR-28-3p in TNBC tissues and cell lines was higher than that in matched paracancerous tissues and MCF10Acells (all P<0.01), respectively.Among the total 83 TNBC tissues, 56 (67.47%) showed high miR-28-3p expression. High expressionofmiR-28-3pwascloselycorrelated with the Ki-67 expression, tumor size and TNM stage (all P<0.05 or P<0.01). Compared with miR-NC group, transfection of miR-28-3p inhibitor significantly decreased the proliferation, invasion and migration of MDA-MB-468 cells while increased the apoptosis rate (all P<0.05 or P<0.01). Luciferase reporter gene assay confirmed that BIN1 was a target gene of miR-28-3p, and miR-28-3p inhibitor could up-regulate BIN1 expression in MDA-MB-468 cells (P<0.05). Conclusion: miR-28-3p is highly expressed in TNBC tissues and cell lines. miR-28-3p inhibitor up-regulates the expression of BIN1 to inhibit the proliferation, invasion and migration ability while promote the apoptosis of MDA-MB-468 cells.

Objective: To investigate the effects of long non-coding RNA nuclear enriched abundant transcript 1 (lncRNA NEAT1) on the proliferation of lung adenocarcinoma PC-9 cells and to explore its mechanism. Methods: qPCR was used to detect the expression level of lncRNA NEAT1 in human lung adenocarcinoma PC-9 cells and human embryonic lung diploid 2BS cells. The sequence of small interfering RNA(siRNA) targeting lncRNANEAT1 gene was designed and synthesized, and then transfected into PC-9 cells by liposome method. The expression level of NEAT1 in PC-9 cells before and after transfection was detected by qPCR. MTT and flow cytometry were used to detect the effect of lncRNANEAT1 knockdown on proliferation and cell cycle distribution of PC-9 cells, respectively. WB assay was used to detect the expressions of DNA damage-related proteins, namely, double-stranded DNA breaks (DSBs) biomarker γ-H2AX and ataxia-telangiectasia mutated (ATM), before and after transfection. Results: Compared with 2BS cells, lncRNA NEAT1 was highly expressed in PC-9 cells (P<0.05). The PC-9 cells with lncRNA NEAT1 knock-down were successfully established. After being transfected with siRNA for 12 h, the proliferation of PC-9 cells in siNEAT1 group and siNEAT2 group significantly decreased as compared with the blank control group and the empty transfection group (P<0.05). In the interference groups, cell cycle was arrested in G1 phase ([88.97±2.64]%, [88.15±1.48]% vs [84.5±1.72]%, P<0.05) and G2/M phase ([8.35±2.02]%, [8.11± 1.36]% vs [4.28±1.28]%, P<0.05). The expression levels of DNA damage-related proteinsATM and γ-H2AX in the interference groups were significantly increased (all P<0.05). Conclusion: lncRNA NEAT1 is highly expressed in lung adenocarcinoma PC-9 cells. lncRNA NEAT1 inhibits DNA damage and causes cell cycle at G1/M phase switch, and thus promotes the proliferation of lung adenocarcinoma cells.

[Abstract] Objective：To study the expression of long non-coding RNA(lncRNA) titin antisense RNA1 (TTN-AS1) in lung adenocarcinoma (LUAD) tissues, and explore its relationship with clinicopathologic characteristics and prognosis of LUAD patients. Methods: The TTN-AS1 expression in LUAD data set was analyzed using TCGAdatabase. 52 pairs of tumor tissues and matched para-carcinoma tissues from LUAD patients, who underwent surgical resection and were later pathologically conformed in Fourth Hospital of Hebei Medical University between Jan. 2014 and Jan. 2015, were used in this study. qPCR was performed to detect TTN-AS1 expression in the specimens. Then, the correlations between TTN-AS1 expression and clinicopathologic characteristics were analyzed. Survival analysis was used to determine the significance of TTN-AS1 expression for predicting the prognosis of LUAD patients. Results: TCGAdatabase analysis and qPCR results showed that TTN-AS1 expression in LUAD tissues was significantly higher than that in normal lung and para-carcinoma tissues (both P<0.01). TTN-AS1 expression in LUAD tissues was significantly correlated with the TNM stage and lymph node metastasis (P<0.05), but not correlated with gender, age, tumor invasion range (P>0.05). Kaplan-Meier univariate analysis result demonstrated that the patients with high TTN-AS1 expression had shorter post-operative disease-free survival (DFS) and overall survival (OS) than those patients with low TTN-AS1 expression (all P<0.01). Cox proportional hazard regression model result demonstrated that wider tumor invasion range, positive lymph node metastasis and high TTN-AS1 expression were significantly correlated with shorter postoperative DFS and OS (P<0.05). Conclusion: TTN-AS1 was highly expressed in LUAD tissues, and closely correlated with TNM stage and lymph node metastasis of LUAD patients (all P<0.05). High expression of TTN-AS1 is significantly correlated with shorter DFS and OS, indicating that TTN-AS1 may be a biomarker for predicting poor prognosis of LUAD patients.

[摘 要] 目的：探讨PD-1抗体联合化疗对比抗血管生成药物联合化疗在晚期驱动基因阴性肺腺癌一线治疗中的疗效和安全性。方法：收集2018年3月至2021年8月河北医科大学第四医院收治的141例不可手术切除的ⅢB/ⅢC和Ⅳ期驱动基因阴性肺腺癌患者，回顾性分析PD-1抗体联合化疗对比抗血管生成药物联合化疗在一线治疗中的疗效与安全性。主要研究终点为无进展生存期（PFS），次要终点为客观缓解率（ORR）、疾病控制率（DCR）和不良反应。结果：141例患者均纳入生存分析，中位随访时间为13.0个月（95% CI：12.0～14.0）。PD-1抗体联合化疗组（A组）和抗血管生成药物联合化疗组（B组）的ORR分别为33.33%和27.38%，DCR分别为98.25%和89.29%，差异均无统计学意义。A组和B组的中位PFS分别为8.4个月（95% CI: 7.3～9.9）和6.9个月（95% CI: 6.1～7.7），差异无统计学意义。亚组分析结果显示，ⅢB/ⅢC期、肝或脑转移患者中，A组中位PFS较B组均延长（均P<0.01）。A组和B组不良反应发生率分别为26.32%和14.29%，多数为1~2级。结论：PD-1抗体联合化疗对比抗血管生成药物联合化疗一线治疗晚期驱动基因阴性肺腺癌疗效相当，不良反应可耐受，可成为晚期驱动基因阴性肺腺癌标准一线治疗。