Objective To discuss the factors which affect the postoperative functions of the ankle joint. Methods A retrospective study was done of 102 patients who had been diagnosed as malleolar fracture and operated on in our institute between January 2005 and January 2008. We recorded their age, gender, body mass index(BMI), fracture type (AO type), time from injury to operation and presence or ab-sence of cast immobilization. Their ankle functions were evaluated by X-ray and the Baird-Jackson evaluation system in regular follow-up. Relationship between the above-mentioned factors and the postoperative functions of the ankle joint was statistically analyzed, using univariate logistic regression and multiple stepwise logistic regression. Results A total of 102 patients were followed up for 24.7 (11 to 43) months. A negative correlation between the age, fracture type, reduction and postoperative function was found. The gender, body mass index (BMI), time from injury to operation and presence or absence of east immobilization, however, had no association with the postoperative function. The conservative treatment of the deltoid ligament injury complicated with the lateral malleolar fracture and/or improper treatment of the syndesmotic injury led to poor function. Conclusions The older a patient and the more serious a fracture, as well as the more unsat-isfactory the reduction, the poorer the postoperative ankle functions may be. To some extent, rational treat-ment of the deltoid ligament injury complicated with the lateral malleolar fracture and the syndesmotic injury may also determine the postoperative function of the ankle joint.

Objective To investigate methods and experience of autologous granular fat transplantation by correction of aging face. Methods 178 cases of aging face subjects were treated by liposuction. Then autologous granular fat was harvested by liposuction,centrifuged and purified, and injected into marked areas of aging face. The injection process should be controled by multilevel and multiple tennel, in order to supplement the loss of facial soft tissue volume and improve the aging face. Results The follow-up period ranged from 3 months to 3 years. All the subjects had a satisfactory results with no obvious complications such as fat liquefaction, infection and ulceration. The effect of autologous granular fat transplantation was obvious and permanent. Conclusions Autologous granular fat transplantation is a safe and effective surgical technique for facial soft tissue augmentation that can effectively improve aging face and worthy of clinical application.

Objective To compare the value of assessment with DWI and contrast-enhanced MRI (CE-MRI) in activity of sacroiliitis of patients with ankylosing spondylitis(AS).Methods Ninety-six patients conforming to modified New York criteria were prospectively collectedas the AS group, and twenty-one healthy volunteers were enrolled into the control group. According to the Bath AS disease activity index (BASDAI), erythrocyte sedimentation rate and C-reaction protein, AS patients were divided into the active AS group (n=60) and the chronic AS group (n=36) . All subjects were performed with conventional MRI, DWI and CE-MRI of bilateral sacroiliac joints. The MRI manifestations were reviewed and the ADC values and signal intensity enhancement rate (ΔSI) were measured.ANOVA was performed for the comparison ofΔSI and ADC values among active AS group, chronic AS group and control group with BASDAI and lab test results as the gold standards. ROC was analyzed with ΔSI and ADC values for activity of AS and paired
samples t test was obtained to comparethe areas under the ROC ofΔSI and ADC values.Results Among 96 cases of AS patients, MRI of sacroiliac jointsshowed that 62 cases had subchondral bone edema (57 cases of active group, 5 cases of chronic group), that 11 cases had bone surface erosion(4 cases of active group, 7 cases of chronic group), that 15 cases had bone sclerosis(6 cases of active group, 9 cases of chronic group) and that 58 cases had fat deposition on the sacroiliac joints (27 cases of active group, 31 cases of chronic group). The ΔSI values of the active group, the chronic group and control group were respectively (2.51 ± 1.69)%,(1.19 ± 0.67)%and(0.75 ± 0.21)%, and the ADCvalues were(1.33 ± 0.33)× 10-3,(1.00 ± 0.43)× 10-3 and(0.38±0.13)×10-3mm2/s. There were significant differences forΔSI and ADC values among three groups (F=18.375, 16.366. P<0.01), and statistical significance ofΔSI and ADC values were found between every two groups of three(P< 0.05).The area under the ROC between ΔSI and ADC to determine activity of AS patients were respectively 0.814 and 0.730, which had nostatistical significance(t=1.632, P=0.103). The sensitivity and specificity to determine activity of AS patients byΔSI=1.44%were 81.67%and 80.00%.The sensitivity and specificity to determine activity of AS patients by ADC=1.15 × 10-3/mm2 were 76.67% and 71.43%.Conclusion DWI and CE-MRI performed equally in detecting activity of AS patients.

OBJECTIVETo study the regulatory effect of Bushenfang on the serum testosterone (T) level of naturally aging rats and its mechanism, in order to provide a theoretical and experimental basis for the clinical treatment of late onset hypogonadism (LOH) in males.

METHODSThirty-two 18-month-old male SD rats were randomly divided into four groups of equal number, naturally aging model and low-, medium- and high-dose Bushenfang groups, and another eight 4-month-old rats were taken as normal controls. The rats of the aging model and normal control groups were treated with normal saline, while those of the low-, medium- and high-dose Bushenfang groups received intragastrically Bushenfang at 3.25, 7.50 and 15.00 g/kg, respectively, all for 3 weeks. Then the rats were sacrificed, the histomorphologic changes of the testis observed by HE staining, the serum T level measured by radioimmunoassay, and the expressions of the StAR protein, P450scc and 3beta-HSD I determined by RT-PCR.

RESULTSThe number of Leydig cells was obviously increased after Bushenfang treatment. The levels of serum T were significantly higher in the low-, medium- and high-dose Bushenfang groups ([6.74 +/- 1.56] nmol/L, [8.50 +/- 1.99] nmol/L and [12.41 +/- 2.91] nmol/L) than in the model group ([3.48 +/- 0.75] nmol/L) (P < 0.05). The three Bushenfang groups also showed a remarkable elevation in the mRNA expressions of StAR (0.74 +/- 0.29, 0.83 +/- 0.32 and 1.35 +/- 0.50), P450scc (0.72 +/- 0.36, 1.023 +/- 0.30 and 1.41 +/- 0.37) and 3beta-HSD I (0.58 +/- 0.14, 0.72 +/- 0.07 and 0.85 +/- 0.18), as compared with the models (StAR: 0.44 +/- 0.09; P450scc: 0.33 +/- 0.05; 3beta-HSD I: 0.34 +/- 0.02), with significant differences in the StAR expression between the high-dose Bushenfang and the model groups, as well as in P450scc and 3beta-HSD I expressions between the medium- and high-dose Bushenfang and the model groups (P < 0.05).

CONCLUSIONBushenfang could improve the pathological status of testicular injury and increase the expression of testosterone synthetase, which might be the mechanism behind its regulatory effect on the serum T level of aging rats.

Aging ; drug effects ; Animals ; Drugs, Chinese Herbal ; pharmacology ; Hypogonadism ; drug therapy ; metabolism ; Male ; Rats ; Rats, Sprague-Dawley ; Testis ; drug effects ; Testosterone ; metabolism

Objective To investigate the intervention effects of Yangqing Chenfei Fang (YCF), Baojin Chenfei Fang (BCF), and Jinshui Chenfei Fang (JCF) at different pathological stages of silicosis in a rat model. Methods A total of 216 specific pathogen free rats were randomly divided into control group, silicosis group, tetrandrine group, YCF group, BCF group and JCF group, with 35-36 rats in each group (11-12 rats at each time point). The rats in control group were treated with intragastric administration of pure water [administration volume at 2.5 mL/(kg·time)], while the rats of other five groups were treated with silica suspension at 250 mg/kg body weight to induce a silicosis model using the one-time non-exposed tracheal method. Intragastric administration of the corresponding drugs was performed at three time points at days 1-14 (early stage of silicosis), days 15-28 (middle stage of silicosis), and days 29-42 (late stage of silicosis) after modeling. Pulmonary function enhanced pause (Penh), forced vital capacity (FVC), and dynamic lung compliance (Cdyn) of rats in the six groups was assessed on days 15, 29, and 43 after modeling. Histopathological changes in lung tissues were observed, and relative expression levels of tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-1β, hydroxyproline, collagenⅠ(COL-Ⅰ), and α-smooth muscle actin (α-SMA) were detected in lung tissues. Results i) Pulmonary function index. The index of Penh in three stages of silicosis of rats in YCF group, BCF group and JCF group was lower than that in the silicosis group at the same stage (all P<0.05), and the index of Penh was higher than that in the tetrandrine group at the same stage (all P<0.05). The index of FVC of rats in YCF group, BCF group and JCF group at the middle stage was higher than that in the silicosis group at the same stage (all P<0.05), as well as the index of Cdyn was higher than that in the tetrandrine group at the same stage (all P<0.05). ii) Histopathology of lung tissue. Rats of the silicosis group exhibited alveolitis, fibro stripe, and collagen deposition in lung tissues in the early stage compared with rat of the control group, with fibrosis progressively worsening over time and inflammation persisting throughout the disease course. Pathological changes of lung tissues were alleviated to varying degrees in the tetrandrine groups, YCF group, BCF group and JCF group compared with that of the silicosis group. Compared with the same stage of silicosis group, the Ashcroft scores of lung tissues in the YCF group and BCF group were lower in the middle and late stages (all P<0.05). The Ashcroft score of lung tissues in the BCF group in the middle and late stages was lower than that in tetrandrine group at the same stage (all P<0.05), while the Ashcroft score in the middle stages was lower than that in YCF group at the same stage (P<0.05). The Ashcroft score of lung tissue in the JCF group was lower than that in the silicosis group, tetrandrine group and YCF group at all three stages (all P<0.05), and was lower than that in BCF group at the early and late stage of silicosis (all P<0.05). iii) Inflammatory factors. IL-6 level in the lung tissues in the YCF group, BCF group and JCF group decreased compared with that in the silicosis group at the same stage (all P<0.05), while IL-1β and TNF-α levels decreased at the early and middle stages (all P<0.05), hydroxyproline level decreased at all three stages (all P<0.05). iv) Collagen. The relatively expression of COL-Ⅰ in the lung tissues in the YCF group decreased at the late stage of silicosis compared with that in the silicosis group at the same stage (all P<0.05), while the relatively expression of α-SMA decreased at the middle and late stages (all P<0.05). Compared with the same stage of silicosis group, the relative expression of COL-Ⅰ and α-SMA of the lung tissues reduced in the BCF group and JCF group at all stages (all P<0.05). The relative expression of COL-Ⅰ of the lung tissues reduced in the BCF group at the late stage compared with that in the YCF group in the same stage (all P<0.05), while the relative expression of α-SMA decreased at the early and middle stages (all P<0.05). The relative expression of COL-Ⅰ of the lung tissues reduced in the JCF group at late stage of silicosis (all P<0.05), while the relative expression of α-SMA decreased at all three stages (all P<0.05), compared with the same stage of YCF group. Conclusion All three formulations of Chinese herbs are effective in improving lung function and alleviating the progress of lung inflammation and fibrosis. YCF is the most effective in suppressing inflammation in the early stage of silicosis. BCF excels in delaying fibrosis in the early and middle stages. JCF is the most effective in improving lung function and delaying fibrosis progression in the late stage.

Objective:To explore the risk factors of cement displacement after percutaneous vertebral augmentation in patients with osteoporotic vertebral compression fracture (OVCF).Methods:A case-control analysis was made on clinical data of 1 538 patients with OVCF admitted to Honghui Hospital Affiliated to Xi′an Jiaotong University from January 2016 to June 2021. There were 377 males and 1 161 females, aged from 45-115 years [(71.7±10.8)years]. Percutaneous vertebroplasty (PVP) or percutaneous vertebroplasty (PKP) was performed. Patients were divided into cement displacement group ( n=78) and cement non-displacement group ( n=1 460) according to the radiographic outcomes. Factors related to cement displacement were analyzed by univariate analysis, including age, gender, body mass index (BMI), preoperative bone mineral density, underlying diseases, involved vertebral segments, surgical methods, surgical approaches, cement leakage (anterior edge), viscosity of cement, dispersion ratio of cement, degree of cement interweaving, sagittal position of cement, targeted location of cement, distance from cement to upper and lower endplates and duration of brace wearing. Independent risk factors for bone cement displacement were identified by multivariate Logistic regression analysis. Results:Univariate analysis showed that bone cement displacement was significantly correlated with BMI, preoperative bone mineral density, involved vertebral segments, operation methods, cement leakage (anterior edge), viscosity of cement, dispersion ratio of cement, degree of cement interweaving, sagittal position of cement, targeted location of cement, distance from cement to upper and lower endplates and duration of brace wearing (all P<0.05), but there was no correlation with gender, age, underlying diseases or surgicales approach (all P>0.05). Multivariate Logistic analysis showed that the preoperative bone mineral density ( OR=2.45, 95% CI 1.81-7.50, P<0.01), operation methods ( OR=4.56, 95% CI 1.86-8.44, P<0.01), cement leakage (anterior edge) ( OR=5.77, 95% CI 2.85-9.20, P<0.01), viscosity of cement ( OR=7.36, 95% CI 1.01-1.77, P<0.01), dispersion ratio of cement ( OR=6.84, 95% CI 1.69-13.39, P<0.01), degree of cement interweaving ( OR=8.97, 95% CI 2.29- 14.97, P<0.01), sagittal position of cement ( OR=6.39, 95% CI 1.06-9.47, P<0.01), targeted location of cement ( OR=7.93, 95% CI 1.64-11.84, P<0.01), distance from cement to upper and lower endplates ( OR=6.78, 95% CI 1.84-6.96, P<0.01) and duration of brace wearing ( OR=9.55, 95% CI 2.26- 9.38, P<0.01) were significantly correlated with bone cement displacement after percutaneous vertebral augmentation. Conclusion:Low bone mineral density preoperatively, PKP, cement leakage into the vertebral anterior edge, low viscosity of cement, small dispersion ratio of cement, small degree of cement interweaving, cement filling in the anterior 1/3 and anterior middle 2/3 of the vertebral body in sagittal plane, non-targeted injection of cement, long distance from cement to upper and lower endplates and short duration of brace wearing are independent risk factors of cement displacement after percutaneous vertebral augmentation for OVCF.

The treatment of hepatobiliary malignant tumor is characterized by the coexistence of multiple treatment methods and multiple disciplines. In order to evaluate the clinical efficacy of different treatment measures or multiple treatment combinations, and to promote the standardized development of comprehensive treatment patterns for hepatobiliary malignant tumor, the Hepatobiliary Center of the First Affiliated Hospital of Nanjing Medical University constructs the registry and follow-up database in hepatobiliary tumor patients based on the information-based platform of the hospital, which will help guide clinicians to make scientific decisions and improve the level of clinical diagnosis and treatment. This study describes the framework design, function modules, data acquisition process and quality control of the database of hepatobiliary malignant tumor. Based on the observational bidirectional cohort study design, the previous clinical data can be sorted to match the current database, on the other hand, the clinical data can be prospectively collected including basic information, admission evaluation, surgical information and postoperative situation, comprehensive treatment measures, regular reexaminations and long-term follow-up, etc. The data quality control system can be improved by formulating standardized operation procedures, regularly personnel training and full-process data management plans. This database will provide high-quality real-world data for clinicians, researchers, and guideline experts, and then provide high-level medical evidence for the standardized development of comprehensive treatment patterns of hepatobiliary malignancies.

Objective:To study the surgical safety and efficacy of preoperative neoadjuvant therapy with immune checkpoint inhibitors combined with anti-angiogenic drugs in patients with China liver cancer staging(CNLC)-Ⅱb and Ⅲa resectable hepatocellular carcinoma.Methods:The data of 129 patients with Ⅱb and Ⅲa hepatocellular carcinoma who underwent surgery at the First Affiliated Hospital of Nanjing Medical University from January 2018 to December 2020 were analyzed. All patients were divided into two groups: the neoadjuvant therapy group( n=14,13 males and 1 female,aged (55.4±12.6)years(range:34 to 75 years)) received immune combined targeted therapy before surgery,immune checkpoint inhibitor camrelizumab was administered intravenously at a dose of 200 mg each time,every 2 weeks for 3 cycles,anti-angiogenesis drug apatinib was taken orally and continuously with a dose of 250 mg for 3 weeks and the conventional surgery group( n=115,103 males and 12 females,aged (55.8±12.0)years(range:21 to 83 years)) did not receive antitumor systemic therapy before surgery. There were 3 patients with CNLC-Ⅱb,11 with CNLC-Ⅲa in the neoadjuvant group;28 patients with CNLC-Ⅱb,87 with CNLC-Ⅲa in the conventional group. Student′s t test or rank-sum test was used to compare the differences between two groups for quantitative data, Fisher′s exact probability method was used to compare the differences of proportions between two groups, and Log-rank test was used to compare survival differences between two groups. Results:The 1-year recurrence rate in the neoadjuvant group was 42.9%,and the 1-year recurrence rate in the conventional group was 64.0%,with a statistically significant difference between the two groups(χ2=3.850, P=0.050);The 1-year survival rate in the neoadjuvant group was 100% and that in the conventional group was 74.2%,with a statistically significant difference between the two groups(χ2=5.170, P=0.023). According to the stratified analysis of the number of tumors,for single tumor,the 1-year recurrence rate in the neoadjuvant group was 25.0%,and that in the conventional surgery group was 71.0%,and the difference between the two groups was statistically significant(χ2=5.280, P=0.022). For multiple tumors, the 1-year recurrence rate in the neoadjuvant group was 66.7%,and the 1-year recurrence rate in the conventional surgery group was 58.9%,with no significant difference between the two groups(χ2=0.110, P=0.736). The operative time,intraoperative blood loss,and postoperative hospital stay in the neoadjuvant group were similar to those in the conventional group,and their differences were not statistically significant. Conclusions:Immune checkpoint inhibitors combined with anti-angiogenic targeted drugs as a neoadjuvant therapy for resectable hepatocellular carcinoma can reduce the 1-year recurrence rate and improve the 1-year survival rate,especially for those with solitary tumor. Limited by the sample size of the neoadjuvant group,the safety of immune combined targeted therapy before surgery cannot be observed more comprehensively,and further studies will be explored.

Objective:To study the surgical safety and efficacy of preoperative neoadjuvant therapy with immune checkpoint inhibitors combined with anti-angiogenic drugs in patients with China liver cancer staging(CNLC)-Ⅱb and Ⅲa resectable hepatocellular carcinoma.Methods:The data of 129 patients with Ⅱb and Ⅲa hepatocellular carcinoma who underwent surgery at the First Affiliated Hospital of Nanjing Medical University from January 2018 to December 2020 were analyzed. All patients were divided into two groups: the neoadjuvant therapy group( n=14,13 males and 1 female,aged (55.4±12.6)years(range:34 to 75 years)) received immune combined targeted therapy before surgery,immune checkpoint inhibitor camrelizumab was administered intravenously at a dose of 200 mg each time,every 2 weeks for 3 cycles,anti-angiogenesis drug apatinib was taken orally and continuously with a dose of 250 mg for 3 weeks and the conventional surgery group( n=115,103 males and 12 females,aged (55.8±12.0)years(range:21 to 83 years)) did not receive antitumor systemic therapy before surgery. There were 3 patients with CNLC-Ⅱb,11 with CNLC-Ⅲa in the neoadjuvant group;28 patients with CNLC-Ⅱb,87 with CNLC-Ⅲa in the conventional group. Student′s t test or rank-sum test was used to compare the differences between two groups for quantitative data, Fisher′s exact probability method was used to compare the differences of proportions between two groups, and Log-rank test was used to compare survival differences between two groups. Results:The 1-year recurrence rate in the neoadjuvant group was 42.9%,and the 1-year recurrence rate in the conventional group was 64.0%,with a statistically significant difference between the two groups(χ2=3.850, P=0.050);The 1-year survival rate in the neoadjuvant group was 100% and that in the conventional group was 74.2%,with a statistically significant difference between the two groups(χ2=5.170, P=0.023). According to the stratified analysis of the number of tumors,for single tumor,the 1-year recurrence rate in the neoadjuvant group was 25.0%,and that in the conventional surgery group was 71.0%,and the difference between the two groups was statistically significant(χ2=5.280, P=0.022). For multiple tumors, the 1-year recurrence rate in the neoadjuvant group was 66.7%,and the 1-year recurrence rate in the conventional surgery group was 58.9%,with no significant difference between the two groups(χ2=0.110, P=0.736). The operative time,intraoperative blood loss,and postoperative hospital stay in the neoadjuvant group were similar to those in the conventional group,and their differences were not statistically significant. Conclusions:Immune checkpoint inhibitors combined with anti-angiogenic targeted drugs as a neoadjuvant therapy for resectable hepatocellular carcinoma can reduce the 1-year recurrence rate and improve the 1-year survival rate,especially for those with solitary tumor. Limited by the sample size of the neoadjuvant group,the safety of immune combined targeted therapy before surgery cannot be observed more comprehensively,and further studies will be explored.

【Objective】 To explore the clinical effect of unilateral double-channel endoscope-assisted bone graft fusion and internal fixation (ULIF) in the treatment of recurrent lumbar disc herniation. 【Methods】 The clinical data of 22 patients with recurrent lumbar disc herniation treated by ULIF in our hospital from August 2020 to October 2020 were analyzed retrospectively. The study indicators included intraoperative blood loss, operation time, bed rest time, and hospital stay. The follow-up data included visual analogue score (VAS) of low back pain, Japanese Orthopaedic Association score (JOA), OSwestry disability index (ODI) score, as well as 36 concise health status survey (SF-36) scores before operation, and 1 week and 6 months after operation. 【Results】 The average operation time was (179.15±42.06) minutes, the average intraoperative blood loss was (132.67±41.92) mL, the average bed rest time was (1.51±0.42) days, and the average hospital stay was (4.82±1.13) days. The VAS score of low back pain at 1 week after operation was lower than that before operation (all P<0.000 1), and further decreased during the follow-up. The ODI score, JOA score and SF-36 score of postoperative follow-up were significantly different from those before operation (P<0.05). The satisfaction rate was 86.4% at 1 week after operation and 95.4% at 6 months after operation. The proportion of significant clinical efficacy at 1 week after operation and postoperative 6 months was 18.2% and 63.6%, respectively. 【Conclusion】 ULIF has the advantages of short-term recovery, less intraoperative blood loss, short bed rest and hospital stay, and good medium-term clinical effect. It is a safe and reliable minimally invasive technique for spinal surgeons in the treatment of recurrent lumbar disc herniation.