ObjectiveTo investigate the relationship between the imaging manifestations and postoperative efficacy scores through measuring postoperative ankle mortise morphometry of Rüedi-Allg(o)wer Ⅲ pilon fracture.MethodsForty-seven cases of Rüedi-Allg(o)wer Ⅲ pilon fracture patients,including 20 males and 27 females with a mean of 43 years (range,21-65 years) were treated and followed up.Indexes including the width,height,depth,coronal angle and sagittal angle of ankle mortise were measured at the last follow-up.According to the Mazur score at the last follow-up,operated ankle functions were evaluated and divide into three groups (excellent group,good group and poor group.By comparing the five indexes of 47 cases and 3 groups between injury ankle and healthy ankle,we analyzed the correlation of the ankle mortise change and the ankle function.ResultsAll patients were followed up 18-24 months(mean,21 months).The results showed there were significant differences about all the measuring indexes except the height of ankle mortise between the injury ankle and healthy ankle of 47 follow-up cases.About the difference between both sides in 3 groups,the results showed there was a negative correlation between all indexes except the height of ankle mortise and the Mazur score.No correlation was found between the height of ankle mortise and the Mazur score.Recovering the ankle mortise's width,depth,coronal angle as well as sagittal anglein the surgery of severe pilon fractures has a significant effect on ankle function.ConclusionRecovery of the ankle mortise's width,depth,coronal angle as welld as sagittal angle during the surgery of severe pilon fractures has a significant effect on ankle function,so the anatomy of the ankle mortise should be recovered as much as possible.

Objective To compare the effect of novomix30 and metformin in treatment of diabetes mellitus combined with osteoporosis.Methods 117 patients diagnosed as type 2 diabetes mellitus (T2DM) combined with osteoporosis were collected from Sep.2013 to Apr.2017 in our hospital.They were divided into two groups:metformin group (n=53),and novomix group (n=64) according to different therapies.General information of the two groups were comparable.The patients of metformin group reveived calcium,alendronate and metformin.The patients of novomix group received calcium,alendronate and novomix.The lumbar bone mineral density (BMD),greater trochanter BMD,femoral neck BMD,Ward triangle BMD,the serum levels of BGP,alkaline phosphatase (ALP),β-cross-linked C-telopeptide of type Ⅰ collagen(β-CTX),1,25-(OH)2D3,the levels of fasting plasma glucose (FPG),2h plasma glucose (2h PG),HBA1c and adverse reactions were recorded during the treatment.Results The lumbar BMD,greater trochanter BMD,femoral neck BMD,Ward triangle BMD of novomix group were higher than those of metformin group after treatment (P＜0.05).The serum β-CTX levels of novomix group were lower than those of metformin group after treatment (P＜0.05),while the serum BGP,ALP,1,25-(OH)2D3 levels of novomix group were higher than those of metformin group after treatment (P＜0.05).The levels of FPG,2hPG,HBA1c had no significant difference between the two groups after treatment (P＞0.05).The adverse reactions rate of metformin group and novomix group was 28.30％ and 25.00％ respectively,and there was no significant difference between the two groups (P＞0.05).Conclusion Novomix30 can significantly improve bone metabolism level for patients combined with T2DM and osteoporosis,maintain bone remodeling balance,reduce bone loss,and improve BMD,which is worthy to be promoted.

Objective:To investigate the immune effects of Clostridium difficile toxoid B (CdtB) vaccine formulated with different mucosal adjuvants through microneedle immunization, and to provide ideas for the prevention and treatment of Clostridium difficile infection. Methods:CdtB vaccine was prepared with purified Clostridium difficile toxin B(TcdB) after formaldehyde detoxification. Female BALB/c mice were immunized with different doses of vaccine alone or in combination with mucosal adjuvants. The titers of specific serum IgG and fecal IgA were detected at 0 d, 7 d, 14 d, 28 d and 42 d after immunization. The protective effects of CdtB vaccine were evaluated by cell neutralization assay and Clostridium difficile challenge infection. Results:(1) With the increase of immune dose, the mice immunized with CdtB vaccine alone by microneedle not only produced better serum specific IgG, but also had higher level of IgA in feces. (2) When the mice were immunized with CdtB vaccine containing LT or CTB adjuvant by microneedle, the trend of serum specific IgG titer in each group increased with the increase of immune dose, especially in the group containing LT adjuvant. There were significant differences in the trend of specific IgA titer in feces between the adjuvant groups and the group without adjuvant, but the adjuvant effect was not obvious. (3) No significant difference in serum IgG titer was observed between the mice immunized with 10 μg CdtB by microneedle or intraperitoneal injection, but microneedle immunization significantly increased fecal IgA level. (4) The neutralization titers of specific antibodies in mouse serum after immunization and the test results of challenge protection in mice confirmed that the use of CdtB vaccine had certain protective effects.Conclusions:CdtB vaccine had better immune effects in mice through microneedle immunization, but the adjuvant effects of LT and CTB were not significant.