Objective To evaluate the feasibility and clinical outcomes of minimally invasive treatment via anterolateral acromial approach (ALA) for severely impeded vaigu fractures of the proximal part of the humerus. Methods From June 2011 to may 2013 a total of 20 patient’s with severly impacted valgus proximal humeral fracture were treated through ALA in a minimally invasive manner. Direct reduction, bone grafting, reconstruction of the rotator cuff insertion and Proximal Humerus Internal Locking System (PHILOS) Planting were well carried out. Systematic rehabilitation exercise of the shoulder joint was performed postoperatively. Results All the patients were followed-up for at least one year. with an average of (15 ± 3) months (range 12~36 months). No axillary neurapraxia occurred that could be attributed to the surgical approach. All fractures healed within 6 months. and tHaverage Constant-Murley score at 1 year was (83.0 ± 1.5) (range 79.0 to 89.5) during a 12-month follow-up. There was no internal fixation failure or avascular necrosis (AVN) of humeral head during follow-up. Conclusion Treatment of severely impacted valgus proximal humeral fractures with minimally invasive ALA through percutaneous plating PHILOS can avoid the injury of nerve and vascular. reduce the dissection of sott tissue. avoid damage to the residual blood supply of the humeral head and achieve stab! fixation, benefiting early function recovery.

BACKGROUND: Local antibiotic delivery system can increase local drug concentration, reduce drug toxicity, and increase drug bioavailability, thereby improving the antibacterial efficacy and providing a new method for the long-term treatment of osteomyelitis. OBJECTIVE: To summarize the application progress of various local drug sustained-release systems in the treatment of osteomyelitis, and analyze the current deficiencies and research directions. METHODS: The authors searched for related articles in PubMed, Web of Science, Medline, Wanfang and CNKI databases published from 2007 to 2020. The key words were “osteomyelitis, drug delivery system, antibiotics, PMMA, degradable material” in English; and “osteomyelitis, drug release system, PMMA, degradable materials” in Chinese. There were 221 preliminary inspection articles, and 76 articles were analyzed after screening. RESULTS AND CONCLUSION: Currently, carrier materials commonly used in local drug release systems include degradable materials such as collagen, bioactive glass, and non-degradable materials such as PMMA bone cement. Non-biodegradable antibiotic carriers have been successfully used clinically, but these carriers need to be removed by a second operation, and their early explosive drug release will have a great impact on their efficacy. Therefore, further research on the improvement of non-degradable materials is needed to better improve their efficacy. The local antibiotic delivery system of biodegradable materials can not only continuously deliver drugs at the infection site, but also act as bone filling materials in the early stage. Some degradation products can even create a good bone conduction environment for blood vessels and new bone formation. However, the precise control of drug release in complex systems requires further research.

Objective To investigate the effect of dexmedetomidine ( Dex) combined with ropivacaine in brachial plexus block ( BPB) on serum basic fibroblast growth factor ( bFGF) levels of upper limb fracture patients in the perioperative period. Methods 80 patients ( ASA gradeⅠ~Ⅱ) scheduled for selective upper extremity surgery were randomly divided into the dexmedetomidine combined with ropiva-caine group ( RD group) and the ropivacaine group ( R group) with 40 patients in each group. BPB was performed at the point of 2 cm below coracoid directed by nerve stimulator. Ropivacaine (200 mg) was diluted into 40 mL in group R and ropivacaine (200 mg) +1 μg/kg dexmedetomidine were diluted into 40 mL in group RD. Drew 5 mL blood at T0~T4 points respectively,and serum bFGF concentration were determined. Results Compared with group R,MAP and HR at T1~T3 points were significantly lower in group RD (P<0. 05). SpO2 in the two groups at each point had no statistical significance (P>0. 05). Compared with T0 points,bFGF concentration were increased in two groups at T1~T4 points (P<0. 05),and it was higher in group RD compared with group R (P<0. 05). Conclusion Dex combined bra-chial plexus block promote the secretion of bFGF more than simple brachial plexus block,which is conducive to fracture healing after opera-tion,but it should be cautious to apply for patients with bradyarrhythmia.

Objective To investigate the effects of cognitive therapy combined with picture recognition training on depression after stroke (PSD).Methods Sixty patients with PSD after cerebral infarction were randomized into study and control groups.All accepted routine rehabilitation therapy.In addition,the study group accepted cognitive therapy combined with picture recognition training.The effects were assessed in terms of average reaction time and accuracy in picture recognition,and using the Hamilton depression rating scales (HAMDs) and the Barthel index (BI) before and after 4 weeks of treatment.Results The average reaction time and accuracy in picture recognition and the HAMD and BI scores improved significantly in both groups.The effects in the study group were significantly better than those of the control group.Conclusion Cognitive therapy combined with picture recognition training can alleviate depression symptoms and improve ability in the activities of daily living after stroke.

Objective To explore the computed tomography (CT)manifestations of adrenocortical oncocytoma (ACO)for better understanding the disease and improving its diagnosis accuracy.Methods The CT manifestations of 9 cases with adrenocortical onco-cytomas confirmed by surgery were retrospectively reviewed and compared with pathological results.Results Five of cases were lo-cated in left side while 4 cases were in right side.Well defined and round or oval border could be found in all the cases.Of all the ca-ses,3 cases were solid lesions with equal density,< 3 cm in diameter,and mild consistent intensification after enhancement.Cystic lesion was detectd in 6 cases with > 3 cm in diameter.The mixed cystic and solid components with polycystic changes could be found on CT image,and remarkable intensification on solid lesion while no intensification on cystic lesion after the enhancement. Moreover,patchy or cotton-like shape could be found on solid lesion in 4 cases and 1 case with island like intensification;reticular pattern could be found in the central of lesion in 3 cases and 1 case with stellate shape.Pathological observation showed that the on-cotytomas were comprised of cells with abundant eosinophilic cytoplasm and necrotic and fibrous capsule without pathological mitosis could be found in some of lesion.Conclusion The characteristic CT features of adrenocortical oncotytoma has a worse specificity,its diagnosis was dependent on pathologic examination.

Objective To investigate the diagnosis and treatment methods of traumatic renal infarction.Methods A retrospective analysis was performed on 6 cases of traumatic renal infarction treated between September 2008 and February 2013.There were 5 males and 1 female,at age of 5-65 years (average,36.2 years).Causes of injury included vehicle collisions in 4 cases and high falls in 2.Out of 6 cases,segmental renal infarction was identified in 2 and total infarction in 4.According to American Association for the surgery of trauma renal trauma grading system,2 cases were classified to grade Ⅳ and 4 to grade Ⅴ.Results Three cases were managed conservatively,which showed segmental infarction in 1 case and total infarction in 2.Three cases underwent surgical exploration,followed by partial nephrectomy in 1 case,left kidney removal plus partial pancreectomy in 1 and right kidney removal in 1.There were no major complications intraoperatively or postoperatively and no cases received blood transfusion.Period of follow-up was 3-34 months.In conservative management,there were no renal atrophies in segmental renal infarction cases and some degree of atrophies in total renal infarction cases,but none presented with arterial hypertension.Conclusions Enhanced CT is the preferred diagnostic tool for evaluation of traumatic renal infarction.Conservative therapy is the optimal option for most cases,but nephrectomy is reserved for cases of infection or renal hypertension.

Objective:To investigate the hippocampal subfield volumes before and after taking hydrochloric donepezil in patients with mild Alzheimer's disease (AD). Methods:From January, 2017 to June, 2018, 25 mild AD patients accepted hydrochloric donepezil (treatment group), 25 patients accepted placebo (placebo group) and 25 age- and gender-matched healthy old people (control group) were scanned with magnetic resonance imaging (MRI) under 3D-T₁ TFE sequence before and after a six-month treatment, and the automated segmentation of the hippocampus subfields was fulfilled with FreeSurfer and the hippocampus subfield volumes were compared, while the patients were assessed with Mini-Mental State Examination (MMSE). Results:Compared with the control group, the volumes of left CA1， CA2-3 and CA4-DG, and right CA1 and CA2-3 were reduced in patients before treatment (t > 2.294, P < 0.05). The volume of left CA4-DG increased in the treatment group compared with that of the placebo group after treatment (t = 2.196, P < 0.05), and the volume of bilateral CA1 and CA2-3 tended to increase but not significantly (t < 1.888, P > 0.065). The MMSE score was more in the treatment group than in the placebo group after treatment (t = 2.764, P < 0.05). Conclusion:The association with asymmetric atrophy in the hippocampal subfields has been found in mild AD patients, especially in left CA4-DG, which may be used as a valuable marker for diagnosis and evaluation for treatment at early stage.

Objective To evaluate the value of multimodal MRI in differential diagnosis of lung squamous cell carcinoma and adenocarcinoma.Methods Routine sequence,diffusion weighted imaging(DWI)and dynamic enhancement images about 1 6 squamous cell carcinoma and 21 adenocarcinoma patients were analyzed retrospectively.Taken a record about the size,edge,internal signal, enhancement types and apparent diffusion coefficient(ADC)values when b=600 s/mm2,and the difference in the degree of pathological differentiation was studied.Results The average diameter of squamous cell carcinoma was (4.17±2.0)cm,while adenocarcinoma was (3.81±1.8)cm,lobulated and spiculation were the most common signs in both of them.Squamous cell carcinoma showed low T1signal in 12 cases(75%),low T2signal in 7 cases(43.7%),adenocarcinoma showed high T1signal in 10 cases(47.6%),high T2 signal in 14 cases(66.7%).Squamous cell carcinoma had lower ADC value than adenocarcinoma(1.27×10-3mm2/s vs 1.38×10-3mm2/s), and well differentiated tumors had higher ADC values than poor ones,it was statistically significant.The most common time-signal intensity curves were type A in squamous cell carcinoma(62.5%)and type B in adenocarcinoma(50%).Conclusion MRI findings of squamous cell carcinoma and adenocarcinoma are associated with the biological characteristics,squamous cell carcinoma has shorter T2signal and adenocarcinoma has shorter T1signal.Squamous cell carcinoma has lower ADC value than adenocarcinoma and is dominated by outflow curve (type A),these features are helpful in subtype and differential diagnosis.

Cholelithiasis is a common disease in clinical practice. At present, surgery is the primary Western treatment method for this disease, but there are problems such as surgical trauma, a high recurrence rate, and postoperative complications. Various traditional Chinese medicine (TCM) methods for the treatment of cholelithiasis have achieved satisfactory results and have been widely used in clinical practice in recent years. This article summarizes the research advances in TCM therapy for cholelithiasis from the aspects of the understanding of cholelithiasis in TCM, TCM treatment methods for cholelithiasis and their mechanisms, and integrated traditional Chinese and Western medicine therapy. It is pointed out that TCM can significantly improve or inhibit the information of cholelithiasis and has the advantages of reliable therapeutic effect, few side effects, and a low recurrence rate; however, its further application is limited by the unclear mechanism of action of TCM and defects of related clinical research such as low quality and poor repeatability. It is recommended to strengthen basic research and conduct high-level randomized controlled clinical trials in the future to provide scientific and objective evidence for clinical diagnosis and treatment of cholelithiasis and thus improve the clinical effect of TCM in the treatment of cholelithiasis.

Osteosarcoma is suggested to be caused by genetic and molecular alterations that disrupt osteoblast differentiation. Recent studies have reported that transmembrane protein 119 (TMEM119) contributes to osteoblast differentiation and bone development. However, the level of TMEM119 expression and its roles in osteosarcoma have not yet been elucidated. In the present study, TMEM119 mRNA and protein expression was found to be up-regulated in osteosarcoma compared with normal bone cyst tissues. The level of TMEM119 protein expression was strongly associated with tumor size, clinical stage, distant metastasis and overall survival time. Moreover, gene set enrichment analysis (GSEA) of the Gene Expression Omnibus (GEO) GSE42352 dataset revealed TMEM119 expression in osteosarcoma tissues to be positively correlated with cell cycle, apoptosis, metastasis and TGF-β signaling. We then knocked down TMEM119 expression in U2OS and MG63 cells using small interfering RNA, which revealed that downregulation of TMEM119 could inhibit the proliferation of osteosarcoma cells by inducing cell cycle arrest in G0/G1 phase and apoptosis. We also found that TMEM119 knockdown significantly inhibited cell migration and invasion, and decreased the expression of TGF-β pathway-related factors (BMP2, BMP7 and TGF-β). TGF-β application rescued the inhibitory effects of TMEM119 knockdown on osteosarcoma cell migration and invasion. Further in vitro experiments with a TGF-β inhibitor (SB431542) or BMP inhibitor (dorsomorphin) suggested that TMEM119 significantly promotes cell migration and invasion, partly through TGF-β/BMP signaling. In conclusion, our data support the notion that TMEM119 contributes to the proliferation, migration and invasion of osteosarcoma cells, and functions as an oncogene in osteosarcoma.
Apoptosis ; Bone Cysts ; Bone Development ; Cell Cycle ; Cell Cycle Checkpoints ; Cell Movement ; Dataset ; Down-Regulation ; Gene Expression ; In Vitro Techniques ; Neoplasm Metastasis ; Oncogenes ; Osteoblasts ; Osteosarcoma* ; RNA, Messenger ; RNA, Small Interfering ; Up-Regulation*