Objective To evaluate the clinical effect of tibial plateau bone defects repair using osteotomy and bone grafting with autogenous bone gain way in total knee arthroplasty.Methods From Mar.2011 to Mar.2015,28 knees of 20 patients with bone defects in medial tibial plateau were in total knee arthroplasty,the bone defects were repaired into horizontal steps,then with autogenous bone grafting by osteotomy.Results The bone defects could be repaired effectively to support the knee joint prosthesis,all the patients were followed-up through outpatient from 1 year to 4 years with the average of 2.6 years,the HSS kness score increased from (20.9 ± 1.2) before opearation to (87.6 ± 1.6) after operation.Hss score were paired t test,there was statistically significant difference (P ＜ 0.05).The location was good and there was no bone defect image,no bone resorption and no joint dislocation under X-ray.Conclusions To repair the bone defects in total nkee arthroplasty,it can use the autogenous bone by osteotomy reasonably,achieve good repair defect site,reserve the bone mass maxium,reconstrust the balanced mechanical support of tibia.

Objective To investigate whether the genetic variant rs10830963 of melatonin receptor 1B(MTNR1B)gene is associated with increased risk for gestational diabetes mellitus (GDM).Methods Eighty-seven GDM subjects(GDM group)and 91 normal pregnant women (control group)were randomly recruited form Women and Children's Hospital of Quzhou,Zhejiang Province,China.The allele and genotype frequencies of the rsi0830963 in MTNR1B gene were determined in all participants with PCR amplification and DNA sequencing.The allele and genotype frequencies of rs10830963 were compared to determine their differences between GDM subjects and normal controls.In addition,multiple linear regression was conducted to investigate the association patterns of the risk allele with fasting glucose and HbAlc levels.Results Both GG genotype and G allele frequencies of the rs10830963 loci in the GDM group were significantly higher than those in the controls,and women with G allele and GG genotype were associated with increased GDM risk(OR=1.53,95％ CI:1.005-2.324,P=0.047 and OR=2.16,95％ CI:1.052-4.434,P=0.034 respectively).After adjusting for age,body mass index before pregnancy,and family history of diabetes mellitus,women carrying GG genotype still had a higher GDM risk(OR =2.07,95％ CI:1.048-4.372,P =0.022).Multiple linear regression showed that the rs10830963 G allele was positively correlated with higher levels of fasting glucose(0.068 mmol/L,P=0.015)and HbAlc(0.073％,P=0.028).Conclusions Genetic variant rs10830963 in MTNR1B gene may contribute to the susceptibility to GDM in Chinese population and the rs10830963 G allele is a risk factor for the GDM susceptibility.

Objective To evaluate the surgical therapy on dislocated fracture of talus. Methods Retrospective analysis was mode in 21 patients with dislocated fracture of talus collected from Jan. 2004 to Jan.2010, which were treated with open reduction, cannulated screw fixation, and kept neutral position plaster fixation with no weight loading, to do functional exercise depending on the Ⅹ film demonstrations. Results All the patients were followed up from 6 months to 3.8 years post-operation, and according to the evaluation standard by American Foot-Ankle Surgery Society, good rate was 61.91%. Conclusion Treating dislocated fracture of talus with emergency operation, anatomical reduction, valid internal fixation and no weight loading plaster fixation post-operation, shows good effect with low rate of complication.

Objective:To evaluate the clinical effect of surgical treatment of scapular body complicated fractures with reverse Judet operation approach.Methods:A retrospective review was made on 36 patients with scapular body complicated fractures from Jan. 2013 to Jan. 2019. All the fractures were type Ⅳ according to Miller ME classification. There were 29 males and 7 females, at mean age of 46 years(ranged from 20 to 63 years). High energy traffic injury occurred in 13 patients, high fall injury in 8 patients, heavy pound in 3 patients.CT scan and 3D reconstruction were performed before operation, to expose the scapula with reverse Judet approach and do the internal fixation operation with reconstruction plate. Instructed the patients in functional exercises and clinic effects. All patients were followed up after operation. Twenty patients with scapular body complicated fractures from Jan. 2013 to Jan. 2019 treated by classic Judet approach operation were control analysised, compared the operation time, blood less, Incision healing and the shoulder function score after 1 year postoperation.Results:One-stage incision healing were achieved in all 36 patients, no infection and necrosis occurred in the muscle and skin flaps, all patients were followed up for 1 to 6 years(mean 3.8 years). According to Hardegger evaluation standard, 28 cases were excellent, 8 cases were good, the excellent and good rate was 100%. Opteration time and blood loss were less than those in classic Judet group, the differences were significant( P<0.001). Conclusion:For the surgical treatment of complicated fractures, reverse Judet approach that muscle flap and skin flap separated is feasible, the operation is simple, which can obviously shorten the operation time and blood loss, sufficient exposure is good for the reduction and stable fixation of fractures in the operation, early functional exercise can be proformed after operation, reverse Judet approach is a safe and efficient choice for the surgical treatment of scapular body complicated fractures.

Hepatotoxicity is a common side effect for patients treated with gefitinib, but the related pathogenesis is unclear and lacks effective predictor and management strategies. A multi-omics approach integrating pharmacometabolomics, pharmacokinetics and pharmacogenomics was employed in non-small cell lung cancer patients to identify the effective predictor for gefitinib-induced hepatotoxicity and explore optional therapy substitution. Here, we found that patients with rs4946935 AA, located in Forkhead Box O3 (FOXO3) which is a well-known autophagic regulator, had a higher risk of hepatotoxicity than those with the GA or GG variant (OR = 18.020, 95%CI = 2.473 to 459.1784, P = 0.018) in a gefitinib-concentration dependent pattern. Furthermore, functional experiments identified that rs4946935_A impaired the expression of FOXO3 by inhibiting the promotor activity, increasing the threshold of autophagy initiation and inhibiting the autophagic activity which contributed to gefitinib-induced liver injury. In contrast, erlotinib-induced liver injury was independent on the variant and expression levels of FOXO3. This study reveals that FOXO3 mutation, leading to autophagic imbalance, plays important role in gefitinib-induced hepatotoxicity, especially for patients with high concentration of gefitinib. In conclusion, FOXO3 mutation is an effective predictor and erlotinib might be an appropriately and well-tolerated treatment option for patients carrying rs4946935 AA.