ObjectiveTo evaluate the effect of surgical treatment of distal tibial facture with minimally invasive perutaneous locking compression plate osteosynthesis.Methods38 patients with distal tibial fracture were treated with minimally invasive percutaneous locking compression plate(LCP) osteosynthesis.According to AO classification,twelve patients belonged to type A,fifteen type B,and eleven type C.ResultsAll patients were followed up for 6 to 19 months,with an average time of 9 months.The X-ray pictures showed that one-stage union was achieved in the patients,with a mean healing time of 16 weeks.No complications such as infection,non-union were found.The clinical outcomes were evaluated according to Mazur ankle joint function scoring.Twenty-nine were rated as excellent,six as good and three as fair,with the good-excellent rate of 92.1％.ConclusionMinimally invasive peteosynthesis is a kind of a good fixation in treatment of accelerating bone and soft tissue healing.

Objective To observe the effect of SSRI and SNRI drugs combined with clinical nursing path of untreated depression in patients with executive function. Methods From October 2014 to April 2016, the third people's Hospital of Yuyao was admitted to the 4 people's Hospital, who met the criteria of diagnosis and inclusion criteria. 80 cases of untreated depressive patients were randomly divided into two groups, according to clinical medication and nursing methods were defined as SSRI group, SSRI group and SNRI group, SNRI group, SSRI group were treated with 8 cycles of Pa Rossi Dean oral treatment, during the treatment group were given routine clinical care, SNRI group were given venlafaxine 8 During the period of oral treatment, treatment group Ⅱ were given clinical nursing path on the basis of conventional nursing, treatment and nursing care of patients before and after the change of executive function evaluation. Results SSRI Ⅱ, SNRI Ⅱ group WCST scores were better than SSRI Ⅰ, SNRI Ⅰ group; SNRI group Ⅱ WCST scores were better than SSRI group; SSRI group, SNRI group Ⅱ TMT evaluation results is better than that of SSRI group, SNRI group; SNRI group Ⅱ TMT evaluation results is better than that of SSRI group; the SSRI Ⅱ SNRI Ⅱ group the experimental results of TOL is better than that of SSRI group, SNRI group; SNRI group Ⅱ TOL experimental results better than SSRI Ⅱ group. Conclusion SSRI and SNRI drug treatment untreated depression patients exactly, combined with clinical nursing path can effectively improve the patients with degree of functional recovery, is worthy of clinical application.

Objective To evaluate operative methods and the clinical effect of closed reduction and percuta-neous locking compression titanium plate internal fixation in treatment of distal tibial fractures.Methods The clinical data of 21 patients with fracture who received closed reduction technology through the subcutaneous tunnel of fracture end,minimally invasive percutaneous treatment of tibial locking titanium plate fixation were retrospectively analyzed. Results All 21 patients were followed up from 6 to 18 months(11 months in average).All patients recovered with good healing of fracture.According to criteria of Johner -Wruhs score,the results were excellent in 12 cases,good in 6 cases,fair in 3 cases,and poor in 0 case.The excellent and good rate was 85.71%.Conclusion The method of closed reduction and percutaneous locking compression titanium plate internal fixation in treatment of distal tibial frac-tures can protect skin soft tissue,reduce the damage to the blood -supply of the fracture,promote the healing of the fracture and reduce complications.

Objective To evaluate operative methods and the clinical effect for comminuted calcaneal fractures.Methods 21 cases(24 feet)of comminuted calcaneal fractures were treated by one stage bone grafting plus open reduction and internal fixation with plastic calcaneus titanium plate.The fractures were classified according to the Sanders system into Sanders Ⅱ,Ⅲ and Ⅳ subgroups.Results All cases were followed up for 9～20 months(14months in average).All cases recovered with good healing of fracture.According to Maryland score,the results were excellent in 14 feet,good in 7 feet,fair in 2 feet,and poor in 1 foot.The excellent and good rate was 87.5％.Conclusions By using the method of internal fixation with plastic calcaneus titanium plate,fracture site can be well exposed,which is helpful to recover calcaneus to its normal length,width,height,Gissane angle and Bohler angle.A reliable internal fixation is helpful for early stage functional excise after surgery,which can maximize the recovery of the ankle function.

Objective To explore the levels of serum alkaline phosphatase ( ALP) as well as its impact on the cognitive impairment in patients with subcortical ischemic vascular disease ( SIVD).Methods One hundred and fifty-eight SIVD patients were divided into two subgroups which included 86 patients with mild cognitive impairment ( SVMCI ) and 72 patients with vascular dementia ( SVaD ) according to the severity of cognitive impairment.Sixty-seven old people with normal cognitive function were selected as control qruop.Multiple lacunar infarction ( LI) or leukoaraiosis ( LA) was detected according to their MRI scan appearances and graded LA according to the severity.Serum ALP was measured by an enzymatic method as well as the Mini-Mental State Examination ( MMSE) and the Cambridge Cognitive Examination-Chinese Version (CAMCOG-C) were used in assessments.Serum ALP was divided into 3 groups and the occurrence rate of LI , LA and cognitive impairment were compared with each other.The levels of ALP were compared in different cognitive impairment and Logistic regression was used to explore the relation between ALP and cognitive impairment.Results Both SVaD and SVMCI groups (17.00 (13.00, 20.00), 59.50 (49.00, 68.75);25.00 (25.00, 26.00), 82.50 (76.75, 89.00)) showed significantly lower scores in MMSE and CAMCOG-C than control group (28.00 (28.00, 29.00), 93.00 (89.00, 96.00); Z=187.337, P=0.000; Z=150.480, P=0.000).A positive relationship between the elevated ALP level and the severity of cognitive impairment was found after adjusting for sex , age and other confunding factors ((68.60 ±15.52), (78.76 ±13.39), (86.75 ±18.85) U/L, F=22.587, P=0.000).The occurrence rate of LI, LA and SVaD among the three groups were significantly different (χ2 =8.008, P=0.018;χ2 =17.998, P=0.000;χ2 =12.255, P=0.002).The ALP level was negatively correlated with MMSE and CAMCOG-C scores ( r=-0.350, P=0.000; r=-0.286, P=0.000 ).Logistic regression analysis revealed the relation between ALP and cognitive impairment was positive when we controlled all the vascular risk factors.However , the relation had gone when futher adjusting for the grade of LA.Conclusions The level of ALP is significantly higher in SIVD patients and positively relates with cognitive impairment especially in those whose grade of LA is severe.

Objective To investigate the expression of DNMT3b and its correlation with clinicopathological parameters of pancreatic cancer.Methods The expressions of DNMT3b protein in 12 pancreatic cancer tissues and para-cancerous tissues were detected by Western blot.The expressions of DNMT3b protein in 59 pancreatic cancer tissues were detected by immunohistochemistry.The association of DNMT3b expression and clinicopathological parameters of pancreatic carcinoma were analyzed.Results Western blot results showed the expressions of DNMT3b protein in pancreatic cancer tissues and para-cancerous tissues were 0.69 ±0.13and 0.14 ±0.03,and the protein level of DNMT3b in pancreatic cancer tissues were significantly higher than that in para-cancerous tissues (t =4.464,P ＜0.05 ).Immunohistochemistry examination showed that the positive rates of DNMT3b protein were 59％ in pancreatic cancer tissues and negative in para-cancerous tissues.DNMT3b expression was positively correlated with the TNM stage and lymph node metastasis.Conclusions DNMT3b is highly expressed in pancreatic cancer tissues,and it is related with malignant biological behaviors of pancreatic cancer cells.

Objective The purpose of this study is to investigate the factors associated with incisional surgical site infection (SSI) in colorectal cancer. Methods We retrospectively analyzed impacting factors of SSI including age, gender, BMI, diabetes mellitus, operation, albumin levels, hemoglobin levels, tumor staging, and length of stay post-operation in 327 colorectal patients from 2001 to 2005. Results The incidences of SSI and fat liquefaction were 2. 4%(8/327) and 12. 2%(40/327) respectively. The incidences of SSI in patients with obesity and diabetes mellitus increased significantly (16. 8% vs. 10. 0% ,28. 6% vs. 13. 7%). The length of stay in patients with SSI prolonged significantly (29.0 d vs. 15.8 d). Conclusion Obesity and diabetes mellitus are the most important factors associated with SSI in colorectal cancer patients.

ObjectiveTo assess the effects of DNA methyhransferase 1 ( DNMT1 ) gene silencing on DNMTs activity and methylated CpG sites of hMLH-1 in pancreatic cancer cell line PaTu8988.Methods DNMT1 siRNA and negative control siRNA was constructed by Ambion Company of United States.Then they were transfected into pancreatic cancer cell line PaTu8988 at the concentrations of 15,30 nmol/L,and the cells without transfection was used as the control group.Real-time PCR and Western blotting were applied to detect the DNMT1 mRNA and protein expression,and DNMTs activity was detected by using DNMTs activity assay kit.Change of methylation of CpG island of hMLH-1 was detected by bisulfite sequencing PCR (BSP).The expression of hMLH-1 mRNA was detected by Real-time PCR.ResultsAt 48 h after transfection,Realtime RT-PCR analysis showed that the levels of DNMT1 mRNA in DNMT1 siRNA group ( 15 nmol/L) and DNMT 1 siRNA group (30 nmol/L) were 0.573 ± 0.026 and 0.143 ± 0.044,which were significantly lower than those in control group 1.020 ±0.217 and negative siRNA 15 nmol/L group 0.900 ±0.475,and negative siRNA 30 nmol/L group 0.938 ± 0.327 (P ＜0.05 ).Western blotting analysis showed that the level of DNMT1 protein of DNMT1 siRNA group was also lower than those of negative siRNA and control groups.DNMT activity in DNMT1 siRNA15,30 nmol/L groups was 0.364 ± 0.124and 0.250 ± 0.072,which were significantly lower than those in control group 0.931 ± 0.065and negative siRNA group 0.665 ± 0.055 and 0.472 ± 0.040.DNMT activity was positively correlated with DNMT1 mRNA expression ( r =0.69,P ＜ 0.01 ).DNMT1 RNA interference decreased 8 methylated CpG sites of hMLH-1 to 1 site.Concluslons DNMT1siRNA can specifically inhibit the expression of DNMT1 gene of PaTu8988 and DNMT activity,and can decrease methylated CpG sites of hMLH-1 gene.

Objective: To investigate the clinicopathological features and prognostic parameters of the inflammatory pseudotumor-like follicular dendritic cell sarcoma (IPT-like FDCS) of liver and spleen. Methods: Ninteen cases of inflammatory pseudotumor (IPT) and 5 cases of IPT-like FDCS of the liver and spleen were collected at the First Affiliated Hospital, Army Medical University from 2006 to 2016. HE sections, immunohistochemical staining, and Epstein-Barr virus encoded nuclear RNA (EBER) in situ hybridization were reviewed along with a summary of the literature. Results: Among the previously diagnosed 19 cases of IPT of the liver and spleen, 2 cases were misdiagnosed (the ratio of 2/19). Among 7 new cases including 3 males and 4 females, 3 cases involved the liver and 4 cases involved the spleen. The age range was 37-64 years (mean 53 years). The maximum tumor diameter ranged from 3.0 to 11.0 cm (mean 6.5 cm). Surgical resections were performed in all patients with follow-up time ranging from 3 to 84 months.All patients were disease-free.7 new cases were all positive for EBER, and showed the expression of at least one of the FDC markers, including CD21, CD23, and CD35. The rest of 17 cases of IPT were all negative for EBER and essentially negative for FDC markers, but were all positive for SMA. Conclusions IPT-like FDCS of the liver and spleen is a rare low-grade malignant tumor morphologically mimicking inflammatory pseudotumor, and is easy to be misdiagnosis due to under-recognition. EBER in situ hybridization and FDC markers are indispensable for confirming the diagnosis.

Objective: To investigate the clinicopathological features, special morphologic variants and potential diagnostic traps of classical follicular dendritic cell sarcoma (FDCS). Methods: A total of 25 cases of classical FDCS diagnosed in the First Hospital Affiliated to Army Medical University from 2006 to 2018 were examined by hematoxylin-eosin staining, immunohistochemistry and in situ hybridization for Epstein-Barr virus-encoded mRNA (EBER). Meanwhile, the types and characteristics of the special variants of FDCS were summarized along with those reported in the literature. Results: The age of patients ranged from 23 to 77 years (mean 52 years), the male to female ratio was 1.5, and the maximum diameter of tumor was 1.5 to 20 cm (mean 7.4 cm). Twelve cases (48%) were misdiagnosed at the initial evaluation. Follow-up information was available for 17 patients, and the follow-up time was 5 to 96 months. The propotion of patients having recurrence, metastasis and mortality was 3/17, 5/17 and 2/17, respectively. Microscopically, besides the typical morphology, 10 cases of FDCS showed special histomorphologies and/or structures, including those mimicking lymphoepithelioma-like carcinoma, desmoplastic infiltrating carcinoma, classical Hodgkin′s lymphoma (CHL), anaplastic large cell lymphoma (ALCL) and hemangiopericytoma. These morphologic variants were potential diagnostic pitfalls and warranted attention. Immunohistochemistry showed that more than two markers of follicular dendritic cells (such as CD21, CD23, CD35, etc.) were expressed in cases showing typical morphology and the special variants. All 25 cases were all negative for EBER by in situ hybridization. Conclusions Classical FDCS is rare, besides the typical morphologic features, there are many special variants. In particular, these may be confused with lymphoepithelioma-like carcinoma in the nasopharynx, CHL or ALCL in the mediastinum/lymph node. Awareness of these variants is essential for accurate diagnosis.