Objective To evaluate the efficacy of less invasive stabilization systems (LISS) fixation and double plating on the treatment of AO-type C3 distal femoral fractures via anterior midline approach.Methods From June 2014 to March 2017,18 cases of AO-type C3 distal femoral fractures treated in our department were recruited in this study.They were 12 males and 6 females,at a mean age of 19-62 years.There were 11 cases due to traffic accidents and 7 due to falls from heights.Six of them had open fractures and 12 had closed fractures.They all were treated with LISS fixation and double plating with anterior midline incision.Kolment and Wulff criteria were used to evaluate knee joint function after internal fixation at the last time of follow-up.Results For all the subjects,the average operative time was 145 (110 to 200) min,and they were followed up for 17.5 (12 to 25) months.They all achieved primary wound healing,and had an average time of 22 (20 to 26) weeks for fracture healing.No nonunion,infection,osteomyelitis or injuries of nerves and arteries were observed.According to the results of Kolment and Wulff criteria for knee joint function evaluation,6 of them got excellent,9 good,2 fair and 1 poor outcomes,with a rate of 83.33％ for good and excellent outcomes.Conclusion The treatment of type C3 distal femoral fractures via anterior middle approach of knee joint can fully reveal the articular surface of the femoral condyle.And the operative vision is clear,making it easy for anatomical reduction of articular surface fractures.Combined with LISS double locking plates fixation treatment,it can avoid the injury of soft tissue,and the fracture also be rigid fixation.Postoperative early functional exercise should be allowed to obtain good clinical results.

Objective To investigate the influences of lysozyme on the mRNA expressions of MMP-1,-12 and lysyl oxidase(LOX)in cultured fibroblasts in vitro.Methods Primarily cultured fibroblasts isolated from human skin were treated with three concentrations(0.1×10~(-8),1×10~(-7)mol/L)of lysozyme followed by another 24-hour cuhure.Subsequently,total RNA was extracted from the fibroblasts and subjected to RT-PCR for the detection of MMP-1,-12 and LOX mRNA.Results There was a significant difference in the mRNA expressions of MMP-1,-12 and LOX among the fibroblasts treated with the three concentrations of lysozyme (F=6.98,4.44,5.24,respectively,all P<0.05).SNK-q test showed that untreated fibroblasts differed signifi-cantly from those treated with lysozyme of 1×10~(-7) mol/L in the mRNA expression of MMP-1 and MMP-12 (P<0.05),and from those treated with iysozyme of 1×10~(-7) mol/L.and 1×10~(-8)mol/L in the mRNA expres-sion of LOX(both P<0.05),whereas no significant difference was ohserved between fibroblasts treated with lysozyme of 1×10~(-8) mol/L and untreated fibrohlasts or those with lysozyme of 1 x 10~(-7)mol/L in the mRNA expression of MMP-1 and MMP-12.or between fibroblasts treated with lysozyme of 1 x 10~(-8)mol/L and those with that of 1×10~(-7) mol/L in the expression of LOX (all P>0.05).Conclusions Lysozyme upregulates the mRNA expression of MMP-1 and MMP-12 but downregulates the mRNA expression of LOX in cultured fibro-blasts in vitro.

Objective:To investigate the effect of the expression levels of CXCL12 and CXCR4 of carbon dioxide (CO2) pneu-moperitoneum on nude mice xenografts from human ovarian cancer SKOV3 cells in the same pressure at different times. Methods:A total of 40 animal models of human ovarian cancer SKOV3 cell-bearing nude mice xenografts were established. The animals were ran-domly divided into four groups (n=10), namely, the simple anesthesia group, 0.5 h laparotomy group, and 0.5 and 1 h CO2 pneumoperi-toneum groups. After the aforementioned treatments in the groups, the expression levels of CXCL12 and CXCR4 mRNAs of tumor tis-sues were detected by reverse transcription-polymerase chain reaction (RT-PCR), whereas those of the CXCL12 and CXCR4 proteins were detected by Western blot. Results:The 40 animal models of human ovarian cancer SKOV3 cell-bearing nude mice were success-fully established. After the treatment, RT-PCR results reveal that the CXCL12 mRNA expression was significantly higher in the 1 h CO2 pneumoperitoneum group than that in the other three groups. However, no differences were observed in the CXCR4 mRNA expression of each group. Western blot analysis also obtained the same results. Conclusion:The expression level of CXCL12 in SKOV3 cells of the 1 h CO2 pneumoperitoneum group increased, which possibly promoted the growth of peritoneal tumors, and had a slight effect on tu-mor metastasis.

Objective:To evaluate the influence of optimized rehabilitation process on prognosis of old patients with Evans type III and IV femoral intertrochanteric fractures and investigate the related efficacy.Methods:A retrospective case-control study was performed on 207 old patients with Evans type III and IV femoral intertrochanteric fractures fixed by proximal femoral nail anti-rotation (PFNA Ⅱ) in People's Hospital of Chongqing Banan District from March 2012 to January 2017. Normal rehabilitation group ( n=100) had rehabilitation education and training after operation and started off-bed exercise at postoperative 48 hours, including 38 males and 62 females, with age from 65 to 75 years in 69 patients and 75 years and over in 31 patients. There were 49 patients with Evans type III fractures and 51 with Evans IV fractures. Optimized rehabilitation group ( n=107) had rehabilitation education and training at admission and started off-bed exercise within 48 hours after operation, including 43 males and 64 females, with age from 65 to 75 years in 79 patients and 75 years and over in 28 patients. There were 63 patients with Evans III fractures and 44 with Evans IV fractures. Operation time, intraoperative bleeding, complications during hospital stay, fracture healing time, internal fixation rupture, femoral head cut, second fracture and mortality rate were recorded and compared between the two groups. Harris hip score was evaluated at postoperative 3, 6 and 12 months. Results:All patients were followed up for 3-12 months, with the average of 11.6 months. Normal rehabilitation group showed introperative bleeding of (119.3±1.9)ml and operation time of (1.13±0.22)hours, which were not significantly differed from that in optimized rehabilitation group [( 121.6±1.2)ml, (1.07±0.25)h] ( P>0.05). In normal rehabilitation group, the complications were hypostatic pneumonia in 19 patients, heart failure or acute myocardial infarction in 8, urinary infection in 18, lower-extremity deep vein thrombosis in 5, pressure ulcer in 4, with 5 deaths within 3 months after surgery. While in optimized rehabilitation group, the complications during hospitalization were hypostatic pneumonia in 6 patients, urinary infection in 6, heart failure or acute myocardial infarction in 1, lower-extremity deep vein thrombosis in 1, pressure ulcer in 0 during hospital ( P<0.05). Within 3 months, mortality rate was 5% in normal rehabilitation group compared to zero in optimized rehabilitation group ( P<0.05). At postoperative 3 months, 6 months and 12 months, Harris hip scores in optimized rehabilitation group[(69.7±6.3)points, (80.2±4.6)points, (89.3±10.2)points] were significantly higher than that in normal rehabilitation group [(53.6±5.4)points, (75.1±9.2)points, (77.5±7.5)points]( P<0.05). Fracture healing time, internal fixation rupture, femoral head cut, second fracture and mortality rate at postoperative 12 months had no significant differences between the two groups ( P>0.05). Conclusion:Optimized rehabilitation process can improve hip function, reduce complication rate and mortality rate at postoperative 3 months in old patients with Evans type III and IV femoral intertrochanteric fractures, which deserves clinical application.

Objective To explore the value of CT radiomics model in predicting three-year survival time in patients with primary hepatocellular carcinoma (HCC). Methods Eighty one patients pathologically or clinically confirmed HCC and B stageof Barcelona clinical liver cancer before transcatheter arterial chemoembolization (TACE) in Zhejiang Cancer Hospitalwere retrospectively enrolled from January 2010 to June 2014.A primary cohort consisted of 64 patients and an independent validation cohort consisted of 17 patients. The patients were divided into survival group of 39 cases and death groupof 42 cases duringthree-year follow-up. All the patients underwentnon-enhanced and contrast-enhanced CTimages scan before TACE. Three hundered and seventy six quantization radiomics features were extracted from the arterial phase and portal phase CTimages of target lesion. LASSO regression model was used for data dimension reduction. Logistic regression was used to develop the prediction model. The predictive ability of the model was validated using the area under the curve (AUC) of receiver operating characteristic(ROC) analysis. Results The radiomics features selected from the arterial and portal phase were 8 and 5, respectively. The arterial prediction model showed AUC=0.833, sensitivity=83.9％(26/31), specificity=81.8％(27/33), accuracy=82.8％(53/64)in primary datasetand AUC=0.861, sensitivity=75.0％(6/8), specificity=100.0％(9/9), accuracy=88.2％(15/17)in independent validation dataset.The portal prediction model showed AUC=0.858, sensitivity=83.3％(25/30), specificity=85.3％(29/34), accuracy=84.4％(54/64)in primary dataset and AUC=0.750, sensitivity=75.0％(6/8), specificity=100.0％(9/9), accuracy=88.2(15/17)in independent validation dataset. Conclusion This study shows CT radiomics model can be conveniently used to facilitate the preoperative individualized prediction of three-year survival time in patients with HCC.

Objective To investigate the effect of dorsal index finger flap pedicled with radial digital proper artery for reconstruction of thumb skin defect.Methods A retrospective case series study was conducted on the clinical data of 78 patients with thumb skin defect admitted from August 2009 through September 2015.According to the treatment method,the patients were divided into Group A which adopted dorsal index finger flap pedicled with radial digital proper artery and Group B which adopted the conventional dorsal index finger flap for the reconstruction of thumb skin defect.Group A (n =47) comprised of 31 males and 16 females,aged averagely 29.6 years (range,20-54 years),and Group B (n =31) comprised of 22 males and nine females,aged averagely 27.3 years (range,19-55 years).The dimensions of skin defect were (9.02 ±0.45)cm2 in Group A and (7.15 ±0.72)cm2 in Group B.The cut flap area,operation time,postoperative visual analogue score (VAS),flap survival rate,two point discrimination recovery,and evaluation criteria of the upper limb function of the Chinese Medical Association (joint activity,shape,muscle strength,sensory recovery,sequelae,and work ability) were compared between Groups A and B.Results The cut flap area was (9.25 ± 0.78) cm2 in Group A and (7.25 ± 0.61) cm2 in Group B (P ＜ 0.05).The operation time was (1.75 ± 0.36) hours in Group A,and (1.64 ± 0.29) hours in Group B (P ＞ 0.05).The VAS was (7.40 ± 0.36) points in Group A,and (6.33 ± 0.47) in Group B (P ＞ 0.05).All flaps of Group A survived without any epidermal necrosis or bister,with the survival rate of 100％;while four cases of Group B had partial or total necrosis,with the survival rate of 87％ (P ＜ 0.05).The two point discrimination was (6.33 ± 1.41) mm in Group A,and (8.80 ± 1.43)mm in Group B (P ＜ 0.05).According to the evaluation criteria of the upper limb function of the Chinese Medical Association,the results of Group A were excellent in 21 cases,good in 22,and poor in four,with the excellent and good rate of 92％;while the results of Group B were excellent in 14 cases,good in 8,poor in 5,and worst in 4,with the excellent and good rate of 71％ (P ＜ 0.05).Conclusion Dorsal index finger flap pedicled with radial digital proper artery for the reconstruction of thumb skin defect is worthy of clinical practices,for the advantages of larger cut flap area,improved flap survival rate and quality,and better recovery of upper limb function.

Objective To evaluate the application value of ultrasound in vascularization of different artificial bones . Methods A total of 15 New Zealand rabbits were utilized for model establishment of classic segmental bone defect in bilateral radius . Recombinant human bonemorphogenic protein-2 ( rhBMP-2 ) coralline hydroxyapatite(CHA) and CHA were implanted into left and right limbs . Each CHA was divided into 4 equal parts which were examined with conventional ultrasonography and contrast-enhanced ultrasonography( CEUS ) on 3 d ,7 d ,11 d ,15 d ,30 d and 45 d respectively . CEUS quantitative was performed by time-intensity curve(TIC) ,which parameters including the basic intensity(BI) ,peak intensity (PI) ,increased signal intensity ( ΔSI) and time to peak ( TTP) . Then the results were analyzed and compared to pathology . Results Within the same duration ,the vascularization degree in rhBMP-2 group was stronger than that in the ordinary group with advanced vascularization time . Positive correlation was detected between ΔSI and time of both groups ( r =0 .938 ,0 .890 ;P =0 .000) ,and negative correlation was found between BI/PI or TTP and time ( BI/PI: r = -0 .798 ,-0 .899 ; P = 0 .000 ;TTP= r -0 .874 ,-0 .868 ;P = 0 .000 ) . No statistical significance was observed among four observation points of both CHA ,which indicated no obvious difference in vascularization degree of each observation point . Conclusions The structure of bone graft can be clearly displayed by conventional ultrasound ,and CEUS is able to show the early blood perfusion in two CHA grafts and to accurately evaluate the difference of CHA microvascular growth before and after rhBMP-2 application . The combination of these two techniques is a promising approach of evaluating bone graft vascularization in clinical practice .

Objective: To investigate the molecular characterization of adult diarrhea cases caused by enterotoxic Escherichia coli (ETEC) and explore the practical model of epidemiology for laboratory technique and data needs based on the surveillance network. Methods: Epidemiological design and sampling targeted adult cases ETEC caused diarrhea in epidemic season. The enterotoxin type, serogroup, resistance, colonization factor and molecular type of ETEC were identified. Multiple dynamic phenotypic characteristics of ETEC were indicated by multidimensional and multivariable data. Results: From 2016 to 2018, 84 eligible ETEC strains were detected. The dominant serums/toxins were O∶6 (STh), O∶25 (LT), O∶159 (STh), O∶153 (STh). O∶6 (STh+CS21), which replaced O∶25 and O∶159 as the popular clones in 2018. Six cases of O∶153 (STh+CFA/I+CS8+PT34) in outbreak in 2017 were imported ones. The resistance rates of ETEC strains detected in adults to sulfasoxazole, naproxinic acid, ampicillin and azithromycin were more than 30%, multidrug resistance (MDR) reached 58.3%. Serum/toxin types suggested that attenuated strains were more likely to become MDR. Molecular typing confirmed that the genetic similarity of the dominant clone of O∶6 serogroup (PT20-24) was higher than O∶25 and O∶159. There was a high correlation between the minimal inhibitory concentration (MIC) of azithromycin and the resistant gene mphA (87.5%, 28/32). O∶6 (STh+CS21+mphA) resistant clone was first detected in 2016. Conclusion A new epidemic clone in adult ETEC diarrhea cases in Shanghai was O∶6 (STh+CS21+mphA). For the first time the association between azithromycin resistance gene mphA and a serum group of ETEC was observed. Multidimensional and multivariate analysis techniques based on epidemiology can help reveal the potential transmission pattern of ETEC for the accurate surveillance and early warning of outbreaks.