Objective To compare the clinical efficacy of single and double locking compressing plates(LCP)treatment for Schatzker type Ⅵ tibial plateau fractures.Methods Patients(n=90)with Schatzker type Ⅵ tibial plateau fractures were randomly divided into two groups according to the treatment methods (single LCP group and double LCP group;45 patients in each group) and analyzed retrospectively.Operative duration,intraoperative bleeding volume,postoperative wound infection,Rasmussen anatomical score and functional score were measured and compared between the two groups.Results More favorable results were achieved in the single LCP group than in the double LCP group in operative duration [(51.4 ± 4.03)h vs.(76.2±5.5)h(t=24.514,P＜0.001)]and intraoperative bleeding volume[(173.7±8.8) ml vs.(212.4 ± 4.9) ml (t =25.911,P ＜ 0.001,respectively)].Further more,three cases of postoperative woundin fection were seen in the double LCP group,while none was observed in the single LCP group.There was no significant difference in the percentage of satisfactory Rasmussenanatomical scores and functional scores between the two groups one year afteroperation(~ =-0.442,P=0.659).Conclusions Compared with double LCP fixation,single LCP fixation is more advantageous for the treatment of Schatzker type Ⅵ tibial plateau fractures.

To observe the dynamic change of parasites in the brains of BALB/c mice infected with Angiostrongylus cantonensis in order to explore its possible mechanism of pathogenesis', BALB/c mice infected with the III stage larvae of A.cantonensis were observed and killed in different times after infection. The number and distribution of parasites in the brains of the infected mice were observed microscopically and macroscopically. It was found that the larvae of A.cantonensis were distributed in the cerebrum and cerebellum of mice in accordance with the rule of parasitization of worms in the host, i.e.multiplication at first and then dropping in number. And the places where the parasites located were damaged due to mechanical action or inflammatory reactions. The time of onset of symptoms, such as ataxia and twitch was coincided with the dynamic changes in the brains of the infected mice.

Objective To investigate the relationship between surgical timing and outcomes of aneurysmal subarachnoid hemorrhage (aSAH).Methods The patients with aSAH retrospectively received clipping or endovascular embolization.Their demographic and clinical data were collected.The modified Rankin Scale (mRS) was used to evaluate the outcomes at 6 month after procedure.Univariate and multivariate logistic regression analyses were used to determine the risk factors that influencing clinical outcomes of patients.Results A total of 198 patients with aSAH were enrolled,118 had good outcome (mRS score0-2),80 had poor outcome (mRS score ＞2; 20 of them died); 32 were early operation (operated within 2 d after onset) and 166 were late operation.Univariate analysis showed that the proportions of hypertension (29.66％ vs.52.50％ ; x2 =10.464,P =0.001),cerebral infarction (11.86％ vs.35.00％ ;x2 =15.269,P ＜0.001),cerebral hemorrhage (9.32％ vs.31.25％ ;x2 =15.410,P ＜0.001),Fisher grade 3-4 (22.88％ vs.47.50％ ; x2 =13.104,P ＜ 0.001),Hunt-Hess grade Ⅳ to Ⅴ (19.49％ vs.52.50％ ;x2 =23.557,P ＜0.001),cerebral vasospasm (5.93％ vs.25.0％ ;x2 =14.719,P ＜0.001),hydrocephalus (5.08％ vs.17.50％ ;x2 =8.093,P =0.004),and late operation (78.81％ vs.91.25％ ; x2 =5.442,P =0.020) in patients of the good outcome group were significantly higher than those of the poor outcome group.Multivariatelogistic regression analysis showed that Fisher grade 3 to 4 (odds ratio [OR] 9.13,95％confidence interval [CI] 2.98-13.45; P ＜0.001),Hunt-Hess grade Ⅳ to Ⅴ (OR 6.86,95％ CI 1.57-12.34; P＜0.001),accompanied with hydrocephalus (OR 2.59,95％ CI 1.17-4.31; P=0.024),and late operation (OR 2.17,95％ CI 1.12-3.95; P=0.029) were the independent risk factors for patients with poor clinical outcomes.The univariate analysis for both early operation and late operation groups showed that only the good outcome rate of the early operation group was significantly higher than that of the late operation group (78.13％ vs.56.2％ ;x2 =5.442,P =0.020),and there were no significant differences in the incidences of rebleeding (6.25％ vs.13.25％; x2=1.235,P=0.266),cerebral vasospasm (12.50％ vs.19.28％;x2 =0.042,P=0.834),and hydrocephalus (12.50％ vs.9.64％;x2 =0.242,P=0.623).Conclusion Early operation may significantly improve the outcomes in patients with aSAH.

Objective To summarize CT and MRI features of hyaline vascular type localized Castleman disease(LCD)and analyze the causes of misdiagnosis,to improve the preoperative diagnosis rate.Methods The clinical and imaging data of 7 patients with hyaline vascular type LCD confirmed by operation and pathology were analyzed retrospectively.Results (1)6 cases were misdiagnosed before operation,1 case was misdiagnosed as pancreatic neuroendocrine tumor,1 case as thymoma,1 case as neurogenic tumor,1 case as pheochromocytoma, 1 case as clear cell renal cell carcinoma and 1 case as small mesenteric stromal tumor.(2)1 case was located in the right neck,1 case in the anterior superior mediastinum,1 case in the neck of the pancreas,1 case in the upper part of the left kidney,2 cases in the retroperitoneum and 1 case in the lower abdomen.(3)3 cases were scaned by dynamic enhanced MRI,3 cases were scaned by dynamic enhanced CT, and 1 case was checked by plain CT and enhanced MRI.CT and MRI showed that 7 cases had a round or elliptical soft tissue mass, and 4 cases with well defined margin,3 cases were not clear in edge,2 cases with spot or strip calcification on CT images,4 cases had slightly longer T1 and longer T2 signal,4 cases were restricted of diffusion and had higher signal on DWI.All the lesions were enhanced in arterial phase,and went on in the delayed phase.There were 5 cases with distorted vascular shadow in the middle and/or around of the mass, 3 cases with strips,spoke-like low-density areas or low-signal areas,and some lesions were filled in delayed phase.Conclusion CT and MRI features of hyaline vascular type LCD have certain characteristics such as rich blood supply,enhancement in persistent,tortuosity of peripheral vascular,with some short strip calcification and high signal on DWI,which may be helpful for preoperative diagnosis.

Objective To investigate the antimicrobial susceptibility of spectinomycin?minocycline?azithromycin and sparfloxacin to mycoplasma(Uu and Mh)and therapeutic effect of spectinomycin to my-coplasma infection in genitourinary tract.Methods①The susceptibility test:each of the4drugs was divided into two concentrations.One was at1?g/mL(sensitive concentration)and the other was at4?g/mL(resistant concentration).If mycoplasma does not grow in both concentrations,it means the drug tested is sensitive.If it grows in both concentrations,the drug tested is resistant.If mycoplasma grows in lower concentration and does not in higher concentration,it means moderate sensitive.②Treatment regimen:Spectinomycin was injected,2g/d IM,for7-10days as a course of treatmeant.Patients were followed-up7days later and2~4weeks after treatment.Results①Among1658specimens,519were found Uu positive,and61Mh positive.The resis-tance rates of Uu to4different drugs were:7.7%for minocycline,21.4%for sparfloxacin,13.9%for azithromycin and7.3%for spectinomycin.Whereas,those of Mh were:18.0%,45.9%,54.1%,and29.5%re-spectively.②The clinical effect of spectinomycin was:out of43treated patients,37(86.0%)cured,4(9.3%)markedly improved,2(4.7%)failed.Total effective rate was95.3%and so was the elimination rate of my-coplasma.Conclusion The resistant rate of mycoplasma to spectinomycin is lower than that to minocycline?azithromycin and sparfloxacin,and the former is widely used in the treatment of mycoplasma(especially Uu)infection,with a satisfactory clinical effect.

Objective To compare the dose distribution between volumetric-modulated arc therapy ( VMAT ) and intensity-modulated radiotherapy ( IMRT ) in patients with brain metastases receiving hippocampus-sparing whole brain radiotherapy. Methods Forty-six patients with brain metastases admitted to our hospital from 2013 to 2016 were recruited in this study. After fusing the CT and MRI images, the hippocampus was delineated on the fusion images. The three-grade hippocampal avoidance regions were created by using a volumetric expansion of 3,5 and 10 mm surrounding the hippocampus. The planning target volume ( PTV) was calculated by subtracting the 5-mm expansion surrounding the hippocampus from the whole brain. The prescription dose was 30 Gy/10 fractions. The 7-field IMRT and single arc VMAT were designed for each case. The dose distribution of PTV,hippocampus and other organs at risk ( OARs) were evaluated in both plans. Results The PTV was statistically compared between VMAT and IMRT:V95:95. 90％ and 94. 97％( P=0. 000 );V90:98. 17％ and 97. 48％( P=0. 000 );CI:0. 825 and 0. 813 ( P=0. 013);HI:0. 277 and 0. 289(P=0. 025).The hippocampal dose was also compared between VMAT and IMRT:the Dmax of hippocampus was 1698. 9 cGy for VMAT and 1784. 9 cGy for IMRT (P=0. 002).TheDmean of hippocampus was 1183. 8 cGy for VMAT and 1112. 7 cGy for IMRT (P=0. 000).No statistical significance was observed between IMRT and VMAT in protecting the OARs except the chiasma opticum ( 3262. 6 cGy and 3529. 3 cGy,P=0. 000).The MU and treatment time of VMAT and IMRT were 651 and 2768( P=0. 000) ,and 188 s and 504 s ( P=0. 000) . Conclusions The dose distribution of PTV in VMAT is significantly better than that in IMRT. VMAT is advantageous in protecting the hippocampus than IMRT. VMAT can significantly shorten treatment time and MU and enhance the equipment utilization. Besides, VMAT can achieve the goal of protecting the hippocampus and meet the prescription dose requirement of PTV.

Objective:To investigate the effect of L-asparaginase on the proliferation, cell cycle, and apoptosis of Burkitt lymphoma cell lines and explore the molecular mechanism.Methods:The effect of L-asparaginase on the cell proliferation of Burkitt lymphoma cell lines was detected using the CCK-8 method. The apoptosis rate and cell cycle were detected using flow cytometry. The expression of related molecules in cell cycle, apoptosis, autophagy, and PI3K/Akt/mTOR signaling pathway was detected and analyzed using qPCR and Western blot assay.Results:L-asparaginase significantly inhibited the proliferation of Burkitt lymphoma cell lines and caused cell cycle arrest at G 0/G 1 phage. L-asparaginase induced cell apoptosis and autophagy in Burkitt lymphoma cell lines. Further results showed that L-asparaginase inhibited the expression of c-Myc and also inhibited the expression of p-PI3K, p-Akt-S473, p-mTOR, p-70S6K, and p-4E-BP1. Combining PI3K inhibitor LY294002 with L-asparaginase further induced apoptosis. Additionally, L-Asp inhibited STAT and ERK signaling pathways. Conclusion:L-asparaginase inhibited Burkitt lymphoma cell proliferation, arrested cell cycle, activated autophagy, and induced apoptosis by inhibiting the PI3K/Akt/mTOR signaling pathway.

Objective:To retrospectively analyze the treatment status of tyrosine kinase inhibitors (TKI) in newly diagnosed patients with chronic myeloid leukemia (CML) in China.Methods:Data of chronic phase (CP) and accelerated phase (AP) CML patients diagnosed from January 2006 to December 2022 from 77 centers, ≥18 years old, and receiving initial imatinib, nilotinib, dasatinib or flumatinib-therapy within 6 months after diagnosis in China with complete data were retrospectively interrogated. The choice of initial TKI, current TKI medications, treatment switch and reasons, treatment responses and outcomes as well as the variables associated with them were analyzed.Results:6 893 patients in CP ( n=6 453, 93.6%) or AP ( n=440, 6.4%) receiving initial imatinib ( n=4 906, 71.2%), nilotinib ( n=1 157, 16.8%), dasatinib ( n=298, 4.3%) or flumatinib ( n=532, 7.2%) -therapy. With the median follow-up of 43 ( IQR 22-75) months, 1 581 (22.9%) patients switched TKI due to resistance ( n=1 055, 15.3%), intolerance ( n=248, 3.6%), pursuit of better efficacy ( n=168, 2.4%), economic or other reasons ( n=110, 1.6%). The frequency of switching TKI in AP patients was significantly-higher than that in CP patients (44.1% vs 21.5%, P<0.001), and more AP patients switched TKI due to resistance than CP patients (75.3% vs 66.1%, P=0.011). Multi-variable analyses showed that male, lower HGB concentration and ELTS intermediate/high-risk cohort were associated with lower cytogenetic and molecular responses rate and poor outcomes in CP patients; higher WBC count and initial the second-generation TKI treatment, the higher response rates; Ph + ACA at diagnosis, poor PFS. However, Sokal intermediate/high-risk cohort was only significantly-associated with lower CCyR and MMR rates and the poor PFS. Lower HGB concentration and larger spleen size were significantly-associated with the lower cytogenetic and molecular response rates in AP patients; initial the second-generation TKI treatment, the higher treatment response rates; lower PLT count, higher blasts and Ph + ACA, poorer TFS; Ph + ACA, poorer OS. Conclusion:At present, the vast majority of newly-diagnosed CML-CP or AP patients could benefit from TKI treatment in the long term with the good treatment responses and survival outcomes.