Objective To explore the surgical treatment of ankle fracture.Methods 326 cases with ankle joint fracture in our hospital treated by surgical treatment were followed up.There were 182 males and 43 females,aged from 7 ～ 75 years.The patients with medial malleolus fracture were cut through postero-medial process,and the lagged screw,absorbed screw,or tension band wire were used.Patients with bimalleolus and trimalleolus fracture were cut through medial and lateral two incision.When the fracture line of the fibula is high,the triangular needle,kirschner wire,plate and the screw,remember alloy were used,when the fracture line of the fibula was high,1 ～ 2 cortical or cancellous bone lagged screw were used.The patients with diastasis of inferior tibiofibular syndesmosis were cut through lateral process,1 lagged screw was used through 3 layer cortical bone.After the operation,the plaster or brace was used according to the stability of the fracture,then systemic functional exercises.Results All the patients were followed up from 4 ～ 120 months,according to the ankle-hind foot score of American Orthopedic Foot and Ankle Society Score(AOFAS),their clinical treatment results were assessed.In 225 cases,excellent and good rate was 86.7％.Connclusion Proper approach,anatomy reduction,articular surface recovery to smooth,stable internal fixation,necessary external fixation and systemic rehabilitation were the key aspects to the surgical treatment.Good result of most of the patients with fracture of the ankle joint can be obtained.

Objective To study the risk factors of aortic arch calcification (AoAC) in maintenance hemodialysis (MHD) patients.Methods Retrospective analysis was performed in patients who accepted MHD ≥ 5 years.The clinical data were collected.The images of plan chest radiograph detected during followup period were reviewed by certain imaging physicians,and the AoAC score was calculated.Logistic regression model analysis was proceeded to study the risk factors of AoAC.The patients were divided into AoAC positive group (29 cases) and AoAC negative group (37 cases) respectively.The clinical parameters were compared between the 2 groups.Results Sixty-six patients (21 male,45 female) were selected.The year AoAC scores from the zeroth to fifth year were (0.013 40 ± 0.074 96),(0.018 90 ± 0.078 55),(0.118 50 ± 0.170 06),(0.157 00 ± 0.207 55),(0.166 00 ± 0.205 37),(0.175 50 ± 0.222 29) scores,progressively.There were significant differences in AoAC score from the third year compared with that of the zeroth year (Z =-3.984,-4.021,-4.017;P ＜ 0.01).Logistic regression model analysis result showed that only the age of dialysis beginning was the risk factor for AoAC (relative risk 1.177,regression coefficient 0.163,P =0.002).The age of dialysis beginning,rate of diabetic nephropathy,serum calcium-phosphate product were significantly higher in AoAC positive group than that in AoAC negative group [(59.5 ± 12.6) years vs.(52.9 ± 13.2) years,27.6％(8/29) vs.2.7％(1/37),(5.81 ± 1.63) mmol2/L2 vs.(4.13 ± 0.86) mmol2/L2].Conclusions The AoAC will aggravate with the increased duration of dialysis in MHD patients.The age of dialysis beginning is the risk factor of AoAC.

Objective To study the protective effect of sodium ferulate (SF) on CPB-induced lung ischemia reperfusion injury (IRI) and discuss its possible mechanism. Methods 40 patients undergoing CPB were randomly divided into contral group(CCG, n=20 ) and SF group(SFG, n=20). In SFG, SF was injected (0.2 g in NS 150 ml) intravenously Bid for one week preoperatively. In CCG, SF was replaced by same volume of NS. The changes of TNF-?、IL-6、IL-8、SOD level in the CCG and SFG would be examined before operation, at 15min、30 min after aortic cross clamp(ACC) and 1 hour after operation. By the time of before ACC、15 min and 30 min after ACC was opened, blood samples were taken from the right and left atrium to examine the amount of neutrophils. Lung tissues were cut for pathological studies in 5 patients in each group randomly. Results At 15 min、30 min after ACC and 1h after operation TNF-?、IL-6、IL-8、SOD levels of 2 groups were significantly higher than that before the operation (P

Objective: To observe the morphological changes of enteric deep muscular plexuses interstitial cells of Cajal (ICC-DMP) in rats with multiple organ dysfunction syndrome (MODS). Methods: Forty Wistar rats were randomly divided into control group and MODS model group. The enteric ICC-DMP network was observed using c-kit immunohistochemical staining with whole-mount preparation technique and confocal laser scanning microscopy , and the ultraslructural features of ICC-DMP was evaluated using transmission electron microscope. Results: Compared with those in control group, the distributions and densities of intestine ICC-DMP in MODS group were significantly decreased (P < 0. 05) , the ICC-DMP network was disrupted and the ultrastructural features of ICC-DMP were severely damaged. Conclusion: The ICC-DMP network was severely damaged in rats with MODS, and the mechanism of gastrointestinal dysmotility in MODS may be related to the morphological changes of ICC-DMP.

Objective To study the effect of apelin-13 on myosin light chain (MLC)phosphorylation in vascular smooth muscle cells under the condition that the permeability of endothelial layer is changed by ADMA.Methods Human umbilical vein endothelial cell (HUVECs) were cultured in bottom of upper well of Transwell system to establish the endothelial monolayer barrier.The cells were cultured normally or incubated with ADMA.Some FITC-apelin-13was added to the upper well.After a period of leakage time,the amount of FITC-apelin-13 in the lower well was measured to evaluate Pa value,which reflected the permeability of endothelial monolayer. Thechangesofcytoskeletonandintercellularjunctionwereobservedby immunofluorescence.Subsequently,Transwell dishes were used to establish a co-culture system with HUVECs in the upper well and human umbilical vein smooth muscle cells(HUVSMCs) in the lower well.There were four groups: blank control group; ADMA group,stimulated by ADMA only;apelin group,apelin-13 used only; ADMA+apelin group,apelin-13 used after HUVECs stimulated by ADMA.Immunofluorescence and Western blotting were used to detect phosphorylation of MLC in HUVSMCs.Results ADMA induced changes of cytoskeleton and intercellular junction and increased endothelial permeability of apelin-13.The percentage of Pa between ADMA-stimulated and control groups varied during the period of apelin-13 pass and peaked at 20 minutes,which was significantly higher than that at 0 minutes [(176.3±9.2)％ vs (100.3±1.5)％,P＜0.05].In the co-culture system,Western blotting showed that p-MLC expression in ADMA +apelin group was significantly higher than that in apelin group(P＜0.05).In ADMA group,a few p-MLC expression was found also.Phosphorylation of MLC in above 3 groups was significantly higher as compared to blank control group(P＜0.05).Conclusions ADMA can increase endothelial permeability of apelin-13 by inducing changes of cytoskeleton and intercellular junction.Apelin-13 passes through the damaged endothelial barrier and directly acts on vascular smooth muscle cells to elevate phosphorylation of MLC,which may play an important role in hypertension of uremic patients.

China is one of the countries with the highest incidence of esophageal cancer, which is still increasing year by year in recent years. Surgical treatment is the first choice for early and middle esophageal cancer. Surgeons have been exploring how to remove the tumor as completely as possible and reduce the trauma as far as possible. In recent years, with the rapid development of minimally invasive surgery and endoscopic technology, minimally invasive esophagectomy(MIE)has led the trend of radical surgery for esophageal cancer. At present, the mainstream minimally invasive surgery is thoracoscopic thoracoscopic(VATS)resection of esophageal cancer, which requires thoracotomy and anesthesia, resulting in large surgical trauma and more complications of postoperative circulatory respiratory system. Mediastinose-assisted esophagectomy(MAE), which eliminates a thoracotomy, is also an important part of MIE. Overseas MAE application started early, but the domestic development is relatively slow. This article summarizes the experience of different MAE surgical methods in China, and provides the basis for its promotion in China.

Objective To study the expression profile of microRNAs in the lung adenocarcinoma tissue and its expression in CD133+ lung cancer cells .Methods The specimens of adenocarcinoma tissue and pericarcinomatous tissue were collected for con-ducting the microRNA expression chip analysis .The flow cytometry(FCM ) was adopted to sort and culture CD133+ A549 cells in serum-free medium for 2 weeks .The positive rate of CD133+CD44+ in those cells was assayed .The expression of miRNA-892b and miRNA-4686 in CD133+ A549 cells were detected by real-time qPCR .Results Compared with the pericarcinomatous tissue ,27 miRNAs expressions in the lung adenocarcinoma tissue were up-regulated(P<0 .05) and 6 miRNAs expressions were down-regula-ted(P<0 .05) .The positive rate of cancer stem like cells CD 133+CD44+ was 75 .0% .The expression of miRNA-892b and miRNA-4686 in CD133+ A549 cells was higher than A549 cells(P<0 .01) .Conclusion Abnormal expression profile of miRNAs in lung ad-enocarcinoma tissue ,and miRNA-892b and miRNA-4686 may play a certain role to maintain the biological characteristics of CD133+ lung cancer cells .

Objective To compare the efficacy of lymph nodes(LNs) dissection between video-assisted thoracic surgery (VATS) and thoracotomy in the treatment of clinical stage Ⅰ lung cancer.Methods A comprehensive search of PubMed,Ovid Medline,EMBASE,Web of Science,ScienceDirect,the Cochrane Library,Scopus database and Google Scholar was performed to identify studies comparing VATS and thoracotomy in LNs dissection.The data was analyzed by RevMan 5.3 software and SPSS 18.0.Results After selection,23 articles met the inclusion criteria.2 316 patients were involved in VATS group and 3 346 patients were involved in Open group.Meta analysis showed that less total LNs(95％ CI:-1.64--0.60,P ＜ 0.0001),totalLNsstations(95％CI:-0.61--0.01,P=0.04) andN1 LNs(95％CI:-0.28--0.02,P=0.02)were dissected in VATS group.On the left side,more LNs were dissected in VATS group(95％ CI:0.51-3.22,P =0.007).The same number of mediastinal LNs (95％ CI:-0.74-0.15,P =0.20),mediastinal LNs stations (95％ CI:-0.20-0.14,P =0.76),right side LNs (95 ％ CI:-1.52-2.23,P =0.71) were harvested in both groups.Conclusion In the surgical treatment of clinical stage Ⅰ lung cancer,less total LNs,total LNs stations and N1 LNs were dissected in VATS group,while more left side LNs were harvested by VATS.The same number of mediastinal LNs,mediastinal LNs stations right side LNs were harvested in the two groups.This conclusion still needs to be further proved by more high-quality and large-scale RCTs.

Objective To explore clinical value of the single-hale video-assisted thoracoscope surgery in lung surgery.Methods In our hospital from January 2015 to June 2015, a total of 60 patients was performed with lung partial resection line thoracoscope surgery, 28 routine puckering traditional video-assisted thoracoscope treatment, in the same period 32 underwent video-assisted thoracoscope surgery.Intraoperative blood loss, operating time, postoperative pain degree, and postoperative chest such as flow rate were compared between two groups.Results Two groups of patients had no perioperative death and severe complications.Intraoperative blood loss and operating time were no significant significance between single-and double-hole operation groups.The degree of postoperative pain score was (0.8 ± 0.5) in puckering thoracoscope group, and (1.2 ± 0.6) in traditional thoracoscope group, with significant difference (P =0.009).Conclusions Single-hole thoracoscope surgery in the treatment of lung diseases is feasible and reliable compared to traditional thoracoscope surgery, and patients can effectively reduce postoperative pain, and improve the quality of life.

Objective To evaluate the clinical effects of medial patellofemoral ligament reconstruction using the semitendinosus tendon autograft for the treatment of the patellar dislocation.Methods From January 2007 to January 2010,16 cases of patellar dislocation were included in this group.Lysholm score was averaged preoperatively.Arthroscopic-assisted in the semitendinosus tendon autograft reconstruction of the medial patellofemoral ligament,the central graft were fixed on the inner edge of the patellar in the upper 1/3 and the mid-point location,the end were fixed on the channel of femoral epicondyle and adductor tubercle.Results All the patients that lined progressive knee rehabilitation after operation,returned to normal walking for 3 months,6 months could be sports.Followed up for 7-54( 26.36 ± 20.48 ) months,all of patients incision were healed as grade Ⅰ,knee function were normal.Postoperative Lysholm score (93.21 ± 4.68) scores compared with preoperative ( 76.53 ± 8.35 ) scores was significant difference (P ＜ 0.05 ).Conclusions Using the semitendinosus tendon autograft for the treatment of the patellar dislocation method is simple and can effectively restore normal patellar trajectory.At the same time,which is an effective surgical method to treat recurrentdislocation of the patellar.