To investigate the clinical improvement of limping gait in patients with ankylotic hips and limb length discrepancy.Methods:From 1996 to 2005,12 patients with ankylotic hips and limb length discrepancy were treated by distraction osteogenesis with a mono-lateral external fixator and an intramedullary nail.The limb length discrepancy was 6.20-12.50 (median 8.45) cm.Limping gait was classified according to the recommendations of the American Academy of Orthopedic Surgeons/Hip Society and scored according to Harris:no limping scored 11 points,mild limping scored 8 points,moderate limping scored 5 points,while severe limping scored 0 points.Limping gait was severe in all patients pre-operatively and the total score was 0.Results:All patients were followed up for 30.00-46.00 (median 38.55) months,and all reported improvement in limping gait.The gain in length was 6.00-12.50 (median 8.20) cm,and the mean residual limb length discrepancy was 0-0.50 (median 0.20) cm.The total treatment time was 41.00-82.00 (median 61.50) weeks,the lengthening time was 14.00-38.00 (median 29.55) weeks.At the last follow-up,10patients had mild limping gait and 2 had moderate limping gait; the total score was 90.00.The median score was 7.50 (P25 was 8.00,P75 was 8.00).According to Wilcoxon signed rank test,the post-operative limping gait scores were significantly higher than pre-operative (P=0.001 ).Conclusion:Femoral lengthening can improve the limping gait significantly in ankylotic hips and limb length discrepancy.

Objective To investigate the feasibility of the lower cervical spine (C3 -C7 ) laminar screw technique for fixing adult posterior cervical spine .Methods We chose 9 formalin fixed moist adult cervical specimens ,which consist of male 6 and female 3 of the age 38 to 63 years old .The average age is 51 .9 years old and the average height is 165 .6 cm .Then we measured the thickness and heightof C3 -C7 lamina ,the lamina length of L1 ,L2 ,and the lamina of axis and the sagittal plane angle .Results The thickness and height of C3 -C7 lamina ,and the lamina length of L1 and L2 of adult male is bigger than adult women .There was statistical sig-nificance between the thickness ,height ,lamina length difference of different genders lamina (P<0 .05) ,but no significant difference between the left and the right (P> 0 .05) .The average lamina thickness of C2 ,C3 ,C4 ,C5 ,C6 ,C7 were respectively 4 .70 ,3 .87 , 3 .30 ,3 .84 and 5 .16 mm .The lamina thickness which was more than 4 .00 mm accounted for 54 .4% .The lamina thickness of C3 , C4 ,C6 ,C7 which was more than 4 .00 mm accounted respectively for 77 .8% ,61 .1% ,33 .3% ,and 88 .9% .Conclusion Crossing laminar screws in cervical spine is feasible in anatomy .The operation can make under direct vision ,and can accurately estimate the screw path length and entry angle .Patients with anatomic abnormalities can be used as an alternative fixation technique or as fixed in the fixed mode fails .So the results can provide a reference for clinical application .

Objective To explore the high risk factors, pathogenesis and methods of early diagnosis of periventricular leukomalacia(PVL) in premature infants.Methods The history of intrauterine hypoxia-ischemia was investigated in premature infants;TORCH-IgM antibodies in cord blood of premature infants were measured by ELISA; Nitric oxide (NO) levels in their cord blood were determined by nitric acid reducing enzyme means. Results Thirty-nine of 52 premature infants in PVL group had a history of intrauterine hypoxia-ischemia; TORCH-IgM antibody positive rate in cord blood of premature infants in PVL group was significantly higher than that in control group(P

Double-hit lymphoma (DHL) is a kind of disease with features intermediated between diffuse large B-cell lymphoma (DLBCL) and Burkitt lymphoma (BL),usually accompanied by myc gene breakpoint with other recurrent chromosomal breakpoint and mainly involving myc and bcl-2 translocation.The presentation of this disease is characterized by elevated serum lactate dehydrogenase levels,B symptoms,bone marrow involvement,advanced stage disease,extranodal involvement,and central nervous system involvement.Because its features are similar with DLBCL and BL,it's difficult to distinguish them by pathological diagnosis.At present,the differential diagnosis is mainly by chromosomal analysis (G-banding),FISH and immunohistochemistry.This subtype received a poor response to conventional chemotherapy for DLBCL,and has a poor prognosis.The median survival time is only 0.2-1.5 years.Currently,the main regimens include RCHOP,RICE,RCVD,methotrexate prophylaxis for central nervous system involvement,high-dose chemotherapy and bone marrow transplantation.

OBJECTIVETo analyze the relationship between symptoms and signs of temporomandibular disorders (TMD) and the patients' quality of life (QOL).

METHODSA total of 492 TMD patients were included in this study. The clinical examination results were recorded using Fricton index of temporomandibular joint function. "Visual analog scale (VAS) evaluation of QOL disturbance" was designed to quantitate patients' QOL, to evaluate the degree that the patients QOL was affected.

RESULTSChewing, daily life and emotion among all 8 items of QOL were frequently affected by TMD, and joint clicking had the least influence on QOL. Intermittent closed lock had more severe interference with QOL than joint clicking only. Severe and moderate pain or limited mouth opening affected the QOL more severely than mild pain or mild limited mouth opening. The simple linear relationship between Fricton index and patients' QOL was poor (r < 0.4).

CONCLUSIONSPain is the most frequently seen symptom in TMD. TMD could affect patients' QOL, including both physical and social-psychological functions. The results suggest that the patients' QOL as well as TMD symptoms and signs should be considered in the management of TMD.

Objective To find out related proteins that could possibly predict curative effects of neoadjuvant chemotherapy(NACT) by applying surface-enhanced laser desorption/ionization time-of-flight mass spectrometry(SELDI-TOF MS)to detect the difference in protein spectrum of breast cancer tissues.Methods Cancer tissue samples from 30 cases of breast cancer patients were detected by SELDI-TOF MS before NACT to get protein spectrum of breast cancer tissues.After NACT,the curative effects were evaluated according to RECIST standard and patients were divided into effective group(19 cases with complete response or partial response)and invalid group (11 cases with stable disease or progressive disease).Results 11 different protein peaks (P ＜ 0.05) were screened out:3491 Da(t =3.189 P =0.004),5158 Da(t =3.897 P =0.001),5360 Da(t =2.157 P =0.04),7549 Da(t =2.173 P=0.038),8451 Da(t =2.258 P =0.032),8694 Da(t =3.234 P =0.003),9089 Da (t =2.653 P =0.013),10528 Da(t =3.127 P =0.004),13445 Da(t =2.231 P =0.034),15118 Da(t =3.255 P =0.003),and 44065 Da(t =2.554 P =0.017).They were all expressed higher in effective group than in invalid group.The difference had statistical significance(P ＜ 0.05).Conclusion SELDI-TOF MS technology can screen out protein spectrum sensitive to NACT,providing evidences for breast cancer patients whether or not taking NACT.

Objective:This study aimed to establish an eXtreme Gradient Boosting(XGBoost) model that can predict the recurrence of hepatocellular carcinoma(HCC)patients after laparoscopic hepatectomy (LH) surgery.Methods:A total of 440 patients with primary HCC who received LH treatment for the first time from January 2013 to September 2016 in Affiliated Hospital of Chengde Medical University were selected as the research objects. The diagnosis method was pathological diagnosis. Research objects were divided into training group ( n=88) and verification group ( n=352) at a ratio of 2∶8 by random number table method. The Kaplan-Meier method was used to draw the recurrence-free survival curve, and the Log-rank test was used to compare the survival of the two groups; the training group was used to establish the COX regression model and the XGBoost model to screen independent predictors of recurrence after LH; receiver operating characteristic(ROC) curve was used to analyze the predictive abilities of the two models, and conducted internal verification in the verification group; Hosmer and Lemeshow Test was used to evaluate the calibration of the two models, and P>0.05 was used as a good fit between the model and the actual situation. Results:Both the COX regression model and the XGBoost model screened out tumor thrombus, low degree of differentiation, tumor microvascular infiltration (MVI), number of tumors, large tumors, and positive hepatitis B surface antigen were independent predictors of tumor recurrence( HR=2.477, 0.769, 1.786, 1.905, 1.544, 1.805; 95% CI: 1.465-4.251, 0.619-0.819, 1.263-2.546, 1.354-2.704, 1.272-1.816, 1.055-2.555). The XGboost model scores were 32 points, 29 points, 24 points, 18 points, 16 points, 11 points, respectively. In the training group, the area under the curve (AUC) of the COX regression model and XGBoost model for predicting recurrence were 0.746 (0.730-0.762) and 0.802 (0.785-0.818), respectively. The XGBoost model had strong predictive ability and was confirmed in the validation cohort. Conclusions:This study had established and verified the XGBoost model that can predict the recurrence of HCC patients after receiving LH for the first time. It can be used in clinics to assist doctors in formulating personalized postoperative monitoring programs for patients. Early detection, early diagnosis and early treatment of tumors and strengthening of postoperative follow-up are important measures to improve the prognosis of patients.

Objective To discuss feasibility and clinical effect of minimally invasive percutaneous plate osteosynthesis (MIPPO) in treatment of unstable anterior pelvic ring fractures.Methods A retrospective study was carried out on data of eight patients with pelvic fractures,including five males and three females at age of 21-57 years (average 38 years).All fractures were identified as unstable type according to Tile classification.MIPPO was performed for all patients after closed reduction.Reduction effect was analyzed according to Matta radiological evaluation criterion.Results All patients were followed up for 3-5 months (average 4.1 months),which showed reduction of anterior pelvic ring in eight patients including satisfactory reduction in five patients and good reduction in three.Fractures in all patients obtained bony union without complications like vascular nerve injury,wound infection,intraoperative massive hemorrhage,deep venous thrombosis or postoperative long-term pain.Conclusion MIPPO has advantages of reduced bleeding,few soft tissue complications,low infection rate and easy removal in treatment of anterior pelvic ring fractures and thereby is a promising surgical method.

BACKGROUND:Dexamethasone can improve the cellapoptosis and decrease the number of osteoblasts and bone cells through increasing the time of cellcycle. Protein kinase C is a kind of intraecellular singnal transduction pathways, and there are related reports on the relationship between protein kinase C and cellapoptosis. OBJECTIVE:To investigate the mechanism of dexamethasone-induced osteoblast apoptosis via protein kinase C intracellular signal transduction pathway. METHODS:Fetal rat bone marrow mesenchymal stem cells were col ected for osteogenic induction, and the cells were divided into dexamethasone group, phorbol group and star cytochalasin group. The cells in the dexamethasone group were added with 1×10-6 mol/L dexamethasone, the cells in the phorbol group were added with 1×10-6 mol/L dexamethasone and 1×10-7 mol/L phorbol, while the cells in the star cytochalasin group were added with 1×10-6 mol/L dexamethasone and 1×10-7 RESULTS AND CONCLUSION:Dexamethasone could induce apoptosis significantly, and after added with mol/L star cytochalasin. The proliferation and inhibition of the cells in different intervention groups were observed, and the content of protein kinase C in the cellmembrane and cytoplasm was measured. phorbol, the apoptosis was increased significantly;while after added with star cytochalasin, the apoptosis was decreased significantly. After added with dexamethasone, the content of protein kinase C in the cytoplasm was significantly decreased, while increased in the cellmembrane. At different time points after added with dexamethasone, the change of the content of protein kinase C in the cytoplasm and cellmembrane was most significant at 30 minutes. The results indicated that mechanism of dexamethasone-induced osteoblast apoptosis was correlated with protein kinase C, and dexamethasone was the agonist of protein kinase C. After the cells were stimulated, the protein kinase C in the cytoplasm wil moved to the cellmembrane, and then the content of protein kinase C in the cytoplasm was decreased, while increased in the cellmembrane.

Objective To discuss the clinical features and prognostic factors of primary testicular lymphoma (PTL). Methods A retrospective review was performed based on the clinical records of 33 PTL cases treated at Tianjin Medical University Cancer Hospital from June 1977 to May 2009.Drawing survival curves by Kaplan-Meier method, using Log-rank test to the univariate analysis, and multivariate analysis by COX regression model to evaluate independent prognostic factors. Results The median age of patients was 62 years at presentation(range 33-81 years). Painless testicular swelling was the initial symptom. The majority of histological subtype was B cell lymphoma, 48% of which was diffuse large B-cell non-Hodgkin's lymphoma. By postoperative chemotherapy and/or radiotherapy, 23 patients achieved complete remission and 7 achieved partial remission, with a median follow-up of 23 months (4-231 months). The 5 years and 10 years of overall survival was 39.1% and 19.5%. The effect of patients who received chemotherapy≥4 cycles and B cell lymphoma patients combination with Rituximab were better. In multivariate analysis, Ann Arbor stage, B symptoms, age of patient and number of extranode site were independent prognostic factors of survival. Conclusions Primary non-Hodgkin lymphoma should be treated with multi-modality strategies. Treatment with doxorubicin-based chemotherapy after orchiectomy should be recommended. Ann Arbor stage, B symptoms, age of patient and number of extranode site were independent prognostic factors of survival in PTL.