[Objective]To retrospectively analyze 39 cases of surgical treatment of fibrous dysplasia of proximal femur,in order to propose a partition method which can be used to guide the surgical treatment,and probe the surgical treatment strategy according to the partition method of fibrous dysplasia of proximal femur. [Methods]The data on 39 cases of fibrous dysplasia of proximal femoral from 1998 to 2009 were retrospectively analyzed.The study determined extent of the lesion according to preoperative X-ray film and proposed partitioning method in accordance with the scope of proximal femoral involvement,analyzed the relation of partition type and surgical treatment,and evaluated the effect of surgical treatment through the postoperative localized lesions control and functional score(MSTS 93).[Results]According to the scope of 39 cases of lesions,combined with characteristics of proximal femoral anatomy,proximal femur was divided into four zones: area I,femoral shaft(below small protuberance);area II,intertrochanteric(small rotor to the neck base division);area III,femoral neck;area IV,the femoral head.Based on the above partition,lesions were divided into 7 types,type I,type II,type III,type I + II,type II + III,type II + III + IV,type I + II + III,type I + II + III + IV.Surgical treatment was performed mainly with curettage of bone lesions,bone grafting and fixation.Internal fixation included DHS,intramedullary nails,and artificial joint replacement,DHS was most common in area II involvement(57.58%),followed by area III involvement(24.24%).Intramedullary nail was most common in area I involvement(64.70%) and area II involvement(35.30%).For lesions involving ≥3 zones,joint replacement was carried out.The patients were all followed up,with a median time of 6.3 years(0.5-11 years).Local recurrence rate was12.82%(5 / 39),local deformity was not found deterious.The followed up results were satisfactory.The selected treatment was reasonable.[Conclusion]When making a surgical treatment regimen for fibrous dysplasia of the proximal femur,Surgeons should consider lesion characteristics,and choose a reasonable internal fixation to achieve better surgical results.Partition method proposed in this paper can be formulated as one of preoperative surgical treatment options.

Objective To observe the pharmacological characteristics of a novel antihypertensive drug iptakalim hydrochloride (Ipt) by dilating large and small arteries. Methods The vasodilating action of Ipt was studied using isolated rat tail artery helical strips and aortic rings. Results The vasodilating action of Ipt at 10 7-10 3mol/L was observed in rat tail artery strips precontracted with potassium chloride (KCl) in a concentration and endothelium dependent manner, but no significant vasodilating effect was seen on rat aortic rings. Ipt-induced relaxation in tail artery was significantly greater in spontaneous hypertensive rats than that in normotensive rats. The vasodilating actions of Ipt in small arteries could be markedly antagonized by glibenclamide, an inhibitor of ATP-sensitive potassium channels. Conclusion The results suggest that iptakalim hydrochloride has a selective vasodilating action in small arteries, and the action is related to activation of ATP-sensitive potassium channels.

Objective To retrospective analysis the onset characteristics and outcome of surgical management in patients with giant cell tumor (GCT) of distal tibia,explore the operation indication and the risk factors for recurrence and limb function.Methods From October 2000 to June 2014,Fifteen patients with GCT in the distal tibia from domestic three bone tumor centers were involved in this study.They included 8 males and 7 females,with an average age of 35.9± 10.4 years.There were 11 cases of Campanacci Ⅱ and 4 cases of Campanacci Ⅲ.Two cases of Campanacci Ⅱ occurred pathologic fracture.Expanded curettage surgery was performed in 11 cases and tumor resection with revascularization was performed in 4 cases.Factors influencing the choice of surgery,recurrence and limb function were analyzed.These included tumor size,ankle condition,Campanacci grade,pathological fracture.Results A1l patients were followed up with a mean duration of 62.3±25.2 months,ranging from 26 to 60 months.One of 11 patients treated with extended curettage underwent local recurrence.One of 4 patients treated with marginal excision underwent local recurrence.The effect of Campanacci classification and pathological fracture on selection of operation scheme was analyzed.The effects of pathological fractures,Campanacci classification,surgical methods and postoperative functional score (MSTS score) on postoperative recurrence rate were analyzed.Single factor analysis showed that the pathological fractures did not affect the selection of GCT surgical treatment plan (P=1.000).Campanacci classification affected the selection of GCT surgical treatment plan (P=0.001).Pathological fractures,Campanacci classification and surgical methods were not related to the local recurrence rate (P ＞ 0.05).Expanded curettage of Campanacci grade Ⅱ patients with better postoperative MSTS score than tumor segment resected Campanacci grade Ⅲ patients (t=3.385,P=0.005).There was no significant relationship between pathological fracture and postoperative MSTS score.Conclusion Distal tibia GCT Campanacci classification and whether combined with pathological fracture or not affects the choice of surgical procedure and postoperative functional recovery.

Objective To introduce a classification of infection interfaces associated with existing implants which was used to guide the treatment algorithms for implants and infection.Methods From January 2006 to April 2016,197 patients were treated at Department of Bone Tumor Osteopathology,Zhengzhou Orthopaedics Hospital for early infection associated with an existing implant.They were 147 males and 50 females,aged from 12 to 63 years (average,47.3 years).After bacterial cultures and drug sensitive tests and other laboratory examinations,their infection interfaces were classified into 3 types.In type Ⅰ of 89 cases,the infection was confined to the soft tissue and spread to only part of the implant;in type Ⅱ of 75 cases,the infection spread to the internal implant but ended at the implant and bone surface,involving no intramedullary cavity;in type Ⅲ of 33 cases,the infection spread to the intramedullary cavity with defects at broken ends.In primary surgery,plating was performed in 126 cases,external fixation in 48 and intramedullary nailing in 23.Type I cases were treated by systemic intravenous infusion combined with local antibiotic therapy and/or limitedly extended debridement while the implants were reserved,type Ⅱ cases by extended debridement while the implants were reserved,and type Ⅲ cases by extended debridement and external fixation while the implants were removed.Antimicrobial therapy was conducted before and after surgery according to their pathogen examination results.Antibiotics were used after surgery according to their pathogen examination results.Their therapeutic outcomes were evaluated according to their systemic and local symptoms,signs,blood routine indexes,erythrocyte sedimentation rate and level of C reactive protein.Results All the patients were followed up for 2 to 5 years (mean,3.4 years).After antibiotic therapy,debridement and vacuum sealing drainage,the implants were reserved in 150 cases,of which 84 were type I and 66 type Ⅱ,and removed in 47 cases,of which 5 were type Ⅰ,9 type Ⅱ and 33 type Ⅲ.By the criteria described in Surgery for Pyogenic Infection of Bone and Joint,the therapeutic outcomes were rated as cured in 185 cases,as effective in 7 and ineffective in 5.Conclusions A classification of infection interfaces associated with existing implants is significant for scientific,reasonable,standardized and individualized treatment algorithms for implants and infection,avoiding not only incidence of osteomyelitis but also unnecessary removal of implants with effective control of inflammation.

According to the pathological characteristics of symptomatic chronic thoracic and lumbar osteoporotic vertebral fracture (SCOVF), the different clinical treatment methods are selected, including vertebral augmentation, anterior-posterior fixation and fusion, posterior decompression fixation and fusion, and posterior correction osteotomy. However, there is still a lack of a unified understanding on how to choose appropriate treatment method for SCOVF. In order to reflect the new treatment concept and the evidence-based medicine progress of SCOVF in a timely manner and standardize its treatment, the clinical guideline for surgical treatment of SCOVF is formulated in compliance with the principle of scientificity, practicability and advancement and based on the level of evidence-based medicine.

Objective:To investigate the incidence and treatment of gastric cancer in 16 medical centers in Tianjin from 2020 to 2021.Methods:The retrospective and descriptive study was conducted. The clinical data of 3 122 gastric cancer patients who underwent surgery in 16 medical centers, including Tianjin Medical University Cancer Institute & Hospital, et al, in Tianjin from 2020 to 2021 were collected. There were 2 112 males and 1 010 females, aged (64±11)years. Observation indicators: (1) general data of patients; (2) treatment situations; (3) postoperative complications. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were descri-bed as absolute numbers or percentages, and comparison between groups was conducted by the chi-square test. Results:(1) General data of patients. From 2020 to 2021, a total of 3 122 gastric cancer patients received surgeries in 16 medical centers in Tianjin, including 2 112 males and 1 010 females. There were 1 443 cases in 2020, including 976 males and 467 females, aged (63±11) years. There were 1 679 cases in 2021, including 1 136 males and 543 females, aged (65±11) years. Of the 3 122 pati-ents, cases in stage Ⅰ, Ⅱ, Ⅲ, Ⅳ were 696, 667, 1 466, 293, accounting for 22.293%(696/3 122), 21.365%(667/3 122), 46.957%(1 466/3 122), 9.385%(293/3 122), respectively. Cases with early gastric cancer, locally advanced gastric cancer, advanced gastric cancer account for 17.265%(539/3 122), 73.350%(2 290/3 122), 9.385%(293/3 122). There were 2 829 patients without distant metastasis and 293 patients with distant metastasis. For the 2 829 patients without distant metas-tasis, cases in stage T1, T2, T3, T4a, T4b accounted for 19.053%(539/2 829), 12.089%(342/2 829), 20.148%(570/2 829), 41.499%(1 174/2 829), 7.211%(204/2 829)respectively, cases in stage N0, N1, N2, N3 account for 37.328%(1 056/2 829), 16.331%(462/2 829), 15.836%(448/2 829), 30.505%(863/2 829). For the 293 advanced gastric cancer patients with distant metastasis, 190 cases had peri-toneal metastasis, 47 cases had lymph node metastasis, 27 cases had ovarian metastasis, 37 cases had liver metastasis, 14 cases had other metastasis (some patients had ≥2 distant metastases). (2) Treatment situations. ① For the 539 with early gastric cancer, cases undergoing endoscopic submu-cosal dissection, laparoscopic surgery, open surgery were 22, 150, 86 in 2020, versus 19, 212, 50 in 2021, showing a significant difference between them ( χ2=19.42, P<0.05). For the 498 patients with early gastric cancer who underwent laparoscopic or open surgery, cases undergoing open surgery including total gastrectomy, distal gastrectomy, proximal gastrectomy were 25, 81, 30, and cases undergoing laparoscopic surgery including total gastrectomy, distal gastrectomy, proximal gastrec-tomy were 18, 309, 35, respectively, showing a significant difference between them ( χ2=40.62, P<0.05). For the 2 290 patients with locally advanced gastric cancer, cases undergoing open surgery and laparoscopic surgery were 446 and 617 in 2020, versus 410 and 817 in 2021, showing a significant difference between them ( χ2=17.75, P<0.05). For the 2 290 patients with locally advanced gastric cancer, cases undergoing open surgery including total gastrectomy, distal gastrectomy, proxi-mal gastrectomy were 336, 377, 143, and cases undergoing laparoscopic surgery including total gastrectomy, distal gastrectomy, proximal gastrectomy were 377, 920, 137, respectively, showing a significant difference between them ( χ2=89.64, P<0.05). Of the 293 patients with advanced gastric cancer, 175 cases underwent surgeries due to hemorrhage, stenosis, perforation, 76 cases under-went surgery after chemotherapy, 42 cases underwent surgery directly. ② For 756 cases of 3 122 pati-ents undergoing total gastrectomy, 357 and 4 cases received open digestive tract reconstruction including Roux-en-Y and other anastomosis, versus 380 and 15 cases with laparoscopic digestive tract reconstruction including Roux-en-Y and other anastomosis, showing a significant difference between them ( χ2=5.57, P<0.05). For 1 687 cases undergoing distal gastrectomy, 84, 160, 158, 55 cases received open digestive tract reconstruction including Billroth Ⅰ anastomosis, Billroth Ⅱ + Braun anastomosis, Roux-en-Y anastomosis, uncut Roux-en-Y anastomosis, versus 154, 489, 417, 170 cases with laparoscopic digestive tract reconstruction including Billroth Ⅰ anastomosis, Billroth Ⅱ + Braun anastomosis, Roux-en-Y anastomosis, uncut Roux-en-Y anastomosis, showing a significant difference between them ( χ2=10.90, P<0.05) . Of the 539 patients with early gastric cancer, 65 cases had lymph node metastasis, in which 18 of 306 stage T1a cases had lymph node metastasis and 47 of 233 stage T1b cases had lymph node metastasis. The number of detected lymph nodes for the 2 290 patients with advanced gastric cancer was 31±15, including ≥16 for 2 059 cases and ≥30 for 1 276 cases. Of the 3 122 patients, cases with neoadjuvant therapy, complete response and incomplete response was 128, 13 and 115 in 2020, versus 250, 49 and 201 in 2021, showing a significant difference between them ( χ2=5.51, P<0.05). (3) Postoperative complications. Of the 3 122 patients, 746 cases had postoperative complications, with an incidence of 23.895%(746/3 122). There were 62 patients with grade 3 or more complications. Reoperation was conducted in 34 patients. There were 14 cases of postoperative death. The duration of postoperative hospital stay and hospital expense were (11±5)days and (98 114±46 598)yuan for the 3 122 patients, (26±14)days and (122 066±68 317)yuan for cases with complications, (40±21)days and (196 926±12 747)yuan for cases with grade 3 or more complications. Conclusion:Compared with 2020, cases undergoing laparoscopic surgery and distal gastrectomy for gastric cancer in Tianjin increases in 2021, and the digestive tract reconstruction also differs. The number of patients with neoadjuvant chemotherapy and complete response rate for advanced gastric cancer increases.

Pulmonary blast injury has become the main type of trauma in modern warfare, characterized by externally mild injuries but internally severe injuries, rapid disease progression, and a high rate of early death. The injury is complicated in clinical practice, often with multiple and compound injuries. Currently, there is a lack of effective protective materials, accurate injury detection instrument and portable monitoring and transportation equipment, standardized clinical treatment guidelines in various medical centers, and evidence-based guidelines at home and abroad, resulting in a high mortality in clinlcal practice. Therefore, the Trauma Branch of Chinese Medical Association and the Editorial Committee of Chinese Journal of Trauma organized military and civilian experts in related fields such as thoracic surgery and traumatic surgery to jointly develop the Clinical treatment guideline for pulmonary blast injury ( version 2023) by combining evidence for effectiveness and clinical first-line treatment experience. This guideline provided 16 recommended opinions surrounding definition, characteristics, pre-hospital diagnosis and treatment, and in-hospital treatment of pulmonary blast injury, hoping to provide a basis for the clinical treatment in hospitals at different levels.