Objective To discuss the value of percutaneous compression plate (PCCP) in treating intertrochanteric fractures. Methods A retrospective study was done on 57 patients with intertrochanteric fractures treated by PCCP from January 2008 to January 2009 to evaluate the operative effect.Results All the fractures were healed in 11-15 weeks after the operation, with no incision infection, hematoma, internal fixation failure or fracture collapse. Two surgical incisions were for 2 cm, with no blood transfusion found in any patient. According to Harris score, the postoperative excellent rate reached 92.6%. Conclusion PCCP can attain similar effect wiht DHS and now is the choice of treatment in treating intertrochanteric fracture in the elderly patients.

Lysozyme generally exists in animals,plants and microorganisms,and it is used as a natural anti?infection materi?al and one of the important non?specific immune factors in organisms. This paper reviews the progress of researches on its classifi?cation,gene structure and function,and expression regulation in Oncomelania hupensis,and on the factors affecting its activi?ties in recent years,in order to further discuss its distribution in O. hupensis.

Objective To analyze and compare the imaging characteristics of contrast-enhanced ultrasound (CEUS) and contrast enhanced magnetic resonance imaging (CEMRI) in diagnosing hepatic epithelioid hemangioendothelioma (HEHE) for improving radiological diagnostic accuracy.Methods The imaging characteristics of CEUS and dynamic CEMRI in 17 patients with histopathological diagnosis of HEHE on specimens obtained after surgical resection or fine needle biopsy were retrospectively analyzed and compared.Results On CEUS,20 lesions in 13 patients demonstrated different enhancement patterns in the arterial phase:13 lesions (65.0％) displayed gross enhancement and 7 lesions (35.0％) displayed a rimlike enhancement.Synchronous enhancement was observed in 17 lesions (85.0％) and rapid enhancement was observed in 3 lesions (15.0％).All these 20 lesions manifested as a hypoechoic mass in the portal venous and delayed phases.Other characteristics included speculated enhancement in the inner margin of the lesions and a vessel sign.On CEMRI,45 lesions (71.4％) manifested slight enhancement in the arterial phase and continuous enhancement in the portal venous and delayed phases.The remaining 18 lesions (28.6％) manifested no enhancement in the arterial phase but progressive enhancement in the portal venous and delayed phases.47 lesions (74.6％) displayed a rim-like enhancement and 16 lesions (25.4％) displayed gross enhancement.Other imaging characteristics included a halo sign,a lollipop sign,a capsular retraction sign or avessel sign.Conclusions On CEUS,characteristic manifestations of HEHE were synchronous enhancement with a quick wash-out.At peak time,the enhancement degree was equal to the normal liver parenchyma.On CEMRI,the main radiological feature of HEHE was a rim-like enhancement.In the arterial phase,the enhancement degree was not high and there was either a continuous enhancement or a progressive enhancement in the portal venous and delayed phases.Furthermore,HEHE lesions always occurred under the liver capsule and showed acapsular retraction sign,ahalo sign,a lollipop sign or a vessel sign.The combination of CEUS and CEMRI helped to improve the diagnostic rate and contributed to selection of clinical treatment.

Purpose To analyze and compare the imaging characteristics of contrastenhanced ultrasound (CEUS) and dynamic contrast-enhanced CT for hepatic epithelioid hemangioendothelioma (HEHE) diagnosis.Materials and Methods The imaging characteristics of CEUS and dynamic contrast-enhanced CT performed on 16 patients with pathological-confirmed HEHE were retrospectively analyzed.Dynamic contrast-enhanced CT was performed on 5 patients,real-time CEUS was performed on 8 patients,and both examinations were performed on 3 patients.Results On CEUS,14 lesions were selected from 11 HEHE cases.In the case of enhancement mode,5 lesions displayed ringenhancement,and 9 lesions displayed global enhancement;in the case of arterial phase,11 lesions were synchronously enhanced,and 3 lesions were rapidly enhanced compared with liver parenchyma;in the case of peak time,hyper-enhancement,iso-enhancement and hypo-enhancement were observed in 2 lesions,9 lesions and 3 lesions,respectively;all 14 lesions manifested hypoechoic mass in portal phase and delayed phase.On dynamic contrast-enhanced CT,29 lesions were found in 8 HEHE cases.In the case of arterial phase,9 lesions (31.0％) showed slight inhomogeneous enhancement,4 lesions (13.8％) showed no obvious enhancement and 16 (55.2％) lesions showed slight edge enhancement;all 29 lesions presented continuous hypo-enhancement in delayed phase.Conclusion Both CEUS and dynamic contrast-enhanced CT have respective characteristic manifestations,and are of high value for the diagnosis of HEHE.

Objective To investigate the clinical effect of the treatment of osteoporotic vertebral compression fractures in the elderly populationthrough different surgical approaches.Methods 98 cases with a single-level osteoporotic vertebral compression fracture in the elderly population were randomly divided into two groups from February 201 1 to June 2013.48 patients were performed by percutaneous vertebroplasty (PVP)through unipedicular approach and 50 patients through bipedicular approachs.The clinical data of patients were prospectively analyzed and the clinical efficacy were compared between two groups using VAS (visual analogue scale method)and ODI (Oswestry disability index)in preoperative,postoperative 1 day and 1 year postoperatively .The data of age, gender,injury to the patients with operation time,postoperative follow-up time,operation time,bone cement injection,bone cement leakage and other complications were observed.Cobb angle,vertebral compression ration were observed by imaging data.Results All the cases were followed-up.There was no statistical difference in preoperative clinical data between the two groups (P >0.05).In unilateral group (48 cases),the data of operation time,bone cement injection,bone cement leakage,Cobb angle improve,vertebral compression ration improve were (34.87±5.91)min,(6.20±0.66)mL,1 6 cases(33%),(10.1 9±2.12)%,(13.23°±1.58°)and adjacent vertebral fractures was 10 cases (20.9%).VAS score was respectively improved (4.05 ± 0.12 ),(5.42 ± 0.12 ) in postoperative 1 day and 1 year than preoperative.VAS score was improved (1.40 ±0.1 1 )in postoperative 1 year than 1 day.ODI score was respectively improved (35.46 ± 1.89)%,(47.88 ±2.21 )% in postoperative 1 day and 1 year than preoperative.ODI score was improved (1 1.42±0.24)% in postoperative 1 year than 1 day.In bilateral group (50 cases).The data of operation time,bone cement injection,bone cement leakage,Cobb angle improve, vertebral compression ration improve were (41.66±6.90)min,(4.88±0.52)mL,9 cases(18.0%),(10.48±1.43)%,(13.04°±2.03°)and adjacent vertebral fractures was 6 cases(12.0%).VAS score was respectively improved (4.06±0.1 1),(5.30±0.10)in postoperative 1 day and 1 year than preoperative.VAS score was improved (1.34± 0.08)in postoperative 1 year than 1 day.ODI score was respectively improved (36.08±2.13)%,(47.54±1.97)%in postoperative 1 day and 1 year than preoperative.ODI score was improved (1 1.26 ± 0.54)% in postoperative 1 year than 1 day.There was no obvious clinical problems after occurred leakage in two groups.there was statistical difference in cement injection,bone cement leakage and postoperative adjacent vertebral fractures after operation between the two groups.there was no statistical difference in Cobb angle improve,vertebral compression ration improve,VAS score and ODI score between the two groups.Conclusion Both approaches are effective in the treatment of osteoporotic vertebral compression fractures in the elderly population ,but there is advantage of decrease the incidence of bone cement leakage and postoperative adjacent vertebral fractures through bilateral approach.

Objective To evaluate the number of lymph node harvested during radical resection of invasive rectal carcinoma(stage Ⅰ toⅢ).Methods From January 2000 to June 2008,the pathological data of colorectal carcinoma patients who were operated on were retrospectively reviewed.Exclusion criteria included recurrent colorectal tumor,Tis tumor,R1 or R2 resection,tumor resection transanally or endoscopically,synchronous diseases affecting the surgical procedure for the reetal cancer(familial adenomatous polyposis.synchronous coloreetal carcinoma)and rectal cancer receiving perioperative neoadiuvant chemoradiation.Statistical analysis was performed using Mann-Whitney Test and Chi-Square Test (SPSS 15.0).Results were expressed as mean±SEM.Results A total of 2282 patients were identified.including 1216 cases in the rectal carcinoma group and 1066 cases in the colon carcinoma group.There were no significant difference in gender(719/1216 vs.593/1066,P=0.092)and overall TNM stage (P=0.067)between the two groups.But patients of rectal cancer were younger(58.6±0.4 vs.62.0±0.4.P=0.000).The lymph node retrieval in the rectal carcinoma group was significantly less than that of colon carcinoma group(9.4±0.1 vs.10.5±0.1,P=0.000).There were significantly less rectal cancer patients with a 1ymph node harvest equal to or more than 12 nodes(P=0.000).Patients in the low rectal cancer group(≤7 cm from the anal verge.n=834)had less lymph nodes harvested than the mid-high rectal cancer group(＞7 am and≤15 cm from the anal verge.n=382)(9.2±0.1 vs.9.9±0.2,P=0.009).Conclusion The lymph node harvest in the rectal carcinoma group was significantly less than that in the colon carcinoma group.A new standard may be necessary to define the adequate number of lymph nodes for rectal cancer.

Objective To explore the clinicopathologic factors impacting recurrence and survival in rectal cancer patients after radical resection.Methods Clinicopathologic data of 1 166 patients with rectal cancer in Changhai Hospital,were recruited between 2005 and 2010.Kaplan-Meier analysis and the logrank test were used to evaluate the effects of the pathology on patients' survival.Cox regression model was used to assess independent factors associated with clinical prognosis.Results The 1,3,5-year overall survival rates were 94.3％,81.2％ and 76.5％,median survival time was 53 months.328 patients had recurrence and metastases,with a median recurrence time of 18 months.The independent prognostic factors for overall survival time were CEA,CA19-9,tumor distance to dentate line,surgical modality,radical operation,tumor invasion,tumor differentiation,lymph node metastasis and postoperative treatment.Surgical treatment,radical operation or not,tumor invasion and lymph node metastasis were statistically significant associated with tumor recurrence and metastases.Conclusions The important factors inffuencing the prognosis of rectal cancer patients were CEA,CA19-9,tumor distance to dentate line,surgical modality,radial operation,tumor in vasion,tumor differentiation,lymph node metastasis,and post operative treatment.

Objective:To explore the diagnostic performance of ultrasound attenuation imaging (ATI) in grading the degree of hepatic steatosis in metabolic dysfunction-associated fatty liver disease (MAFLD).Methods:The liver gray-scale ultrasound and ATI examinations were performed on 212 subjects who were treated in Zhongshan Hospital Affiliated to Fudan University from August 2020 to March 2021. The attenuation coefficient(AC) values among different degrees of hepatic steatosis were analyzed and the diagnostic performance of ATI was evaluated. Relationships between AC values and clinical characteristics were assessed by Pearson′s correlation analysis.Results:The AC values for normal liver, mild, moderate and severe fatty liver were (0.56±0.05)dB·cm -1·MHz -1, (0.68±0.09)dB·cm -1·MHz -1, (0.82±0.09)dB·cm -1·MHz -1, (0.94±0.09)dB·cm -1·MHz -1, respectively. There were significant differences in AC values among different hepatic steatosis divisions( P<0.008). There was highly significant correlation between AC values and the degree of hepatic steatosis( r=0.860, P<0.01), moderate correlation between AC values and BMI( r=0.425, P<0.01), weak correlation between AC values and HDL-C( r=-0.237, P=0.029), no correlations between AC values and age, TC, TG, LDL-C ( r=0.083, 0.055, 0.133, -0.039, all P>0.05) .The areas under the receiver operating characteristics curve of ATI for mild fatty liver and above, moderate fatty liver and above, severe fatty liver and above were 0.958, 0.962, 0.918; the sensitivity were 90.1%, 95.8%, 94.9%, the specificity were 96.1%, 87.1%, 73.9%, and the cut-off values were 0.666 dB·cm -1·MHz -1, 0.719 dB·cm -1·MHz -1, 0.803 dB·cm -1·MHz -1, respectively. Conclusions:ATI is a reliable and convenient method for evaluating the degree of hepatic steatosis in MAFLD.

OBJECTIVETo identify the risk factors associated with lymph node metastasis in rectal cancer after neoadjuvant chemoradiotherapy (CRT).

METHODSFrom January 2005 to December 2013, the clinical data of 178 patients with advanced rectal cancer undergoing radical excision after neoadjuvant CRT in our department were reviewed retrospectively. A total of 11 clinicopathologic factors relating to lymph node metastasis were studied using univariate and multivariate Logistic regression analyses.

RESULTSThere were 74(41.6%) cases with lymph node metastasis, while 104 cases without lymph node metastasis. Univariate analysis showed that age(P=0.000 2), post-CRT CEA level(P=0.011 2), ypT stage(P=0.000 0), pathologic type(P=0.004 0), and tumor regression grade(TRG)(P=0.033 8) were significantly associated with lymph node metastasis. Multivariate analysis showed that age(OR=2.385, 95% CI:1.372 ~ 4.147, P=0.002 1), post-CRT CEA level(OR=2.310, 95% CI:1.005 ~ 5.307, P=0.048 6) and ypT stage(OR=2.592, 95% CI:1.236 ~ 5.432, P=0.011 7) were independent risk factors. However, 15.8% of the patients who achieved TRG1 had lymph node metastasis and TRG failed to independently correlate with lymph node metastasis in rectal cancer after neoadjuvant CRT.

CONCLUSIONSThere was a higher ratio of lymph node metastasis in rectal cancer patients who were young, CEA≥5 μg/L or deep invasion after neoadjuvant CRT. Therefore, neoadjuvant CRT should be carefully considered in these patients.

Age Factors ; Carcinoembryonic Antigen ; blood ; Chemoradiotherapy ; Female ; Humans ; Lymphatic Metastasis ; diagnosis ; Male ; Neoadjuvant Therapy ; Neoplasm Grading ; Neoplasm Invasiveness ; Rectal Neoplasms ; complications ; epidemiology ; therapy ; Remission Induction ; Retrospective Studies ; Risk Factors ; Treatment Outcome

OBJECTIVETo investigate the relationship between tumor regression grade (TRG) and lymph node regression grade (LRG) after neoadjuvant chemoradiotherapy (CRT) for rectal cancer and its clinical implication.

METHODSClinicopathological data of 176 rectal cancer patients undergoing radical excision after neoadjuvant CRT from January 2005 to December 2013 in our department were retrospectively analyzed.

INCLUSION CRITERIA(1) Radiology indicated locally advanced low rectal cancer and patients had strong desire to preserve the sphincter before neoadjuvant CRT; (2) there was no definite metastatic lesion before neoadjuvant CRT; (3) patients received whole course of neoadjuvant CRT (regular radiotherapy plus synchronous fluorouracil-like drugs chemotherapy); (4) patients underwent radical operation after neoadjuvant CRT. Patients with short-course CRT and emergency surgery were excluded. TRG and LRG of postoperative specimens (including tumor and lymph nodes) were carried out based on the percentage of the fibrosis and the cancer residue. No cancer residue was defined as TRG1 and LRG1; rare cancer cell residue as TRG2 and LRG2; fibrosis growth over residual cancer as TRG3 and LRG3; residual cancer growth over fibrosis as TRG4 and LRG4; absence of regressive changes as TRG5 and LRG5; and normal lymph nodes as LRG0. Spearman correlation test was used to assess the correlation between TRG and LRG.

RESULTSOf 176 patients, 111 were men and 65 were women. The mean age was (53.9±13.0) years. The number of patients with stage I(, II(, and III( before operation was 10, 49 and 62 while other 55 patients were unknown. Transabdominal low anterior resection (LAR) was performed in 118 cases and abdominal-perineal resection(APR) in 47 cases following the principle of total mesorectal excision (TME). Postoperative pathology of specimens revealed that the number of patients from TRG1 to TRG5 was 19 (10.8%), 25 (14.2%), 66 (37.5%), 47 (26.7%), 19 (10.8%), and from LRG0 to LRG5 was 35 (19.9%), 68 (38.6%), 10 (5.7%), 14 (8.0%), 15(8.5%), 34 (19.3%), respectively. TRG was correlated to LRG (P=0.005) while the Spearman correlation coefficient was only 0.24. The analysis of subgroup without LRG1 also showed that TRG was correlated to LRG(P=0.0005) and the Spearman correlation coefficient was 0.40.

CONCLUSIONSTRG can not represent LRG. Therefore, both TRG and LRG should be assessed when evaluating the response of rectal cancer to neoadjuvant CRT.