Objective To discuss the mechanism of injury,treatment decisions,complications and surgical results of the floating hip injuries (FHI).Methods Thirty-three patients with FHI were retrospectively analyzed in our hospital from June 2001to June 2011.There were 25 males and 8 females,with an average age of 34.6 years (range,4-73 years).The mechanism of injury was motor vehicle collision for 20 patients,fall down from a height for 11,crushed injury for 1,and sports-related injury for 1.According to Liebergall classification for the floating hip injuries,there were 7 cases for type Ⅰ (21.2％),9 for type Ⅱ (27.2％)and 17 for type Ⅲ (51.6％).All patients had associated injuries,the average injury severity score (ISS) was 28.9.Thirty-two of the femoral fractures underwent surgical stabilization of their femoral fractures.Surgical stabilization methods included ORIF or intramedullary nailing (29 cases),external fixation (1 case),total hip arthroplasty (2 cases).Acetabular fractures were treated with open reduction and internal fixation (ORIF) in 16 cases.Thirteen patients suffered pelvic fractures underwent surgical stabilization for at least one component of ring disruption.Results Twenty-eight cases (84.8％) were followed up for 2.3 to 10.1 years (average,3.5 years).Thirteen patients were followed up in the 16 patients who suffered type Ⅰ or Ⅱ fractures.According to Majeed functional evaluation,the results were excellent in 8 cases,good in 3 and fair in 2,with the excellent and good rate being 84.6％.Fifteen patients with type Ⅲ were followed up,according to D'Aubigné and Postel evaluation criterion.The joint functions were excellent in 7 cases,good in 4,fair in 3,and poor in 1,with the excellent and good rate being 73.3％.According to Ma Yuanzhang functional evaluation,the knee functions of the all patients were excellent in 23 cases,good in 3,and fair in 2,with the excellent and good rate being 92.9％.Complications seen in these patients included post-traumatic osteoarthritis of the hip developed in one hips,2 patients developed heterotopic ossification (HO),one case of avascular necrosis of the femoral head,and two femoral nonunions.The most severe complication was traumatic sciatic nerve palsy,which was found in 5 patients.Conclusion Ipsilateral injuries to the femur and the pelvis or acetabulum (floating hip) are severe injuries usually caused by high-energy trauma.The femur fracture will most commonly be addressed first,and surgeons should be aware of the high incidence of sciatic nerve palsy as well as treatment options and potential complications associated with this devastating combination of injuries.

Objective To analyze the feasibility and practicality of the navigational template for antegrade lag screw fixation of the fractures in the posterior column of acetabulum.Methods Spiral CT scan data of 40 normal adult pelvis was collected.3D CT scans of pelvics were performed.Virtual 3D pelvic models were reconstructed with software Mimics 10.01.Virtual cylindrical implants were placed along the longitudinal axis of the acetabular posterior column via the ischial tuberosity among the ipsilateral hemipelvis and some anatomical parameters were measured.To adjust cylinder position to determine the best projection point,the shortest distance of the point to the linea terminalis and the anterior border of the auricular surface,the angle between the cylindrical and the coronal plane (α),and the angle between the quadrilateral district and iliac fossa plane (β) were measured respectively.The 3D models were imported into software UG 6.0.The models of navigational templates were designed according to the anatomic features of the acetabulums and the measured parameters.16 cases of dry left side of pelvis specimens were collected.Simulate acetabular posterior column screw fixation from different screw holes and verify the accuracy of navigation template assisted in the nail.Results The navigational templates was designed and manufactured successfully which was more consistent with the anatomical features of the quadrilateral plane.Placement of lag screw from the first hole:6.3％ achieved accurate positioning,75％ well positioning,and 18.7％ loose.From the second hole:81.3％ had accurate positioning,18.7％ well positioning.From the third hole:37.5％ had accurate positioning,62.5％ loose.Conclusion The navigational template designed according to the anatomic features of acetabulum and the measured parameters can accurately assist lag screw placement.

OBJECTIVETo study the clinicopathologic and immunohistochemical features of diffuse large B-cell lymphoma (DLBCL) and the significance of immunohistochemistry in diagnosis and differential diagnosis of DLBCL.

METHODS60 cases of DLBCL were studied and immunohistochemical staining for LCA, L26, BLA-36, CD30, bcl-6 were carried out with the EnVision 2 step method.

RESULTSThe age range of 76.7% (46/60) patients was 40 - 70 years. The location of the lesion includes nodal and extranodal sites. 90.0% (54/60) were in clinical stages of II (24/54), III (21/54), IV (9/54). Histopathologic morphology presented as centroblastic (88.3%, 53/60), immunoblastic (3.3%, 2/60), anaplastic large B cell type (3.3%, 2/60) and T cell rich B cell type (5.0%, 3/60). Immunostaining showed 100% (60/60) DLBCL were positive for LCA, L26, BLA36, 3.3% (2/60) DLBCL positive for CD30, 95% (57/60) expressed bcl-6 protein.

CONCLUSIONSDLBCL is an aggressive lymphoma which shows cytologic variability from case to case. The evaluation of pathologic features and immunohistochemistry in DLBCL are useful and practical for diagnostic purposes, but cannot delineate distinctive morphologic subtypes.

Adult ; Aged ; Antigens, CD20 ; analysis ; DNA-Binding Proteins ; analysis ; Female ; Humans ; Immunohistochemistry ; Ki-1 Antigen ; analysis ; Leukocyte Common Antigens ; analysis ; Lymphoma, B-Cell ; metabolism ; pathology ; Lymphoma, Large B-Cell, Diffuse ; metabolism ; pathology ; Male ; Middle Aged ; Proto-Oncogene Proteins ; analysis ; Proto-Oncogene Proteins c-bcl-6 ; Transcription Factors ; analysis

Ten patients diagnosed with multifocal motor neuropathy ( MMN) were recruited in the Department of Neurology at Chinese PLA General Hospital from January 1, 2009 to August 31, 2015.The clinical and electrophysiological features were analyzed retrospectively .All patients complained of progressive asymmetric limb weakness , which was more severe in distal than in proximal . Five presented muscle atrophy.None had sensory disturbances .All suffered diminished or disappeared tendon reflex , whereas Babinski signs were negative .Multi-focal conduction block ( CB) was confirmed by nerve conduction studies ( NCS) in all patients and 7 showed spontaneous potentials in needle electrode electromyography .Abnormal sensory nerve conduction was seen in 3 patients.Laboratory test revealed anti-ganglioside GM1 antibody in cerebrospinal fluid (CSF) in 6 cases and elevated CSF protein in 7 cases.Limb weakness alleviated greatly in 9 cases after intravenous immunoglobulin ( IVIg) treatment.But the other one reported poor response , who had long course of disease , serious limb weakness and obvious muscle atrophy .Motor nerve damage is the most important manifestation of MMN and sensory nerve damage may also appear .NCS is essential to the diagnosis of this disease , with CB as the characteristic electrophysiological feature .IVIg is an effective treatment.

Objective:To investigate the clinical and electrophysiological characteristics of ANCA-associated vasculitic neuropathy (VN) and analyze the predictors of treatment outcomes.Methods:Retrospective case series. In all, 652 consecutive patients with ANCA-associated vasculitis were admitted to the First Medical Center of the Chinese PLA General Hospital between January 2006 and December 2022. Peripheral neuropathy occurred in 91 patients. Patients were excluded if other known causes of neuropathy were present. Sixty-one patients were eventually enrolled, including 17 with eosinophilic granulomatosis with polyangiitis (EGPA), 11 with granulomatosis polyangiitis (GPA), and 33 with microscopic polyangiitis (MPA). Their clinical data were collected and clinical characteristics, VN manifestations, electrophysiological findings (including interside amplitude ratio [IAR]), and treatment outcomes were compared among the three subsets of AAV. Then, factors influencing the treatment outcomes were analyzed using multivariable logistic regression analysis.Results:Peripheral neuropathy occurred in 62.1%(18/29) of EGPA, 8.3%(15/180) of GPA, and 13.1%(58/443) of MPA patients. The age at onset and examination was higher in patients with MPA than those with EGPA or GPA ( P<0.01). The occurrence of VN was later in patients with GPA than those with EGPA ( P<0.01), and the GPA group had fewer affected nerves than the other two groups ( P<0.016). The abnormal IARs of motor nerves in lower limbs were more detected in the EGPA than the MPA group ( P<0.01). Logistic regression analysis suggested that higher Birmingham vasculitis activity score-version 3 (BVAS-V3) ( OR=6.85, 95% CI 1.33-35.30) was associated with better treatment outcomes of VN. However, central nervous system involvement was a risk factor for poor treatment outcomes ( OR=0.13, 95% CI 0.02-0.89). Conclusions:The clinical and electrophysiological characteristics of VN were slightly different among subsets of AAV. Patients with GPA often presented with polyneuropathy and had fewer nerves affected; mononeuritis multiplex was more common in EGPA than GPA and MPA. Higher BVAS-V3 and central nervous system involvement might predict the treatment outcome of VN.

Objective:Charcot-Marie-Tooth disease (CMT) comprises a group of clinically and genetically heterogeneous inherited neuropathies with an estimated prevalence of 1 in 2500. This study aimed to analyze the clinical and mutational characteristics of Chinese CMT patients with MFN2, BSCL2 and LRSAM1 variants.Methods:In this study, genetic analysis was performed in 206 Chinese patients at Chinese PLA General Hospital from December 2012 to March 2020 with clinical diagnosis of CMT, and reported variants of MFN2, BSCL2 and LRSAM1 related to CMT2.Results:We reported ten MFN2 mutations in ten unrelated patients (7 male, 3 female), two of whom had positive family history. Three novel mutations were detected including c.475-2A>G (splicing); c.687dupA (p.E230Rfs*16) and c.558dupT (p.S186fs). We reported three BSCL2 mutations of four unrelated patients, including c.461C>G (p.S154W), c.461C>T(p.S154L), and novel variants of c.1309G>C (p.A437P) and c.845C>T (p.A282V). Furthermore, two novel variants of LRSAM1, including c.1930G>T (p.G644C) and c.1178T>A (p.L393Q) were detected in two unrelated patients.Conclusion:Mutational spectrum of MFN2-, BSCL2-and LRSAM1-related CMT disease is expanded with the identification of novel variants in Chinese patients.

Objective:To investigate the association between split foot and electrophysiology in patients with amyotrophic lateral sclerosis (ALS).Methods:The clinically definite or clinically probable ALS patients hospitalized in the Department of Neurology, the First Medical Center of Chinese People′s Liberation Army General Hospital from April 2021 to December 2022 were prospectively collected. From April 2021 to December 2022, patients who visited the Chinese People′s Liberation Army General Hospital for other reasons without abnormal electrophysiological examination were collected as the control group. The incidence of split leg [the limb whose modified Medical Research Council Muscle Strength Scale (mMRC) score of ankle dorsiflexors was lower than that of ankle plantarflexors] in ALS patients was calculated, and the incidence of split foot (the limb whose mMRC score of hallux dorsiflexors was lower than that of hallux plantarflexors) in ALS patients was calculated. The amplitude of compound muscle action potential (CMAP) of common peroneal nerve and tibial nerve was detected to observe the involvement of motor neurons innervating ankle dorsiflexors and ankle plantarflexors. The characteristics of split leg and split foot in ALS patients were analyzed from the perspective of muscle strength, and the characteristics of split foot in ALS patients were analyzed from the perspective of electrophysiology. Receiver operating characteristic (ROC) curve was used to analyze the sensitivity and specificity of peroneal nerve/tibial nerve CMAP amplitude ratio in distinguishing ALS patients from controls.Results:A total of 101 ALS patients with lower limb involvement and 110 controls with normal lower limb muscle strength were collected. Among the 101 ALS patients with lower limb involvement, strength of ankle plantarflexors was greater than that of ankle dorsiflexors in 35.64% (36/101) patients, strength of ankle dorsiflexors was greater than that of ankle plantarflexors in 5.94% (6/101) patients, and strength of ankle plantarflexors and ankle dorsiflexors was equal in 58.42% (59/101) patients. Strength of hallux dorsiflexors was lower than that of hallux plantarflexors in 53.47% (54/101) patients, strength of hallux dorsiflexors was greater than that of hallux plantarflexors in 1.98% (2/101) patients, and the strength of hallux dorsiflexors and hallux plantarflexors was equal in 44.55% (45/101) patients. The incidence of split leg was negatively correlated with age ( OR=0.25, 95% CI 0.16-0.40, P<0.05), course of disease ( OR=0.52, 95% CI 0.38-0.80 P<0.05) and ALS functional revised scores ( OR=0.29, 95% CI 0.12-0.67, P<0.05). The incidence of split foot was negatively correlated with the onset time of lower limb symptoms ( OR=0.96, 95% CI 0.93-0.99, P<0.05). Compared with the control group, the differences of the decrease of CMAP amplitude in the common peroneal nerve and tibial nerve [the common peroneal nerve (6.45±2.56) mV vs (3.63±1.83) mV, tibial nerve (12.87±4.72) mV vs (9.18±6.22) mV] were statistically significant ( t=-4.65, t=-3.44, both P<0.001) and the differences of the peroneal nerve/tibial nerve CMAP amplitude ratio (0.54±0.24 vs 0.36±0.18) decrease was statistically significant ( t=-4.31, P<0.001) in patients with split foot. ROC curve analysis showed that the area under the ROC curve of CMAP amplitude ratio of common peroneal nerve/tibial nerve in ALS patients with split foot was 0.70, indicating that the accuracy of CMAP amplitude of common peroneal nerve/tibial nerve in distinguishing ALS patients from controls was low. Conclusions:In ALS patients with lower limb involvement, strength of ankle dorsiflexors is weaker than that of ankle plantarflexors, and strength of hallux dorsiflexors is weaker than that of hallux plantarflexors. At the diagnostic level, the CMAP amplitude ratio of common peroneal nerve/tibial nerve in ALS patients with split foot has a lower accuracy in the diagnosis of ALS.

Objective To evaluate the effect of surgery-radiotherapy interval (SRI) on clinical prognosis of locally advanced stage c Ⅱ-Ⅲ breast cancer patients treated with neoadjuvant chemtherapy and modified radical mastectomy.Methods Clinical data of 1 087 breast cancer patients treated with neoadjuvant chemotherapy and modified radical mastectomy from 11 hospitals in China were retrospectively analyzed.The optimal threshold value of SRI upon clinical prognosis was determined by maxstat method.The effect of SRI on clinical prognosis was evaluated by using multivariate Cox regression analysis and propensity score matching (PSM).Results The median follow-up time was 72.9 months.The 5-year disease-free survival (DFS) and overall survival (OS) rates were 68.1％ and 81.8％.All patients were divided into SRI ≤18 weeks (n=917) and SRI＞ 18 weeks groups (n=170).Multivariate Cox regression analysis demonstrated that hormone receptor status (P＜0.001),pathological T stage (P＜0.001),pathological N stage (P＜0.001) and SRI (P=0.023) were independent influencing factors of DFS.Hormone receptor status (P=0.013),pathological T stage (P=0.006),pathological N stage (P＜0.001),endocrine therapy (P=0.013) and SRI (P=0.001) were significantly associated with OS.After balancing the clinical and pathological factors with PSM,patients with SRI＜ 18 weeks had superior DFS and OS to those with SRI＞ 18 weeks.Conclusions SRI affects the clinical prognosis of locally advanced breast cancer patients treated with neoadjuvant chemotherapy and modified radical mastectomy.Radiotherapy should be performed within 18 weeks after mastectomy.

Objective To analyze the clinical characteristics and nursing strategies of elderly patients with type 2 diabetes mellitus complicated with acute myocardial infarction(AMI).Methods A total of 138 elderly patients with type 2 diabetes mellitus combined with AMI admitted to Jiangsu Province Hospital from January 2019 to December 2021 were included in observation group,and 346 patients with AMI without diabetes mellitus were enrolled in control group.The clinical data,complications,coronary angiography results and prognosis of two groups were collected and analyzed.Results The proportion of smoking,hypertension and typical chest pain in observation group were significantly lower than those in control group,while the proportion of hyperlipidemia and Killip grade≥Ⅲ were significantly higher than those in control group(P<0.05).The proportion of patients with three branch lesions or left main trunk lesions in observation group were significantly higher than those in control group(P<0.05).The incidences of arrhythmia,acute heart failure and pulmonary infection in observation group were significantly higher than those in control group(P<0.05).There was no significant difference in the incidence of cardiogenic shock and cardiac death during hospitalization between two groups(P>0.05).Conclusion Elderly patients with type 2 diabetes mellitus complicated with AMI have atypical clinical symptoms and more complications.Early identification and active control of cardiovascular risk factors by medical staff can reduce the mortality of patients and improve the long-term prognosis.