OBJECTIVETo solve the problem of screw penetrating the joint surface easily by determining the angle of inclination and the mean longth screw plated on the posterior column.

METHODSTen specimens of adult male cadavers, aged 20 to 74 years old, averaged 54.5 years old, were collected. After removal of the bilateral femurs from the hip joints, and sawing through the sacral and pubic symphysis in the median sagittal plane, 20 semi pelvic specimens were used for this study when the osseous abnormalities were excluded. The specimens were air dried naturelly after the soft tissue attaching to the pelvis had been eliminated. The margin of superior acetabular and inferior acetabular were determined, and the serial cross-sections of the acetabular posterior column were made. The width of posterior column,the width of acetabulum,the width ratio of acetabulum to posterior column, the angle of inclination and the mean length of screw on all entry points were measured. Defined the level parallel to 1/2 section of superior acetabulum was cross-section B; 1/2 section of acetabulum was C; 1/2 section of inferior acettabulum was D. At the different levels, defined the entry point on the outer edge of posterior column of the acetabulum or the trailing edge of acetabulum was B0, C0 or D0; lateral 1/2 of posterior column of the acetabulum was B1, C1 or D1; 1/2 of posterior column of the acetabulum was B2, C2 or D2; medial 1/2 of posterior column of the acetabulum was B3, C3 or D3; the inner edge of posterior column of the acetabulum was B4,C4 or D4.

RESULTSOn cross-section B, the angle of inclination and the mean length of screw at B0 was 41 degrees and 44.0 mm; at B1 was 66 degrees and 42.2 mm; at B2 was 91 degrees and 59.5 mm; at B3 was 107 degrees and 64.0 mm; the maximum angle and the mean length at point B4 was 123 degrees and 65.5 mm; the minimum angle and the mean length at point B4 was 109 degrees and 59.0 mm. On cross-section C,the angle and the mean length at point CO was 39 degrees and 39.0 mm; at C1 was 57 degrees and 36.0 mm; at C2 was 74 degrees and 36.0 mm;at C3 was 90 degrees and 36.0 mm; at C4 was 106 degrees and 76.0 mm. On cross-section D,the angle and the mean length at DO was 42 degrees and 35.5 mm; at D1 was 61 degrees and 33.0 mm; at D2 was 81 degrees and 32.0 mm; at D3 was 100 degrees and 31.0 mm; at D4 was 120 degrees and 74.0 mm.

CONCLUSIONWhen using the fixation technique of acetabular posterior column plate, the angles of screw-posterior column are 40 degrees to 60 degrees, 60 degrees to 75 degrees, 75 degrees to 90 degrees and 90 degrees to the angle of parallel to the square area respectively on the region of outer 1/4,outer-middle 1/4,inner-middle 1/4 and inner 1/4 of the acetabulum region, and the screw length is 30 mm.

Acetabulum ; anatomy & histology ; injuries ; surgery ; Adult ; Aged ; Bone Plates ; Bone Screws ; Fracture Fixation, Internal ; instrumentation ; Fractures, Bone ; surgery ; Humans ; Internal Fixators ; Male ; Middle Aged ; Young Adult

Adolescent ; Adult ; Casts, Surgical ; External Fixators ; Female ; Finger Joint ; Fracture Fixation ; instrumentation ; Fractures, Bone ; pathology ; physiopathology ; surgery ; Humans ; Male ; Middle Aged ; Young Adult

Objective To understand college students on-site first aid training demand situation in Chongqing ,in order to provide the basis for college students to carry out on-site first aid training .Methods Using stratified random sampling method ,a question-naire survey was conducted on 1 232 students of 6 university in Chongqing .Results 90 .9% of the students hoped that they could master the on-site first-aid knowledge and skills ,students of different genders had significant differences on learning attitude of field first aid knowledge(P<0 .05) .The on-site first-aid knowledge among college students in Chongqing city most wanted to know was thetrauma emergency stop(74 .8% ) ,the most loving way of learning was to the hospital or emergency center study tour(47 .7% ) ,The love of on-site first aid training and learning style were theory teaching+watch video teaching or teacher demon-stration+classroom practice (63 .6% ) ,The operation way of learning the most love was teacher ,all the students into groups of two ,mutual operation practice(65 .9% ) ,and in both gender and specialty had significant differences(P<0 .05) .The survey of col-lege students in Chongqing city training status display results ,43 .5% of the students never received on-site first aid training .In ad-dition ,college students receive on-site first aid training frequencies were low ,48 .6% students in more than 2 years received 1 ses-sions of training .while the rescue confidence survey of college students after the on-site first aid training ,only 13 .1% of the students“completely had the confidence to do” .Conclusion College students in Chongqing have strong desire to learn on-site first aid training ,and there are differences in gender and major on demand ,past state of first aid training is poor ,in urgent need of the relevant departments give attention ,and formulate the on-site first aid training programs to improve college students′competence .

OBJECTIVETo study the effects of aromatase on breast cancer proliferation and invasive ability, so as to detect the relationship between in situ estrogen levels and molecular biological characteristics of breast cancer.

METHODSBy immunohistochemistry staining, the expression of aromatase, matrix metalloproteinases 2 (MMP2) and matrix metalloproteinases (MMP 9) in the primary breast cancers were detected, the associations between aromatase and MMPs as well as clinical-pathological factors were analyzed.

RESULTSThe positive rates of aromatase were 25.0% (+) and 29.9% (++). Aromatase status was associated with MMP2, MMP9 and co-expression of MMP2 and MMP9 (P < 0.05), but not associated with tumor size, ER/PR status, menopausal status and tumor grade (P > 0.05). In the postmenopausal patients there was a relationship between aromatase and tumor size (P < 0.05), but not in the premenopausal patients (P > 0.05); there was a relationship between aromatase and co-expression of MMP2/MMP9 in the patients with ER and/or PR positive (P < 0.05), but not in the patients with ER and PR negative (P > 0.05).

CONCLUSIONSIn the breast cancer in situ estrogen produced by tumor aromatase may promote the cancer cells proliferation and invasiveness and maybe through ER pathway especially in the postmenopausal patients.

Adult ; Aged ; Aromatase ; metabolism ; Breast Neoplasms ; enzymology ; metabolism ; pathology ; Female ; Humans ; Immunohistochemistry ; Matrix Metalloproteinase 2 ; metabolism ; Matrix Metalloproteinase 9 ; metabolism ; Middle Aged ; Receptors, Estrogen ; metabolism ; Receptors, Progesterone ; metabolism

OBJECTIVETo study effects of estrogen receptor beta (ER beta) on the biological behavior of a human breast cancer cell line MDA-MB-435.

METHODSHuman ER beta cDNA was introduced into MDA-MB-435 cells by stable transfection. Effects of ER beta expression on cell proliferation and invasion were investigated by MTT, flow cytometry and transwell techniques. Cyclin A, cyclin E, cyclin D1, p21, MMPs, Ets-1, VEGF and b-FGF were detected by RT-PCR and/or Western blot or gelatin zymography.

RESULTSER beta was shown to be able to significantly increase the proliferation and invasion of MDA-MB-435 cells in an estradiol-independent manner. The S phase distribution of the cells with ER beta overexpression was 46.8%, significantly higher than that of wild type (29.9%) and mock transfected cells (27.6%) (P = 0.01). In ER beta transfected cells, the expression of p21 decreased by 33.3% at mRNA level (P = 0.03) and by 47.4% at protein level (P = 0.02), respectively. The expression of MMP-9 increased by 91.3% at mRNA level (P < 0.01) and its activity was up-regulated by 67.3% (P = 0.02). Furthermore, the mRNA and protein levels of Ets-1 increased 62.2% (P = 0.01) and 51.0% (P = 0.01), respectively. No significant difference was observed in the mRNA levels of cyclin A, cyclin E, cyclin D1, MMP-1, MMP-2, MMP-7, VEGF and b-FGF among these cells.

CONCLUSIONER beta can enhance proliferation and invasion of breast cancer cells. Down-regulation of p21 and up-regulation of MMP-9 and Ets-1 may be involved in its mechanisms.

Breast Neoplasms ; metabolism ; pathology ; Cell Proliferation ; Cyclin-Dependent Kinase Inhibitor p21 ; biosynthesis ; genetics ; DNA, Complementary ; genetics ; Estrogen Receptor beta ; biosynthesis ; genetics ; Female ; Humans ; Matrix Metalloproteinase 9 ; biosynthesis ; genetics ; Neoplasm Invasiveness ; Proto-Oncogene Protein c-ets-1 ; biosynthesis ; genetics ; RNA, Messenger ; biosynthesis ; genetics ; Transfection ; Tumor Cells, Cultured

Objective To explore the changes in the serum periostin (PN) and vascular endothelial growth factor (VEGF) level in patients with diabetic retinopathy (DR) and the clinical significance.Methods The serum samples from 53 patients with diabetes mellitus (DM) as case group and 50 healthy subjects as control group were collected and compared in this study.And the DM patients included 15 patients with DM without fundus lesions (DM group),18 patients with non-proliferative diabetic retinopathy (NPDR,NPDR group) and 20 patients with proliferative diabetic retinopathy (PDR,PDR group).The serum levels of PN and VEGF were analyzed by ELISA assay,and the correlation of DR with serum PN and VEGF levels was evaluated.Results The differences in serum PN and VEGF between the case group and control group were statistically significant (both P ＜ 0.05).And there were significant difference in PN and VEGF levels among the DM group,NPDR group,PDR group and control group (all P ＜ 0.05).Meanwhile,there was no significant difference in serum PN between the DM group and NPDR group (P ＞ 0.05),but there were statistically significant differences among the other groups (all P ＜ 0.05).There were statistically significant differences in serum VEGF among the four groups (all P ＜ 0.05).And finally,positive correlations were found between PN and VEGF in the NPDR group and PDR group (r =0.483,0.509,both P ＜ 0.05).Conclusion PN and VEGF play an active role in the initiation and development of DR,and they have a close correlation with the neovascularization and fibrovascular membrane of the advanced stage of DR.

BACKGROUNDThere are limited data on longer-term outcomes (>5 years) for patients with unprotected left main coronary artery (ULMCA) disease who underwent percutaneous coronary intervention (PCI) in the drug-eluting stents (DES) era. This study aimed at comparing the long-term (>5 years) outcomes of patients with ULMCA disease underwent PCI with DES and coronary artery bypass grafting (CABG) and the predictors of adverse events.

METHODSAll consecutive patients with ULMCA disease treated with DES implantation versus CABG in our center, between January 2003 and July 2009, were screened for analyzing. A propensity score analysis was carried out to adjust for potential confounding between the two groups.

RESULTSNine hundred and twenty-two patients with ULMCA disease were enrolled for the analyses (DES = 465 vs. CABG = 457). During the median follow-up of 7.1 years (interquartile range 5.3-8.2 years), no difference was found between PCI and CABG in the occurrence of death (P = 0.282) and the composite endpoint of cardiac death, myocardial infarction (MI) and stroke (P = 0.294). Rates of major adverse cardiac and cerebrovascular events were significantly higher in the PCI group (P = 0.014) in large part because of the significantly higher rate of repeat revascularization (P < 0.001). PCI was correlated with the lower occurrence of stroke (P = 0.004). Multivariate analysis showed ejection fraction (EF) (P = 0.012), creatinine (P = 0.016), and prior stroke (P = 0.031) were independent predictors of the composite endpoint of cardiac death, MI, and stroke in the DES group, while age (P = 0.026) and EF (P = 0.002) were independent predictors in the CABG group.

CONCLUSIONSDuring a median follow-up of 7.1 years, there was no difference in the rate of death between PCI with DES implantation and CABG in ULMCA lesions in the patient cohort. CABG group was observed to have significantly lower rates of repeat revascularization but higher stroke rates compared with PCI. EF, creatinine, and prior stroke were independent predictors of the composite endpoint of cardiac death, MI, and stroke in the DES group, while age and EF were independent predictors in the CABG group.

Aged ; Coronary Artery Bypass ; Coronary Artery Disease ; physiopathology ; therapy ; Drug-Eluting Stents ; Female ; Humans ; Male ; Middle Aged ; Percutaneous Coronary Intervention ; Stroke Volume

Objective:To investigate the surgical efficacy and prognosis influencing factors of hilar cholangiocarcinoma based on multidisciplinary diagnosis and treatment.Methods:The retrospective cohort study was conducted. The clinicopathological data of 91 patients with hilar cholangiocarcinoma who underwent surgery in Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from April 2004 to April 2021 were collected. There were 59 males and 32 females, aged (61±10)years. Patients who were admitted from April 2004 to March 2014 underwent traditional surgical diagnosis and treatment, and patients who were admitted from April 2014 to April 2021 underwent multidisciplinary diagnosis and treatment. Observation indica-tors: (1) surgical situations; (2) postoperative situations; (3) postoperative pathological examina-tions; (4) postoperative prognosis analysis; (5) influencing factors of postoperative prognosis. Follow-up was conducted using telephone interview and outpatient examination. Patients were followed up once every 6 months after surgery to detect survival. The follow-up was up to April 2023. Measure-ment data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M(range), and comparison between groups was conducted using the Mann-Whitney U test. Comparison of ordinal data was conducted using the rank sum test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test or Fisher exact probability. The Kaplan-Meier method was used to draw survival curve and calculate survival rate. The Log-Rank test was used for survival analysis. Univariate and multivariate analyses were conducted using the COX proportional hazard model. Results:(1) Surgical situations. Of the 91 patients, there were 65 cases receiving hemi- or expanded hemi-hepatectomy, 13 cases receiving tri-hepatectomy, 9 cases receiving partial hepatectomy, 4 cases receiving extrahepatic bile duct resection. There were 24 cases receiving combined vein resection and reconstruction, 8 cases receiving combined pancreaticoduodenectomy, 6 cases receiving com-bined hepatic artery resection and reconstruction, including 24 cases receiving extended radical surgery (tri-hepatectomy, hepatic artery resection and reconstruction, hepatopancreaticoduodenec-tomy). The operation time, volume of intraoperative blood loss and intraoperative blood transfusion rate of 91 patients was (590±124)minutes, 800(range, 500?1 200)mL and 75.8%(69/91), respectively. Of the 91 patients, cases receiving extended radical surgery, the volume of intraoperative blood loss were 4, 650(range, 300?1 000)mL in the 31 patients who were admitted from April 2004 to March 2014, versus 20, 875 (range, 500?1 375)mL in the 60 patients who were admitted from April 2014 to April 2021, showing significant differences between them ( χ2=4.39, Z=0.31, P<0.05). (2) Post-operative situations. The postoperative duration of hospital stay and cases with postoperative infectious complications were (27±17)days and 50 in the 91 patients. Cases with abdominal infection, cases with infection of incision, cases with bacteremia and cases with pulmonary infection were 43, 7, 5, 8 in the 91 patients. One patient might have multiple infectious complications. Cases with bile leakage, cases with delayed gastric emptying, cases with chylous leakage, cases with liver failure, cases with pancreatic fistula, cases with intraperitoneal hemorrhage, cases with reoperation, cases dead during the postoperative 90 days were 30, 9, 9, 6, 5, 3, 6, 3 in the 91 patients. Cases with abdominal infection was 10 in the 31 patients who were admitted from April 2004 to March 2014, versus 33 in the 60 patients who were admitted from April 2014 to April 2021, showing a significant difference between them ( χ2=4.24, P<0.05). Cases dead during the postoperative 90 days was 3 in the 31 patients who were admitted from April 2004 to March 2014, versus 0 in the 60 patients who were admitted from April 2014 to April 2021, showing a significant difference between them ( P<0.05). (3) Post-operative pathological examinations. Of the 91 patients, cases with Bismuth type as type Ⅰ?Ⅱ, type Ⅲ, type Ⅳ, cases with T staging as Tis stage, T1 stage, T2a?2b stage, T3 stage, T4 stage, cases with N staging as N0 stage, N1 stage, N2 stage, cases with M staging as M0 stage, M1 stage, cases with TNM staging as 0 stage, Ⅰ stage, Ⅱ stage, Ⅲ stage, ⅣA stage, ⅣB stage, cases with R 0 radical resection, cases with R 1 or R 2 resection were 15, 46, 30, 1, 9, 25, 30, 26, 49, 36, 6, 85, 6, 1, 7, 13, 58, 6, 6, 63, 28. Cases with R 0 radical resection, cases with R 1 or R 2 resection were 15, 16 in the 31 patients who were admitted from April 2004 to March 2014, versus 48, 12 in the 60 patients who were admitted from April 2014 to April 2021, showing a significant difference between them ( χ2=9.59, P<0.05). (4) Postoperative prognosis analysis. Of the 91 patients, 3 cases who died within 90 days after surgery were excluded, and the 5-year overall survival rate and median overall survival time of the rest of 88 cases were 44.7% and 55 months. The 5-year overall survival rate was 33.5% in the 28 patients who were admitted from April 2004 to March 2014, versus 50.4% in the 60 patients who were admitted from April 2014 to April 2021, showing a significant difference between them ( χ2=5.31, P<0.05). Results of further analysis showed that the corresponding 5-year overall survival rate of cases without lymph node metastasis was 43.8% in the 16 patients who were admitted from April 2004 to March 2014, versus 61.6% in the 31 patients who were admitted from April 2014 to April 2021. There was a significant difference in the 5-year overall survival rate between these patients without lymph node metastasis ( χ2=3.98, P<0.05). The corresponding 5-year overall survival rate of cases with lymph node metastasis was 18.5% in the 12 patients who were admitted from April 2004 to March 2014, versus 37.7% in the 29 patients who were admitted from April 2014 to April 2021. There was no significant difference in the 5-year overall survival rate between these patients with lymph node metastasis ( χ2=2.25, P>0.05). (5) Influencing factors of postoperative prognosis. Results of multivariate analysis showed that poorly differentiated tumor and R 1 or R 2 resection were inde-pendent risk factors influencing prognosis after surgical treatment of hilar cholangiocarcinoma ( hazard ratio=2.62, 2.71, 95% confidence interval as 1.30?5.29, 1.30?5.69, P<0.05). Conclusions:Compared with traditional surgical diagnosis and treatment, treatment of hilar cholangiocarcinoma based on multidisciplinary diagnosis and treatment can expand surgical indications, reduce proportion of dead patients within 90 days after surgery, improve proportation of radical resection and long-term survival rate. Poorly differentiated tumor and R 1 or R 2 resection are independent risk factors influencing prognosis after surgical treatment of hilar cholangiocarcinoma.

Objective: To analyze the clinical epidemiological characteristics including composition of pathogens , clinical characteristics, and disease prognosis acute bacterial meningitis (ABM) in Chinese children. Methods: A retrospective analysis was performed on the clinical and laboratory data of 1 610 children <15 years of age with ABM in 33 tertiary hospitals in China from January 2019 to December 2020. Patients were divided into different groups according to age,<28 days group, 28 days to <3 months group, 3 months to <1 year group, 1-<5 years of age group, 5-<15 years of age group; etiology confirmed group and clinically diagnosed group according to etiology diagnosis. Non-numeric variables were analyzed with the Chi-square test or Fisher's exact test, while non-normal distrituction numeric variables were compared with nonparametric test. Results: Among 1 610 children with ABM, 955 were male and 650 were female (5 cases were not provided with gender information), and the age of onset was 1.5 (0.5, 5.5) months. There were 588 cases age from <28 days, 462 cases age from 28 days to <3 months, 302 cases age from 3 months to <1 year of age group, 156 cases in the 1-<5 years of age and 101 cases in the 5-<15 years of age. The detection rates were 38.8% (95/245) and 31.5% (70/222) of Escherichia coli and 27.8% (68/245) and 35.1% (78/222) of Streptococcus agalactiae in infants younger than 28 days of age and 28 days to 3 months of age; the detection rates of Streptococcus pneumonia, Escherichia coli, and Streptococcus agalactiae were 34.3% (61/178), 14.0% (25/178) and 13.5% (24/178) in the 3 months of age to <1 year of age group; the dominant pathogens were Streptococcus pneumoniae and the detection rate were 67.9% (74/109) and 44.4% (16/36) in the 1-<5 years of age and 5-<15 years of age . There were 9.7% (19/195) strains of Escherichia coli producing ultra-broad-spectrum β-lactamases. The positive rates of cerebrospinal fluid (CSF) culture and blood culture were 32.2% (515/1 598) and 25.0% (400/1 598), while 38.2% (126/330)and 25.3% (21/83) in CSF metagenomics next generation sequencing and Streptococcus pneumoniae antigen detection. There were 4.3% (32/790) cases of which CSF white blood cell counts were normal in etiology confirmed group. Among 1 610 children with ABM, main intracranial imaging complications were subdural effusion and (or) empyema in 349 cases (21.7%), hydrocephalus in 233 cases (14.5%), brain abscess in 178 cases (11.1%), and other cerebrovascular diseases, including encephalomalacia, cerebral infarction, and encephalatrophy, in 174 cases (10.8%). Among the 166 cases (10.3%) with unfavorable outcome, 32 cases (2.0%) died among whom 24 cases died before 1 year of age, and 37 cases (2.3%) had recurrence among whom 25 cases had recurrence within 3 weeks. The incidences of subdural effusion and (or) empyema, brain abscess and ependymitis in the etiology confirmed group were significantly higher than those in the clinically diagnosed group (26.2% (207/790) vs. 17.3% (142/820), 13.0% (103/790) vs. 9.1% (75/820), 4.6% (36/790) vs. 2.7% (22/820), χ²=18.71, 6.20, 4.07, all P<0.05), but there was no significant difference in the unfavorable outcomes, mortility, and recurrence between these 2 groups (all P>0.05). Conclusions: The onset age of ABM in children is usually within 1 year of age, especially <3 months. The common pathogens in infants <3 months of age are Escherichia coli and Streptococcus agalactiae, and the dominant pathogen in infant ≥3 months is Streptococcus pneumoniae. Subdural effusion and (or) empyema and hydrocephalus are common complications. ABM should not be excluded even if CSF white blood cell counts is within normal range. Standardized bacteriological examination should be paid more attention to increase the pathogenic detection rate. Non-culture CSF detection methods may facilitate the pathogenic diagnosis.
Adolescent ; Brain Abscess ; Child ; Child, Preschool ; Escherichia coli ; Female ; Humans ; Hydrocephalus ; Infant ; Infant, Newborn ; Male ; Meningitis, Bacterial/epidemiology* ; Retrospective Studies ; Streptococcus agalactiae ; Streptococcus pneumoniae ; Subdural Effusion ; beta-Lactamases