Objective To analyze the biomechanical changes of lateral atlantoaxial articulation by means of three‐dimensional fnite element models of craniocervical junction malformation(CJVM) .Methods CT scan images of 1 patients with CJVM were ob‐tained .The analytical model was constructed by advanced three‐dimension modeling and finite element softwares .A comparison of range of motion difference between the deformity model and normal model ,referring to the experience of clinical observation ,was used to verify the validity of the model .Applying respectively the same loads and boundary conditions on finite element model .The effectiveness was verified by contrastive analysis of the variation in lateral atlantoaxial joint stresses .Results The finite CJVM ele‐ment model with high geometric accuracyand reliable parameter had built .Compared to the results of cadaver test and finite element model based in normal cranio‐cervical junction ,the segment mobility coincides with the actual clinical performance in patients .The stress distribution the lateral junction between atlas and axis of can be reasonably explained the deformation of lateral atlanto‐axial joint structure and its important role in remaining stable between atlantoaxial vertebraeunder different physiological conditions .Con‐clusion The structure of lateral atlantoaxial joint changes in patients of CJVM ,the biomechanical stability for preoperative diagno‐sis and intraoperative treatment operation has a certain value .

Objective:To investigate the clinical effect of primary debridement combined with external fixation and secondary sequential internal fixation in the treatment of Rüedi-Allg?wer Ⅱ Pilon fracture.Methods:The clinical data of 36 patients with Rüedi-Allg?wer Ⅱ Pilon fracture from January 2017 to December 2019 in the People′s Hospital of Quzhou City, Zhejiang Province were retrospectively analyzed. Among them, 16 patients were treated with primary debridement with calcaneal traction and secondary internal fixation (internal fixation group), and 20 patients were treated with primary debridement combined with external fixation and secondary sequential internal fixation (combined fixation group). The operative time, intraoperative blood loss, postoperative drainage volume, time of full weight bearing, fracture healing time, American Society of Foot and Ankle Surgery (AOFAS) posterior ankle foot function score, visual analogue score (VAS), reduction quality (Burwell-Charnley score) and incidence of complication were compared between 2 groups.Results:The patients were followed up for 6 to 18 (10.7 ± 2.8) months. The time of full weight bearing and fracture healing time in combined fixation group were significantly shorter than those in internal fixation group: (7.2 ± 1.9) weeks vs. (9.4 ± 2.1) weeks and (3.4 ± 0.8) months vs. (4.1 ± 1.2) months, and there were statistical differences ( P<0.05 or <0.01); there were no statistical differences in operative time, intraoperative blood loss and postoperative drainage volume between 2 groups ( P>0.05). There was no statistical difference in AOFAS posterior ankle foot function score 1 month after surgery between 2 groups ( P>0.05); the AOFAS posterior ankle foot function score 3 and 6 month after surgery in combined fixation group was significantly higher than that in internal fixation group: (86.4 ± 1.7) scores vs. (75.7 ± 1.2) scores and (93.6 ± 2.2) scores vs. (82.1 ± 1.9) scores, and there was statistical difference ( P<0.05). There was no statistical difference in VAS between 2 groups ( P>0.05). There were no statistical differences in rate of reduction satisfaction and incidence of complication between 2 groups ( P>0.05). Conclusions:The primary debridement combined with external fixation and secondary sequential internal fixation for the treatment of Rüedi-Allg?wer Ⅱ Pilon fracture is conducive to the rapid recovery, which is worthy of extensive clinical promotion.

OBJECTIVETo observe clinical efficacy of intra-articular injection of Sodium hyaluronate (SH) accompanied with external application of Sanhua ointment (SHO) for knee osteoarthritis.

METHODSOne hundred and twelve patients with osteoarthritis were randomly divided into two groups, Group I was treated with SH and Group II was treated with SH plus SHO. The entire condition of knee joint in the two groups were compared before and after treatment according to Lysholm's function scoring.

RESULTSThe functional score in the two groups at the 2nd week, 5th week, 3rd month and end of 1st year of the treatment course were significantly higher than that before treatment (P < 0.05), and the scores continuously increased within the first 3 months of treatment. Comparison of scores between the two groups showed that scores in Group II was significantly higher than those in Group I at the corresponding period. The total effective rate after 1 year treatment in Group lI was higher than that in Group II (81.5% vs 96.6%, P < 0.05). In Group II , the initial time of symptom improving was earlier and the adverse effect disappeared more quickly than those in Group I markedly.

CONCLUSIONThe efficacy of combined therapy of intra-articular injection of SH and SHO for knee osteoarthritis was superior to that of intra-articular injection of SH only.

Administration, Topical ; Adult ; Aged ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; administration & dosage ; Female ; Humans ; Hyaluronic Acid ; administration & dosage ; Injections, Intra-Articular ; Male ; Middle Aged ; Osteoarthritis, Knee ; drug therapy ; Phytotherapy

Objective To investigate the clinical and prognostic significance of ABO promotor methylation level in adult patients with leukemia and myelodydysplastic syndrome(MDS). Methods ABO promoter methylation level of 182 malignant hematological disease patients and 68 normal controls were detected by bisulfite sequencing PCR. Then clinical features and outcome were compared between hypermethylation group and hypomethylation group. Results The median methylation rate of ABO promoter in newly diagnosed acute myeloid leukemia (AML) and acute lymphocytic leukemia (ALL) were 46.98％ and 11.01％ respectively, which were both higher than that in controls (2.30％, P<0.05). The methylation rates in remission AML and ALL were 1.58％and 2.30％respectively, which were comparable with that in normal group (P>0.05). As to relapse AML and ALL, methylation rates were 41.26％ and 17.50％respectively, also significantly higher than that in controls (P<0.05).In patients with chronic myeloid leukemia (CML) chronic phase, the median methylation rate was 1.00％, which was similar to normal group. But a CML patient who transformed to ALL hadextremely high methylation rate 92.56％. The median methylation rate in patients with MDS significantly elevated as 5.81％ compared with that in controls (P<0.05). The median overall survival (OS) of ALL and AML (non-M3) patients with hypermethylation were 12.5 months and 15.3 months, which were significantly shorter than those with hypomethylation (24.0 months and 20.0 months) (P<0.05). The median disease-free survival (DFS) of ALL and AML (non-M3) patients with hypermethylation were 9.9 months and 12.0 months, which were significantly shorter than those with hypomethylation (22.3 months and 18.5 months), (P<0.05). Multivariable analysis suggested that ABO promoter methylation level was an independent predictive factor of OS and DFS in ALL and AML (non-M3) patients. Conclusion ABO promoter hypermethylation is closely related to genesis, development and prognosis of leukemia and MDS. Hypermethylationis related to a clinical poor prognosis compare with hypomethylation.

Objective To detect the down-regulation ofmiRNA-99b expression in cell invasion and its mechanism in human glioma cell line U251.Methods Glioma cell line U251 were routinely cultured in vitro.(1) U251 cells were divided into blank control group,negative control group and miRNA-99b inhibitor group;cells in the latter two groups were transfected with negative control sequences and miRNA-99b inhibitors,respectively;and cells in the blank control group did not give any treatment;mRNA expressions of miRNA-99b and mammalian target of rapamycin (mTOR) in U251 cells were measured by reverse transcription (RT)-PCR;the changes of mTOR,eIF4E-binding protein 1 (4E-BP1) andphosphorylated (p)-4E-BPl protein expressions in U251 cells were detected by Westem blotting;cell invasion was evaluated by Transwell assay.(2) U251 cells were divided into negative control group Ⅰ and mTOR siRNA group,and cells in the two groups were transfected with negative control sequences and mTOR siRNA,respectively;the miRNA-99b and mTOR mRNA expressions in U251 cells were measured by RT-PCR;the mTOR and p-4E-BP1 protein expressions in U251 cells were measured by Western blotting.(3) U251 cells were divided into miRNA-99b inhibitor+negative control group and miRNA-99b inhibitor+mTOR siRNA group,and cells in the two groups were transfected with miRNA-99b inhibitor+negative control sequences and miRNA-99b inhibitor+mTOR siRNA,respectively;the p-4E-BP1 protein expression in U251 cells was measured by Western blotting;cell invasion was evaluated by Transwell assay.Results (1) As compared with those in the blank control group and negative control group,the miRNA-99b rnRNA expression was significantly decreased,the mTOR mRNA and protein expressions and p-4E-BP1 protein expression were significantly increased,and the number of transmembrane cells was significantly larger in U251 cells of miRNA-99b inhibitor group (P＜0.05);there were no significant differences in 4E-BP1 protein expression among the three groups (P＞0.05).(2) As compared with those in the negative control group Ⅰ,the mTOR mRNA and protein expressions and p-4E-BP1 protein expression were significantly decreased in U251 cells of mTOR siRNA group (P＜0.05);there was no significant difference in miRNA-99b mRNA expression between the two groups (P＞0.05).(3) As compared with those in the miRNA-99b inhibitor+negative control group,the p-4E-BP1 protein expression and number of transmembrane cells were significantly decreased/smaller in U251 cells ofmiRNA-99b inhibitor+mTOR siRNA group (P＜0.05).Conclusions Down-regulation ofmiRNA-99b expression promotes glioma cell invasion,and its mechanism is related to the regulation of mTOR/4E-BP1 signaling pathway.

【Objective】 To statistically analyze the perioperative results of patients with ABO-incompatible kidney transplantation (ABOi-KT), in order to explore the changes in blood group antibody of type-A/B recipients. 【Methods】 A total of 33 cases of blood group A/B ABOi-KT recipients in our hospital from January 2021 to October 2023 were recruited and divided into two groups of group A(n=18) and group B(n=15) according to the different blood types of recipient. The effects of preoperative plasmapheresis on antibody titer, antibody rebound and renal function after operation(serum urea nitrogen, creatinine and estimated glomerular filtration rate on the 1st, 3rd, 7th and 14th day) were analyzed between the two groups. According to the postoperative rebound of blood type antibodies, 33 recipients were divided into antibody rebound group(n=7) and non rebound group(n=26), and the differences in initial blood type antibody titers between the two groups were analyzed. 【Results】 There was no significant difference in the clearance rate of IgM with preoperative plasma exchange between the two groups (Z=-0.26, P>0.05); Levels of serum urea nitrogen and creatinine on the 1st, 3rd, 7th and 14th day after operation between group A and group B were not statistically significant(P>0.05), the same as eGFR. Group B was more prone to rebound antibody compared with group A (P<0.05). There was a significant difference in the initial IgM antibody titer between the blood type antibody rebound group and the non rebound group (Z=-2.127, P<0.05), but no statistically significant difference in the initial IgG antibody titer (Z=-1.835, P>0.05) between the two groups was found. 【Conclusion】 The patients type B receiving type AB kidney donors are more prone to rebound antibody after ABOi-KT operation compared to the the patients type A receiving type AB.

Background and objective As computed tomography (CT) screening for lung cancer becomes more common in China, so too does detection of pulmonary ground-glass nodules (GGNs). Although anumber of national or international guidelines about pulmonary GGNs have been published,most of these guidelines are produced by respiratory, oncology or radiology physicians, who might not fully understand the progress of modern minimal invasive thoracic surgery, and these current guidelines may overlook or underestimate the value of thoracic surgery in the management of pulmonary GGNs. In addition, the management for pre-invasive adenocarcinoma is still controversial. Based onthe available literature and experience from Shanghai Pulmonary Hospital, we composed this consensus about diagnosis and treatment of pulmonary GGNs. For lesions which are considered as adenocarcinoma in situ, chest thin layer CT scan follow-up is recommended and resection can only be adopt in some specific cases and excision should not exceed single segment resection. For lesions which are considered as minimal invasive adenocarcinoma, limited pulmonary resection or lobectomy is recommended. For lesions which are considered as early stage invasive adenocarcinoma, pulmonary resection is recommend and optimal surgical methods depend on whether ground glass component exist, location, volume and number of the lesions and physical status of patients. Principle of management of multiple pulmonary nodules is that primary lesions should be handled with priority, with secondary lesions taking into account.
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Adenocarcinoma ; diagnosis ; diagnostic imaging ; surgery ; Adenocarcinoma of Lung ; China ; Consensus ; Hospitals ; Humans ; Lung Neoplasms ; diagnosis ; diagnostic imaging ; surgery ; Physicians ; psychology ; Positron Emission Tomography Computed Tomography ; Practice Guidelines as Topic ; Retrospective Studies ; Solitary Pulmonary Nodule ; diagnosis ; diagnostic imaging ; surgery ; Tomography, X-Ray Computed