Objective To evaluate the outcomes of open reduction and internal fixation of complex tibial plateau fractures with improved three combined approaches.Methods In the period from July 2014 to February 2016,7 complex tibial plateau fractures underwent surgical treatment.These patients included 5 male and 2 female,aged from 24 to 68 years old (average,39.7± 15.3 years).According to Schatzker classification,they were all of type V.And all of type 41B-3.1 by AO/OTA classification.All these fractures were exposed and reduction via three combined approaches.First let the patients lied in lateral prone position,expose the anterolateral and the posterolateral of the tibia1 plateau,and fix the fractures of the posterior in the posterolateral approach,then fix the fractures of the lateral in the anterolateral approach.Then turn the patients to supine position,fix the fractures of the medial in the anteromedial incision.All patients received regular reexamination.The knee function was evaluated at the final follow-up using The Hospital for Special Surgery (HSS) score,the activity of the knee was evaluated by Lysholm score,and the stability of the knee was checked by Lachmantest and Pivot-shift test.The tibial plateau angle,the posterior slope angle and Rasmussen X-ray score were assessed on the X-ray films.Results The average time of operation is (3.3±0.9) h,and the hemorrhage volume in operation was (341± 106) ml for the 7 patients.The wounds of 6 patients healed by (11.8± 1.3) days,while the wound of the rest one of them occurred fat liquefaction after operation who is very fat (BMI ＞ 30) and suffered from diabetes.His wound healed by 21 days.These patients obtained follow-ups of 8 to 14 months (average,11.4±2.8 months).The average full weight-bearing time was 2-3 months (average,2.5±0.4 months).The fractures healed after 8 to 16 weeks (average,11.1 ±2.8 weeks).No displacement of the fractures or breakage of the implants occurred in our series.Nobody has activity limitation of the knee or pain because of the implant,and no never symptoms were noted postoperatively,so we would not take out the implant for these patients.The mean HSS score was 93.1±4.8 (range,from 85 to 100) at the final follow-up,and the excellent rate is 100％.The Lysholm score was 97.1±3.6 (range,from 90 to 100) at the final follow-up.The Lachman test and the Pivot-shift test were negative in our patients,and the mean knee flexion was 128.6±12.8°(range,from 105°to 140°).The fractures were all anatomical reduction by the X-ray after operation,and there had being no displacement of the fractures or breakage of the implants occurred during the follow-up period.The mean posterior slope angle was 8.29±2.87° (range,from 4 °to 12°),which was 8.71±2.63° (range,from 5 °to 14°) 6months after operation.The mean tibial plateau angle was 86.00± 1.41° (range,from 84 °to 88°),which was 86.43± 1.62° (range,from 84 °to 89°) 6 months after operation.The mean Rasmussen X-ray score was 16.86±1.57 (range,from 14 to 18),which was 16.57±1.51 (range,from 14 to 18) 6 months after operation,and the excellent rate are 100％.Conclusion For the complex tibial plateau fractures which simultaneous involved the medial,the lateral and the posterior,the improved three combined approaches showed the advantages of the convenient operation,the satisfactory results of reduction and fixation,and the less trauma and secondary damage,and could be worth for clinic.

Objective To investigate the therapeutic mechanism of bazedoxifene, the third-generation selective ER modulator (SERM), on endometriosis lesions in a rat model. Methods Endometriosis was induced by transplanting pieces of endometrium from other syngeneic rats that were as donors onto the subcutaneous of other unmated female rats. The rats with successful ectopic implants were divided into two groups:control group (n=10) and bazedoxifene group (n=10). The macroscopic morphology, volume, histopathology of ectopic implant and rats uterine wet weight were determined before and after the treatment. Expression of proliferation cell nuclear antigen (PCNA), ER and PR in the eutopic endometrium and endometriosis lesions detected by immunohistochemistry in the two groups. Results (1) The gross morphology and histological changes of endometriosis lesions in rats after treatment: compared with the control group, it was obviously depauperated and had more less glands and blood vessels in the stroma. (2) The change of rats′weight, the volume of endometriosis lesion before and after treatment and rats uterine wet weigh after treatment respectively in the control group and the bazedoxifene group:rats′ weight were respectively before treatment: (201±17) g, (202±18) g, that were respectively after treatment: (266±16) g, (261±16) g, which showed no significant difference between two groups before and after treatment (P>0.05). The volume of ectopic implant before treatment were respectively (85±17) mm3, (85±12) mm3, and showed no significant difference between two groups;that were respectively (48±11) mm3, (24±9) mm3 afte rtreatment, which was significantly decreased compared with the control group (P<0.05). Rats uterine wet weight after treatment were respectively:(0.77±0.16) g, (0.45±0.18) g, and was significantly reduced compared with the control group (P<0.05). (3) The protein expression levels of PCNA, ER and PR in the endometriosis lesions after treatment were respectively 0.282 ± 0.044, 0.51 ± 0.06, 0.49 ± 0.05 in the control group, 0.191 ± 0.020, 0.23 ± 0.03, 0.48 ± 0.06 in the bazedoxifene group; that in eutopic endometrium were respectively 0.369 ± 0.081, 0.56 ± 0.08, 0.56 ± 0.10 in the control group, 0.211 ± 0.037, 0.27 ± 0.05, 0.54 ± 0.08 in the bazedoxifene group;the protein expression levels of PCNA and ER in endometriosis lesions and the eutopic endometrium were significantly decreased in the bazedoxifene group compared with the control group (P<0.05), but the protein levels of PR in endometriosis lesionsand and the eutopic endometrium were not significantly altered by treatment (P>0.05). Conclusion Bazedoxifene could obviously reduce the size of endometriosis lesions, the mechanism may be related with suppressing estrogen-induced proliferation, the expression of ER and direct ER antagonism by this SERM.

Obj ective To observe the position fertilization (IVF)treatment cycle of in vitro cultivation quality blastocyst formation and analyze its relationship with pieces of D2D3 embryo cleav-age count and rating.Methods Cleavage stage 3 day (D3 )frozen surplus embryos were selected and cultured to blastocyst stage.Quality of blastocyst formation was observed,and at the same time their D2D3 embryo cleavage count and debris were discussed.Results The high quality D3 10 or more cells blastocyst formation rate was 38.9%,which was almost equal to 43.1%of 7 to 9 cells blastocyst formation rate (P>0 .05 ).7 to 9 cell quality blastocyst formation rate was 43 .1%, which was significantly higher than 10.2%of 4 to 6 cells (P<0.05).D2 4 cell quality blastocyst formation rate was 43.1%,which was significantly higher than 28.9%of 5 cells and 12.3%of 2 to 3 cells (P<0 .05 ).5 cells quality blastocyst formation rate was 28 .9%,which was almost equal to 23 .4%of 6 cells blastocyst formation rate (P>0 .05 ).Ⅰand classⅡD3 embryos pieces of high quality blastocyst formation rate was 36.4%,which was significantly higher than 6.1%of gradeⅢorⅣ(P<0 .05 ).Ⅰand class ⅡD2 embryos pieces of high quality blastocyst formation rate was 35.3%,which was significantly higher than 4.7% of grade Ⅲ or Ⅳ (P<0.05).Conclusion Extending IVF can effectively filter the embryo developmental potential.The more D3 embryo cleavage count ,the more high-quality blastocysts .D2 4 cells ,embryo blastocyst development ability is good.Ⅰand classⅡD2 and D3 embryos pieces of high quality blastocyst formation rate is higher.High quality blastocyst formation and D2 and D3 embryo cleavage count and debris are closely related to the ratings.

Obj ective To observe the position fertilization (IVF)treatment cycle of in vitro cultivation quality blastocyst formation and analyze its relationship with pieces of D2D3 embryo cleav-age count and rating.Methods Cleavage stage 3 day (D3 )frozen surplus embryos were selected and cultured to blastocyst stage.Quality of blastocyst formation was observed,and at the same time their D2D3 embryo cleavage count and debris were discussed.Results The high quality D3 10 or more cells blastocyst formation rate was 38.9%,which was almost equal to 43.1%of 7 to 9 cells blastocyst formation rate (P>0 .05 ).7 to 9 cell quality blastocyst formation rate was 43 .1%, which was significantly higher than 10.2%of 4 to 6 cells (P<0.05).D2 4 cell quality blastocyst formation rate was 43.1%,which was significantly higher than 28.9%of 5 cells and 12.3%of 2 to 3 cells (P<0 .05 ).5 cells quality blastocyst formation rate was 28 .9%,which was almost equal to 23 .4%of 6 cells blastocyst formation rate (P>0 .05 ).Ⅰand classⅡD3 embryos pieces of high quality blastocyst formation rate was 36.4%,which was significantly higher than 6.1%of gradeⅢorⅣ(P<0 .05 ).Ⅰand class ⅡD2 embryos pieces of high quality blastocyst formation rate was 35.3%,which was significantly higher than 4.7% of grade Ⅲ or Ⅳ (P<0.05).Conclusion Extending IVF can effectively filter the embryo developmental potential.The more D3 embryo cleavage count ,the more high-quality blastocysts .D2 4 cells ,embryo blastocyst development ability is good.Ⅰand classⅡD2 and D3 embryos pieces of high quality blastocyst formation rate is higher.High quality blastocyst formation and D2 and D3 embryo cleavage count and debris are closely related to the ratings.

Acute traumatic spinal cord injury (SCI) represents one of the most devastating injuries that afflict the human body. Ascorbic acid ( AA) plays an important role in mammalian central nervous system, especially in SCI. In this study, the change of AA concentration after SCI was investigated by using an on-line electrochemical method integrated with in vivo microdialysis. A microdialysis probe (2 mm in length) was implanted into the spinal cord of an anesthetized rat (Thoracic-10). Microdialysis perfusate (2 μL/ min) was collected in the sample loop of an on-line injector for direct injection onto a glassy carbon electrode which was modified with the heat-treated single-walled carbon nanotubes (SWNTs). Normal ascorbic acid concentration in the extracellular fluids of spinal cords was (26. 17 ± 1. 25) μmol/ L (n =8). The experimental spinal cord injury, induced by a lesion at T-10, significantly increased the extracellular ascorbic acid levels to (53. 24± 1. 95) μmol/ L (n =8). This study provides the experimental evidence on the essential roles of ascorbic acid in spinal cord injuries.

AIM:To verify the safety application of MIL60 in the treatment of corneal neovascularization both in vivo and in vitro.METHODS:We observed the biological characteristics of human corneal epithelial cells.The cell proliferation was analyzed using CCK-8 assay,which also used to test the toxicity of MIL60 and the solvent on cultured human corneal epithelial (HCE).FACs was used to analyze the apoptosis of HCE after treated with MIL60.Also we evaluated the effect of subconjunctival injection of MIL60 on corneal epithelial healing model in normal rat and rats with epithelium defect through slit lamp-microscopy,Draize scores and histopathology way.RESULTS:The proliferation speed of HCE in three groups was the same.MIL60 did no harm on the proliferation of HCE and the apoptosis of HCE,and has no effect on corneal epithelial healing and other parts of the ocular in rats without inflammation cells infiltration.CONCLUSION:When given subconjunctival injection,Mil60 does no harm to the proliferation and apoptosis of HCE,and is safe with ocular application.

Objective To understand Chinese public knowledge of Traditional Chinese Medicine ( TCM) and offer references for general education approaches. Methods Based on government guideline and pre-vious research, a questionnaire was designed and distributed randomly among Chinese residents in the country. Among the 1,800 questionnaires distributed, 1,486 was returned with 1,050 valid ones identified. The questionnaire consisted of seven demographic items including gender and ages;it also included seven-teen items of general TCM knowledge such as the nature of TCM discipline, advantages of TCM, and com-mon sense of health care in TCM. SPSS 20. 0 software was used to analyze the data obtained. Mean and standard deviation ( SD) was calculated for normal distribution and the homogeneity of variance test. One-
way ANOVA analysis was used to compare differences between groups. LSD test was conducted for homoge-neous variance and Tamhance’ T2 test for heterogeneous results. Results Chinese public knowledge about TCM was overall limited. Average score (x)of all 17 questions was 2. 07 (SD=0. 53). The best known item was precautions for decoction administration(x=2. 47)while the worst known one was about theory of five phases(x=1. 78). Comparison among groups indicated that students knew the most about TCM when compared with peasants(P <0. 001,Δaverage =6. 125); Difference was the most significant be-tween groups of different incomes (5 000-999 RMB/month vs. 1 000-4 999 RMB/month, P<0. 001,Δaverage=2. 870). Health status over the past year influenced the public’s knowledge as there was a significant difference between“I have been feeling better” and“I have been feeling worse” groups ( P<0. 001,Δaverage=7. 058) Conclusions Chinese public knowledge about TCM was generally limited. General education is in urgent need to provide systematic training to help the public know more about TCM philosophy and basic theories. Educators need to work from the grass to promote public’ s health care and benefit social awareness. The quantitative assessment of TCM general education also merits im-provement. This study proves to be a positive innovation.

BACKGROUNDAtopic dermatitis (AD) is characterized by defective skin barrier and imbalance in T helper 1/T helper 2 (Th1/Th2) cytokine expression. Filaggrin (FLG) is the key protein to maintaining skin barrier function. Recent studies indicated that Th1/Th2 cytokines influence FLG expression in keratinocytes. However, the role of Th1/Th2 cytokines on FLG processing is not substantially documented. Our aim was to investigate the impact of Th1/Th2 cytokines on FLG processing.

METHODSHaCaT cells and normal human keratinocytes were cultured in low and high calcium media and stimulated by either interleukin (IL)-4, 13 or interferon-γ (IFN-γ). FLG, its major processing proteases and key protease inhibitor lymphoepithelial Kazal-type-related inhibitor (LEKTI) were measured by both real-time quantitative polymerase chain reaction and Western blotting. Their expression was also evaluated in acute and chronic AD lesions by immunohistochemistry.

RESULTSIL-4/13 significantly reduced, while IFN-γ significantly up-regulated FLG expression. IL-4/13 significantly increased, whereas IFN-γ significantly decreased the expression of kallikreins 5 and 7, matriptase and channel-activating serine protease 1. On the contrary, IL-4/13 significantly decreased, while IFN-γ increased the expression of LEKTI and caspase-14. Similar trends were observed in AD lesions.

CONCLUSIONSOur results suggested that Th1/Th2 cytokines differentially regulated the expression of major FLG processing enzymes. The imbalance between Th1 and Th2 polarized immune response seems to extend to FLG homeostasis, through the network of FLG processing enzymes.

Caspase 14 ; metabolism ; Cell Line, Tumor ; Cells, Cultured ; Dermatitis, Atopic ; metabolism ; Humans ; Immunohistochemistry ; Interferon-gamma ; metabolism ; Interleukin-13 ; metabolism ; Interleukin-4 ; metabolism ; Intermediate Filament Proteins ; metabolism ; Keratinocytes ; enzymology ; metabolism ; Proteinase Inhibitory Proteins, Secretory ; metabolism ; Serine Peptidase Inhibitor Kazal-Type 5 ; Th1 Cells ; metabolism ; Th2 Cells ; metabolism

Objective:To compare the effect of reduction and internal fixation of composite acetabular fracture with the modified two-window iliofemoral approach and ilioinguinal approach.Methods:A retrospective cohort study was used to analyze the clinical data of 160 patients with composite acetabular fracture admitted to First Affiliated Hospital of Nanjing Medical University from January 2016 to August 2021, including 117 males and 43 females, aged 15-78 years [(44.1±16.0)years]. According to the Letournel classification system, there were 101 patients with both-column fracture, 5 with anterior wall/column combined with posterior semi-transverse fracture and 24 with T-shaped fracture. A total of 80 patients were treated using the modified iliofemoral incision combined with limited Pfannstiel incision (modified two-window iliofemoral approach group) and the other 80 patients were treated using the ilioinguinal approach (ilioinguinal approach group). The fracture healing was observed. The operation time and intraoperative bleeding volume were compared between the two groups. The quality of fracture reduction was evaluated by Matta scoring standard at 1 day and 6 months after operation. The modified Merle d′Aubigne & Postel scoring standard was used to evaluate the function of the affected hip joint at the last follow-up. The incidence of complications such as neurovascular injury, iatrogenic bladder injury, heterotopic ossification and femoral head necrosis were compared between the two groups.Results:All patients were followed up for 12-78 months [(43.3±17.9)months], with bony union of the fracture. The operation time and intraoperative bleeding volume in modified two-window iliofemoral approach group were 150.0 (123.8, 180.0)minutes and 600.0 (500.0, 787.5)ml when compared to 190.0 (150.0, 240.0)minutes and 700.0 (562.5, 887.5)ml in ilioinguinal approach group (all P<0.01). There was no significant difference between the two groups in the quality of fracture reduction at 1 day and 6 months after operation, function of hip joint at the last follow-up and incidence of complications (all P>0.05). Conclusions:For reduction and internal fixation of composite acetabular fracture, the modified two-window iliofemoral approach has advantages over the ilioinguinal approach in reducing operation time and intraoperative bleeding, although both methods yield similar results in fracture reduction quality, postoperative hip function and complication rate.

Objective:To compare the clinical efficacy of anatomical reconstruction of coracoclavicular ligament at the original insertion point and clavicular hook plate fixation in the treatment of acromioclavicular joint dislocation.Methods:Retrospective analysis was made on the data of 67 patients with acromioclavicular joint dislocation who received surgical treatment in the Department of Orthopaedics of the First Affiliated Hospital of Nanjing Medical University from June 2015 to January 2021. According to the surgical method, they were divided into reconstruction group (using the technique of anatomical reconstruction of coracoclavicular ligament at the original insertion point) and hook plate group (using the clavicular hook plate). There were 37 cases in the reconstruction group, including 26 males and 11 females, aged 47.2±9.6 years (range, 18-65 years), 13 cases on the left and 24 cases on the right. Among the 37 patients, 8 were sports injuries, 14 were falls, 11 were traffic accidents, and 4 were external force injuries. The average time from injury to surgery was 8.3±2.3 days. There were 30 cases in the hook plate group, including 24 males and 6 females, aged 47.4±9.7 years (range, 18-67 years), 12 cases on the left and 18 cases on the right. Among the 30 patients, 7 were sports injuries, 11 were falls, 9 were traffic accidents, and 3 were external force injuries. The average time from injury to surgery was 7.9±2.6 days. The surgical time, incision length, intraoperative bleeding, hospital stay, postoperative coracoclavicular separation ratio, and postoperative complications were compared between the two groups. Constant-Murley score and visual analog scale (VAS) were used to assess the shoulder joint function and pain degree of patients.Results:Both groups of patients were followed up, with a follow-up time of 12.3±0.4 months for the reconstruction group and 12.2±0.5 months for the hook plate group. The operation time (105.8±10.0 min), incision length [12.0 (11.0, 13.0) cm] and hospitalization time (6.8±2.1 d) in the reconstruction group were longer than those in the hook plate group [48.3±4.9 min, 10.0 (10.0, 11.0) cm, and 5.5±2.7 d], while the intraoperative blood loss (75.1±3.9 ml) was less than that in the hook plate group (90.3±6.3 ml), the differences were statistically significant ( P<0.05). The VAS [4.0 (3.0, 5.0), 3.0 (3.0, 3.0), 2.0 (1.0, 2.0) points] and Constant-Murley score (65.4±4.5, 84.9±2.5, 90.1±2.5 points) of the reconstruction group at 3 days, 3 months, and 12 months after surgery were better than those of the hook plate group [5.0 (4.0, 5.0), 4.0 (4.0, 4.0), 3.0 (3.0, 4.0) and 56.9±3.5, 79.6±4.0, 86.8±2.4 points], the difference was statistically significant ( P<0.05). At the last follow-up, there was a statistically significant difference in the separation ratio of coracoclavicular distance between the reconstruction group (0.12±0.08) and the hook plate group 0.22±0.15 ( t=3.25, P=0.002). There was no significant difference ( Z=-0.52, P=0.605) in the separation ratio of acromioclavicular distance [0.16 (0.05, 0.25) and 0.16 (0.04, 0.40)]. In the hook plate group, 6 cases had shoulder joint foreign body sensation and 2 cases had acromioclavicular joint redislocation (both Rockwood type III). Because the shoulder joint function did not affect their daily life, neither patient underwent secondary surgery. And no case of acromioclavicular joint redislocation occurred in the reconstruction group. Conclusion:Compared with the clavicular hook plate fixation, anatomic reconstruction of coracoclavicular ligament at the original insertion point in the treatment of acromioclavicular joint dislocation can reduce the pain of the shoulder joint earlier, which has the characteristics of small trauma, good effect, and reduces the steps of internal fixation removal, and has good clinical curative effect.