BACKGROUND:Posterior maleolar fracture is an important factor affecting the prognosis of ankle fractures. Posterior maleolar fracture often caused by high energy trauma. Using what kind of fixation and fixation materials biomechanics, and how to embed has become a current research hotspot. OBJECTIVE:To compare the clinical outcomes of different fixation materials on posterior maleolar fracture, and analyze the effect of different fixation methods on biomechanical outcome of posterior maleolar fracture fixation, so as to provide a basis and reference of selecting the best fixation for the clinical treatment of ankle fracture. METHODS: The relevant literature included by PubMed database and the China National Knowledge database from the year of 1976 to 2015 were retrieved by the first author through computer. English key words are “Ankle fracture; internal fixation; biomechanics; biocompatibility”, Chinese language search terms are “posterior maleolar fracture; internal fixation; biomechanics; biocompatibility”. Summarize the most commonly used metal fixation materials and absorbable content materials. The clinical commonly used metal fixation materials including bone plate and screws, absorbable fixation materials such as biodegradable material polylactic acid, polyethylene plastic ester, polylactide gum ester, etc. The biomechanical properties were analyzed. RESULTS AND CONCLUSION: The new locking screw can withstand more buckling and shear force. Lag screw has a tapping action, and the puling was stronger after tapping, but for patients with osteoporosis, the pressure effect of screw on fracture fragments was limited, the strength was not enough, at this time, locking plate should be used. Locking plate has a greater stability and higher confrontational feature to bending stress, less likely to pul out. Steel coupling screw provides better stability. To avoid secondary removing of the fixation, stress protection after fixation and other shortcomings after the metal material fixation fracture healing, the strength of the absorbable fixation material made by biodegradable material polylactic acid, polyvinyl acetate glue and polypropylene plastic ester after high temperature and pressure processing was increased. Absorbable fixation material may overcome the adverse effects associated with metal fixation, such as imageological examination, secondary implant removal. These results show that the mechanical properties of the absorbable screws are more closer to human bone, no surrounding bone vulnerability due to stress shields, no osteoporosis occurs, and can degrade in the body, but its fixation strength is stil less than the traditional fixed screw and bone plate. We should choose a suitable fixation material according to the forces of fracture site and the size of the fracture fragments.

Objective To report and analyze the renal function improvement in a case with ad-vanced bilateral renal cell carcinoma after targeted therapy. Methods The patient was a 60-year-old man who complained of lower back pain for 1 month. Ultrasound and CT scan detected bilateral renal masses, left lesion was 11.0 cm×9.4 cm×8.5 cm, and the right one was 3.5 cm×4.3 cm×4.1 cm. X-ray examination showed metastatic lesions in liver and lower right lung. GFR was 20.39 ml/min of left kidney, 25.40 ml/min of right kidney. The renal biopsy confirmed renal clear cell carcinoma. Sorafenib was administrated 400 mg twice or once daily for 12 weeks. Results After the targeted therapy, the decreased bilateral kidney tumor sizes were identified by CT scan. There was liquid nec-rosis in the tumor, and no new metastatic lesion detected. The kidney function was improved as well. The total GFR increased to 71.38 ml/min. Left kidney GFR increased to 31.57 ml/min, right kidney GFR increased to 39.81 ml/min, respectively. Conclusion Targeted therapy could improve renal function in advanced renal cell carcinoma cases by controlling tumor development.

ObjectiveTo study the efficacy of adjuvant percutaneous transhepatic portal vein chemoembolization (PVCE) in the prevention of tumor recurrence after partial hepatectomy for hepatocellular carcinoma.MethodsThe clinical data of 89 patients who received liver resection for hepatocellular carcinoma in our hospital from January 2007 to January 2010 were studied retrospectively.41patients received PVCE (the treatment group) while 48 patients received no PVCE (the control group).Postoperative recurrence and cumulative disease free survivals were compared using the Kaplan-Meier method.ResultsOn follow-up which ranged from 6-42 months,the 1- and 2-year disease free survivals were 76.5％ and 48.0％ in the treatment group,and 53.8％ and 25.8％ respectively in the control group (P＜0.05).The mean disease free survivals were 19.91 (95％ CI,16.09-23.73)and 13.8 months (95 ％ CI,10.95-16.65),respectively.The cumulative disease free survivals in the PVCE group were significantly higher than the control group (P=0.01).Cox multivariate analysis showed that adjuvant PVCE,tumor size,portal vein thrombosis,and postoperative transcatheter arterial chemoembolization (TACE) were independent factors of disease free survival.ConclusionAdjuvant PVCE was effective in preventing postoperative recurrence of hepatocellular carcinoma after partial hepatectomy.

Objective To investigate the effect of butylphthalide (NBP) on H2S content and the expression of NR2B in the hippocampus of alcohol dependence rats. Methods A total of 84 SD male rats were randomly divided into 6 groups. Except for the normal group, other groups were subjected to alcohol solution with concentration of 6% ( V/V) for 28 d. Drug intervention began at the 14th day,and rats in the low,medium,high dose group were treated with NBP with a different concentration. Erden abstinence scoring was used to evaluate the rats withdrawal symptom. H2S content was measured in one side of hippocampus and CBS activity was tested in the other side of hippocampus. Hippocampus of 3 rats from each group was used to investigate NR2B mRNA level. Results Withdrawal symptom score ( 12.27 ± 1. 19),H2S content(30. 25 ±8.82), CBS activity (72. 44 ±7. 46) and NR2B mRNA expression( 19. 47 ±0. 86) in medium dose NBP group rats were lower than withdrawal symptom score(14.09 ±2.21) ,H2S content(44. 50 ±6. 65) , CBS activity(79. 06 ±4. 57) and NR2B mRNA expression (29. 13 ±1.39) in experimental control group (P<0.05). Withdrawal symptom score(12. 18 ±1.08) ,H2S content(33.00 ±5.38) ,CBS activity(67. 81 ±9. 37) and NR2B mRNA expression(23. 12 ± 1. 86) in high dose NBP group rats were lower than experimental control group (P < 0. 05). Conclusion NBP can reduce withdrawal symptoms of alcohol dependence rats,may be related to decreased expression of H2S/CBS system, and NR2B mRNA expression.

Alcoholism ; metabolism ; Animals ; Brain ; metabolism ; Chemokine CCL2 ; genetics ; metabolism ; Male ; RNA, Messenger ; genetics ; metabolism ; Rats ; Rats, Sprague-Dawley ; Receptors, CCR2 ; genetics ; metabolism

OBJECTIVETo summarize the clinical manifestation and diagnosis of ganglioneuroma in spine and investigate the clinical effect of surgical treatment.

METHODSThe clinical data of 6 patients underwent a surgery for ganglioneuroma in spine from January 2008 to January 2015 were retrospectively analyzed. There were 4 males and 2 females, aged from 2 to 63 years old with an average of 34.6 years. The courses of disease were from 3 days to 17 years. Five patients complicated with superficial hypesthesia in correlative level of tumor, and the muscle strength under tumor plane had decreased at different levels, with the strength of grade II-IV. Two cases complicated with hypermyotonia and positive bilateral Hoffmann's and Babinski sign. Five cases were sporadic lesion in correlative spinal canal and one case complicated with the giant occupying lesion in thoracic cavity.

RESULTSSix operations had been performed including 5 en bloc and 1 subtotal resection. Postoperative pathological results showed tumor cells scattered or fasciculated inserted into Schwann cells in the stroma. In 2 patients complicated with radiculalgia before operation, 1 case was relieved and 1 was invariant after operation. All 4 patients with preoperative dyscinesia in the limbs obtained improvement after operation. All the patients were followed up from 0.3 to 6.8 years with an average of 2.5 years. At the final follow-up, according to ASIA grade, 5 cases were good and 1 case was invariant. During the follow-up, only 1 patient experienced chemoradiation because of merging ganglioneuroblastoma and receiving subtotal resection. No recurrence in other 5 cases.

CONCLUSIONGanglioneuroma is a benign and rare tumors in spine. Clinically, radicular pain and sensory-motor disorders are the main manifestations. Its diagnosis depends on pathological examination. Prognosis of surgical treatment is good.

Adolescent ; Adult ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Ganglioneuroma ; diagnosis ; surgery ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Spinal Neoplasms ; diagnosis ; surgery

Objective To construct multiple myeloma mucin MUC1-2VNTR gene eukaryotic expressing vector,which provided the basic material for further study of multiple myeloma DNA vaccine.Methods MUC1-2VNTR coding gene as target gene,and a KOZAK sequence was inserted before it.Hind Ⅲ and Xba Ⅰ restriction enzyme site were inserted on both ends.Then the whole sequence was synthesized and cloned into pcDNA3.1/myc-his B vector,and the recombinant vector was identified by restriction enzyme digestion and DNA sequencing.Results Synthesized MUC1-2VNTR gene was 140 bp.Restriction enzyme digestion and DNA sequencing confirmed pcDNA3.1/MUC1-2VNTR/myc-his B including the whole exact translation frame region and MUC1-2VNTR gene.Condnsion The pcDNA3.1/MUC1-2VNTR/myc-his B has been successfully constructed,which provides the basic material for further studies of MUC1 mucin function and multiple myloma DNA vaccine.

Objective To investigate the impact of blood glucose level on the recurrence of liver cancer after laparoscopic surgery. Methods The clinical data of 98 patients with primary hepatocellular carcinoma from January 2012 to January 2015 were retrospectively analyzed. All patients were treated by laparoscopic radical resection of hepatocellular carcinoma. Patients were divided into elevated blood glucose group (n = 23) and control group (n = 75) according to whether the fasting blood glucose was ≥6.1 mmol/L. The recurrence of liver cancer in 1 year and 2 years after operation was compared. The factors influencing the recurrence of liver cancer were analyzed by univariate and multivariate analysis. Results The recurrence rates were 47.82% and 21.33% respectively in the patients with elevated blood glucose and the control group. The recurrence rates were 73.91% and 36.00%respectively in the 2-year postoperative patients with blood glucose and 1 year and 2 years. The recurrence rate was higher than that of the control group, the difference was statistically significant (P < 0.05). Logistic multivariate analysis showed that fasting blood glucose was high, Child-Pugh grade B, intraoperative blood transfusion, lymphatic invasion, high clinical pathology stage, postoperative alpha-fetoprotein (AFP) high, no postoperative adjuvant therapy (P < 0.05). Conclusion The recurrence rate of patients with elevated liver cancer after laparoscopic surgery is high, and fasting blood glucose is high, Child-Pugh grade is B grade, blood transfusion is high, there is lymphatic invasion, high clinical pathology stage after AFP high, no postoperative adjuvant therapy for its postoperative recurrence of risk factors, should strengthen the monitoring of high-risk patients, reduce postoperative recurrence rate.

OBJECTIVETo identify the biomechanical feasibility of the thoracic extrapedicular approach to the placement of screws.

METHODSFive fresh adult cadaveric thoracic spine from T1 to T8 were harvested. The screw was inserted either by pedicular approach or extrapedicular approach. The result was observed and the pullout strength by pedicular screw approach and extrapedicular screw approach via sagittal axis of the vertebrale was measured and compared statistically.

RESULTSIn thoracic pedicular approach, the pullout strength of pedicle screw was 1001.23 N+/-220 N (288.2-1561.7 N)ls and that of thoracic extrapedicular screw approach was 827.01 N+/-260 N when screw was inserted into the vertebrae through transverse process, and 954.25 N+/-254 N when screw was inserted into the vertebrae through the lateral cortex of the pedicle. Compared with pedicular group, the pullout strength in extrapedicular group was decreased by 4.7% inserted through transverse process (P larger than 0.05) and by 17.3% inserted through the lateral cortex (P less than 0.05). The mean pullout strength by extrapedicular approach was decreased by 11.04% as compared with pedicular approach (P less than 0.05).

CONCLUSIONSIt is feasible biomechanically to use extrapedicular screw technique to insert pedicular screws in the thoracic spine when it is hard to insert by pedicular approach.

Adult ; Biomechanical Phenomena ; Bone Screws ; Female ; Humans ; Male ; Middle Aged ; Thoracic Vertebrae ; surgery