Objective To evaluate the diagnostic value of Achilles tendon rupture by using X-ray plain films and MR images. Methods The plain films and MRI findings in 21 patients with operation proved acute Achilles tendon rupture were analyzed, and every manifestation on MR and operation were compared.Results The Achilles tendon rupture was diagnosed on MRI in all 21 cases. Complete rupture of Achilles tendon was showed in 7 and partial rupture in 14. MRI appearance of the rupture represented as thickening of Achilles tendon, hyperintensity in the tendon, and completely or partly discontinuance of the fibrous bundle. X-ray showed Achilles tendon rupture in 5, suspicious rupture in 12, and normal in 4. Operation showed Achilles tendon complete rupture in 9 and partial rupture in 12.Conclusion MRI can accurately show the degree and location of acute Achilles tendon rupture, which is very helpful for treatment. X-ray is the adminicular method in detecting Achilles tendon rupture and the diagnosis should be depended on MRI to confirm the the acute Achilles tendon rupture.

Objective To introduce and evaluate an improved technique of vertical mammaplasty for correction of severe breast ptosis. Methods Vertical mammaplasty that was first reported by Ma-deleine Lejour in Brussels is a technique that uses adjustable markings, an upper pedicle for the areola, and a central breast reduction with lower skin undermining. To shorten vertical scar, it was important to locate new nipple position and move up new inframammary fold. The shape of the breast was crea-ted by suturing the gland and did not rely on the skin. No scar was produced in submammary fold. Re-sults 36 cases were treated with vertical mammaplasty in our department since August 1999. The shape of the new breast was satisfactory in all patients after 3-24 months following-up. Areora necro-sis was not found in all the cases. Conclusion The vertical mammaplasty is an optical technique for correction of severe breast ptosis, Stable results are produced because the gland is strongly sutured.

Objective To evaluate mammaplasty for repairing the serious breast asymmetry.Methods Different mammaplasty was used to repair 38 cases of breast asymmetry,including 13 cases of unilateral breast augmentation,10 cases of breast reduction after different volume resection on each side,4 cases of unilateral partial breast resection,5 cases of breast reduction on one side and breast suspended on another side,4 cases of breast suspension on one side and augmentation on the other side,and 2 cases of only suspension on unilateral breast.The 38 cases were followed up for 3 to 12 months postoperatively to evaluate the results.Results One case had slight ptosis in half a year after breast suspension.Apart from mentioned above,the rest of 11 had favorable and satisfactory results.Conclusions The serious breast asymmetry deformities should be corrected with the method of the simple and minimum injuries to make the best result.

Objective To study the technique, clinical effect and safety of endoscopic calcaneoplasty for Haglund disease. Methods Clinical data of 12 patients with Haglund disease having underwent endoscopic calcaneoplasty were collected and retrospectively reviewed. All the patients experienced conservative treatment for 3 to 6 months which was failed and then turned to endoscopic calcaneoplasty. The American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score before and after operation, patient′s satisfaction and complication were recorded. Postoperative complications were also observed. Results All the patients underwent the operation successfully within 70 min, with 42 min on average, and no complications occurred. All the patients were followed up for 12.4 (8-16) months, the AOFAS ankle-hindfoot score after operation was significantly higher than before operation:94.6 (86-100) scores vs. 58.6 (32-72) scores, and there was statistical difference (P<0.05). After operation, 10 cases were excellent, and 2 cases were good. All patients were satisfied with the surgery, and no recurrence occurred during the follow-up period. Conclusions Endoscopic calcaneoplasty appears to be a safe, minimal invasive and effective surgical procedure for the treatment of Haglund disease.

Objective To summarize the experience of the integrated treatment on mid-face ageing for better cosmetic results.Methods A total of 56 cases were treated.With using subciliary approaches,the orbicularis oculi was resected to expose the orbital septum,the orbital fat relieved and orbital septum reseted.Hyaluronic acid was injected to some patients with obvious nasolabial fold after operation.Results 56 cases were all followed up from 6 to 26 months (11.8 months on average) postoperatively.The flabby tissue had been tightened and all got better effects.Conclusions Various combination of technologies can be applied to reach the purpose of rejuvenation by correcting the volume abnormality,resetting the tissue,elevating reasonably,and filling the facial depression.

Objective To seek an effective surgical procedure to treat patients with the varying degrees of breast ptosis and micromastia.Methods Patients were classified into Ⅰ-Ⅳ degrees based on different breast ptosis,and treated by different methods.Degree Ⅰ was treated with implanting prosthesis to the post-pectoralis major space; degree Ⅱ patients were repaired with avulsion of deeper mammary gland and pectoralis major and hanging fixed breast tissue,based on the degree Ⅰ procedure; degree Ⅲ was fixed with breast tissue flap,excised redundant epidermis by the method of double-rings and the complex of nipple and areola was shifted,based on the degree Ⅱ procedure; degree Ⅳ was repaired with implanting prosthesis and the method of lines to hanging fixed breast.Results In 116 cases of this study,there were no hematoma,infection and nipple and areola necrosis by the combined strategies.The follow-up period after the surgery was 6-31 months (mean 13.3 months).All cases had voluptuous and upright breasts,rectified breast ptosis,with the normal sense of nipple and areola.Conclusions For breast ptosis and hypoplasia,the combined strategies have better clinical therapeutic effects.

Objective To evaluate the effect of Lejours' procedure in the treatment of breast prolapse.Methods From July 2014 to July 2018,the Second People's Hospital of Guangdong Prov ince accepted 36 female patients with breast prolapse and correction failure,aged 25 42 years,with an average age of 32.1 years.According to the preoperative design,the pedicel epidermis,the redundant skin,the prosthesis and capsule were removed,and the mammary flap was fixed on the fascia of pectoralis major muscle,and the nipple and areola were fixed and sutured layer by layer.Results In 36 cases,the shape of breast was improved,the scar of incision was smaller,and the color of scar became lighter with time.There were no serious complications such as nipple and areola necrosis.The breast was straight and round after operation.After 6-24 months follow-up,one patient had delayed wound healing and received repeated dressing changes for 7 days.Conclusions The design of the op eration is simple,with little scar,few complications and good long term effect.The shape of the breast after repair is round and straight,which can be used as one of the feasible operation methods for the repair of breast ptosis.

Objective:To investigate the protective effect of Xuebijing injection on acute lung injury (ALI) associated with cardiopulmonary bypass (CPB) by regulating the apoptosis of polymorphonuclear neutrophils (PMN).Methods:Thirty male Sprague-Dawley (SD) rats were randomly divided into sham operation group (Sham group), CPB model group (CPB group) and Xuebijing pretreatment group (XBJ group) according to the random number table method, with 10 rats in each group. Rats in the CPB group and XBJ group undergoing CPB procedures for 60 minutes. Rats in the Sham group did not undergo CPB. Rats in the XBJ group received intraperitoneal injection of 4 mL/kg Xuebijing injection 2 hours before CPB. Rats in the Sham group and CPB group were injected with an equal amount of normal saline. 4 hours after CPB, arterial blood was collected for blood gas analysis to calculate respiratory index (RI), and lung tissue of rats was collected for determination of lung index (LI) and pulmonary water containing rate. PMN in bronchoalveolar lavage fluid (BALF) were collected and the activity of caspase-3 was detected. The apoptosis rate was detected by flow cytometry. The expressions of microRNA-142-3p (miR-142-3p) and FoxO1 mRNA were detected by real-time fluorescence quantitative polymerase chain reaction (RT-qPCR). The protein expression of FoxO1 was detected by Western blotting. In addition, HL-60 cells were divided into control oligonucleotide transfection group, miR-142-3p mimics transfection group, and miR-142-3p inhibitor transfection group. After 48 hours of transfection, the activity of miR-142-3p binding to FoxO1 was detected using dual luciferase reporter genes.Results:Compared with Sham group, RI, LI and pulmonary water containing rate were significantly increased in CPB group. The caspase-3 activity and apoptosis rate of PMN obtained from BALF were significantly decreased, the expression of miR-142-3p was decreased, and the expression of FoxO1 protein was increased. However, compared with CPB group, RI, LI and pulmonary water containing rate were significantly decreased in XBJ group [RI: 0.281±0.066 vs. 0.379±0.071, LI: 4.50±0.26 vs. 5.71±0.42, pulmonary water containing rate: (80.31±32.50)% vs. (84.59±3.41)%, all P < 0.01]. The caspase-3 activity and apoptosis rate of PMN obtained from BALF were significantly increased [caspase-3 activity: 0.350±0.021 vs. 0.210±0.014, apoptosis rate: (15.490±1.382)% vs. (8.700±0.701)%, both P < 0.01], the expression of miR-142-3p was significantly up-regulated (2 -ΔΔCt: 2.61±0.17 vs. 0.62±0.05, P < 0.01), and the protein expression of FoxO1 was decreased [FoxO1/GAPDH (relative expression level): 0.81±0.04 vs. 1.22±0.06, P < 0.01]. However, there was no statistically significant difference in FoxO1 mRNA expression among the three groups. The bioinformatics analysis results showed that miR-142-3p can bind to the FoxO1 3'untranslated region (3'UTR). In HL-60 cells, compared with control oligonucleotide transfection group, the transfection of miR-142-3p mimics could reduce the expression of FoxO1 protein [FoxO1/GAPDH (relative expression level): 0.48±0.06 vs. 1.00±0.05, P < 0.01], however, the transfection of miR-142-3p inhibitor increased the expression of FoxO1 protein [FoxO1/GAPDH (relative expression level): 1.37±0.21 vs. 1.00±0.05, P < 0.05]. But, transfection with miR-142-3p mimics or inhibitor had no effect on FoxO1 mRNA expression. The luciferase reporter gene showed that miR-142-3p could bind to the FoxO1 3'UTR to inhibit FoxO1 expression. Conclusion:Xuebijing injection may promote the apoptosis of pulmonary alveolar PMN through the miR-142-3p/FoxO1 axis, and play a role in the prevention and treatment of CPB-induced ALI.

Objective:To investigate the clinical effects of a single lateral-rectus approach (LRA) in the Ti-Robot-assisted treatment of acetabular fractures involving the posterior column.Methods:A retrospective study was conducted to analyze the clinical data of 16 patients with acetabular fracture who had been admitted to Department of Trauma Orthopedics, Taihe Hospital from August 2021 to March 2023. There were 13 males and 3 females with a mean age of 51.5 (35.8, 56.8) years. By the Judet-Letournel classification, there were 4 anterior and posterior semi-transverse fractures, 2 T-shaped fractures, and 10 double-column fractures. The time from injury to operation was 6.0 (5.3, 7.8) d. All their acetabular fractures involving the posterior column were treated by a single LRA with the assistance of a Ti-Robot. Operation time, blood loss, complications, quality of fracture reduction, modified Merle d'Aubigné & Postel scores and acetabular recovery at the last follow-up were recorded.Results:In this cohort, the operation time was (4.1±0.6) h and the blood loss 400 (300, 575) mL. By the Matta evaluation, the fracture reduction was excellent in 10 cases, good in 5 cases, and poor in 1 case. The follow-up time was (11.3±3.9) months. Bone union was achieved in all fractures after 3.0 (2.3, 4.0) months. By the modified Merle d'Aubigné & Postel scores at the last follow-up, 9 cases were excellent, 6 cases were good and 1 case was fair. Injury to the lateral femoral cutaneous nerve occurred in 1 patient, and deep venous thrombosis in 6 patients. Follow-ups revealed no iatrogenic vascular injury, loosening or rupture of internal fixation, or incision infection.Conclusion:A single LRA approach can be used in the minimally invasive treatment assisted by a Ti-Robot for acetabular fractures involving the posterior column, demonstrating advantages of minimal invasion, high reduction quality and good functional recovery of the hip joint.

Objective To investigate the risk factors for postoperative deep wound infection after open reduction and internal fixation for closed calcaneal fractures.Methods From January 2014 to January 2017,190 patients with closed calcaneal fracture were treated at Department of Traumatic Orthopaedics,Taihe Hospital.They were 118 males and 72 females with an average of 39.8 years (range,from 18 to 73 years).They were divided into a deep infection group and a non deep infection group according to the presence or absence of deep wound infection in the follow-up period.The 2 groups were compared in the general clinical data.In statistical analysis,the related risk factors were first screened by single factor analysis and followed by multivariate logistic regression analysis to identify the independent risk factors associated with the postoperative deep wound infection in patients with closed calcaneal fracture.Results The 190 patients were followed up for an average of 21.3 months(range,from 13 to 31 months).Postoperative deep wound infection occurred in 11 patients,giving an overall incidence of 5.7％ (11 / 190).The single factor analysis showed that the deep infection group incurred significantly longer time for tourniquet and used significantly more conventional extensile lateral approach than the non deep infection group (P ＜ 0.05).There were no significant differences between the 2 groups in general data,injury cause,fracture type,drainage,or incision closure technique (P ＞ 0.05).The multivariate logistic regression analysis revealed that tourniquet time ＞ 80 min (OR=5.949,95％ CI:1.216～ 29.108,P=0.028) and conventional extensile lateral approach (OR =5.414,95％ CI:1.507 ～ 19.452,P =0.01) were independent risk factors fo r the postoperative deep wound infection in patients with closed calcaneal fracture after open reduction and internal fixation.Conclusions Tourniquet time and conventional extensile lateral approach may be the independent risk factors for postoperative deep wound infection in patients with closed calcaneal fracture after open reduction and internal fixation.Therefore,it is important to adopt the sinus tarsi approach and control tourniquet time within 80 minutes for prevention of deep wound infection as long as the surgical quality is ensured.