Objective:To confirm the expression and localization of augmenter of liver regeneration(ALR) in baby,mature and the old rat testis and to evaluate the function of ALR in reproduction.Methods:ALR expression and localization in baby,mature and the old rat testis were examined by immunohistochemistry,ALR expressions of the mature rat testis and liver were examined in 12h,24h and 48h after 70 percent partial hepatectomy(PH) as well.Results:ALR was expressed in the cytoplasm and membrane of cells and it commonly existed in Leydig cells,Sertoli cells and sperm cells of rat testis,especially in spermatogonia and spermatocytes.ALR expressions differed among baby,mature and the old rat testis,in the way from the strongest to the weakest.After 70 percent PH ALR expression increased in liver,peaking in 24h,while that in testis didn't change.Conclusion:ALR expression in testis is strong which is necessary for testis development,spermatogenesis and mature sperm.The function of ALR is organ special.

This paper introduces orthopedic resident training system of America including its devel-opment, certification system, selection system, clinical training mode and investigate system. And we hope to improve orthopedic resident training of China by analyzing the new rule of Chinese standardized resident training and the training experience of Peking Union Medical College Hospital.

Objective:To evaluate our self-made distraction reductor used in the percutaneous minimally invasive treatment of calcaneal fractures.Methods:A retrospective study was conducted of the 32 patients (37 feet) who had been treated at Department of Orthopaedics, The First Affiliated Hospital to Chongqing Medical University from January 2017 to December 2019 for calcaneal fractures. They were 26 males and 6 females, aged from 20 to 67 years (average, 46.5 years). The height and length of the calcaneus were restored by our self-made tri-plane distraction reductor in all patients; the displaced fracture blocks were reset in a minimally invasive manner in patients with intra-articular fracture; final fixation was performed with a minimally invasive plate and screws. Time for reductor installation, operation time and intraoperative blood loss were recorded; complications, fracture union and reduction were observed; height, length and width of the calcaneus, ankle-hindfoot scores of American Society of Foot and Ankle Surgery (AOFAS), Maryland scores, and visual analogue scale (VAS) were recorded at the last follow-up; B?hler and Gissane angles were compared between pre- and post-operation.Results:All patients were followed up for 12 to 36 months (average, 17.2 months). Time for reductor installation averaged 5.0 min (from 3 to 8 min), operation time 91.5 min(from 70 to 110 min), and intraoperative blood loss 25.2 mL (15 to 50 mL). Superficial infection of traction track occurred in one patient and sural nerve injury in one patient. All fractures united without any reduction loss by the last follow-up. On average, the last follow-up observed a calcaneal height of 39.3 mm, a calcaneal length of 70.6 mm, a calcaneal width of 32.7 mm, an AOFAS score of 87.8, a Maryland score of 86.7 and a VAS score of 2.2. The calcaneal B?hler angle was recovered significantly from 3.7°±13.7° preoperatively to 25.8°±6.4° at the last follow-up, and the calcaneal Gissane angle from 112.2°±21.3° preoperatively to 125.8°±5.7° at the last follow-up ( P< 0.05). Conclusion:In percutaneous minimally invasive treatment of calcaneal fractures, application of our self-made tri-plane distraction reductor can lead to fine clinical efficacy.

Recently, traditional Chinese medicine (TCM) researches on diabetic peripheral neuropathy made great progress. It is found that theetiology and pathogenesis was the deficiency in origin and the ecessive in superficialty. The deficiencyincluded Yin deficiency, Qi deficiency, blood deficiency, deficiency of both Qi and Yin, Yang deficiency, while the ecessive in superficialty included blood stasis, stasis of phlegm and blood. Thus, the principles of treatment were supplementing Qi and nourishing Yin, warming Yang, promoting blood and removing blood stasis, and smooth Luo, all of which showed the characteristics of TCM treatment were combination of inside and outside, and multi-target effects. This paper reviewed the progress of clinical and experimental studies on the TCM for diabetic peripheral neuropathy.

Objective To analyze treatment strategies for complications following lumbopelvic fixation for unstable sacral fractures.Methods Between May 2014 and December 2015,20 patients diagnosed with unstable sacral fracture were treated by lumbopelvic fixation.They were 9 males and 11 females,with an average age of 35.5 years (range,from 14 to 59 years).According to the Denis classification,5 fractures were type Ⅰ,7 type Ⅱ and 8 type Ⅲ.Complications related to lumbopelvic fixation were recorded and followed up.Results All the patients were followed up for an average of 18 months (range,from 12 to 31 months).All the fractures healed after an average of 19 weeks (range,from 15 to 32 weeks).Early complications included neural injury in 2 cases,incision infection in one and pressure ulcer in 2;late complications included prominence of internal implants in 7 cases,loosening of internal implants in 5,lumbopelvic pain or discomfort in 3,limited motion of lumbar vertebrae in 4,limb discrepancy in 3 and rotation deformity of lower limb in one.Conclusions Complications related to wound and internal implants are common following lumbopelvic fixation for sacral fractures.Careful planning and correct choice of internal fixators are the key to decreasing complications.Internal implants should be removed as soon as a sacral fracture unites to decrease the risk of long-term complications.

In this study, the underlying antileukemic mechanisms of homoharringtonine (HHT) were investigated. K562 cell line was used to observe the effects of HHT on the induction of apoptosis and on the expression of the specific chimeric protein P210(bcr/abl), as evaluated by flow cytometric annexin V-PI dual labeling technique and Western blot. The results showed that HHT induced K562 cells to apoptotic death at the concentrations of 5 - 20 ng/ml, and some of the cells became necrotic when exposed to a higher concentration. The amount of P210(bcr/abl) oncoprotein was decreased by approximately 70% when the cells were exposed to HHT for 48 hours, however, that of its partner P145(c-abl) proto-oncoprotein was not affected. It is clear from the study that HHT is an inhibitor of P210(bcr/abl) oncoprotein and therefore promotes the apoptosis of CML cells. It could be promising that HHT be used extensively in the chemotherapy of patients with CML.

Objective To evaluate the different effects of laryngeal mask and mask ventilation during bronchoscopy in elder patients. Methods 120 old patients (ASA I-III) were divided into three group according to the table of random number as following:surface anesthesia with autonomous respiration (group I);endoscope mask ventilation (group II);laryngeal mask airway ventilation (group III). Oxygen inhalation through nasal tube in groupⅠ,group II and group III was ventilated with endoscope mask and LMA respectively ,thenwe observed whether there were adverse effects or not during the procedure. Results The adverse reactions of group I were more than other groups. Compared with the group I, variance of MAP,HR, RR, SpO2 in the groupⅡand groupⅢ had less changes, the cases with severe bucking decreased significantly, and satisfaction degree increased markedly, (P <0.01or P<0.05 ) . The incidence rate of resp iratory depression and airway obstruction in groupⅡwas higher than that in groupⅢ (P<0.05). Conclusion Endoscope mask ventilation and LMA can both be adopted in analgesia bronchoscopy for old patient. LMA under general anesthesia to transbronchial lung biopsy would control respiration according to the demand at any time.LMA has more advantage in the operation for the stable respiration and hemodynamics and less complications.

Diabetic peripheral neuropathy is one of the microvascular complications of diabetes. traditional Chinese medicine (TCM) attributed it to theXiaoke disease andBizheng, with the views ofLuo disease and its TCM patterns differentiation. Based on the treatment for deficiency,Tongluo drugs were added and they made good curative effect. Recently the TCM researches on it have been deepened in the etiology, pathogenesis, treatment, experimental and clinical research, which showed some new under standings. Thus, this paper summarized the relevant researches.

Objective To evaluate the clinical outcomes of lumbopelvic fixation of vertically unstable Tile type C pelvic fractures combined with complex sacral fractures.Methods A prospective study was made on 21 cases of vertically unstable type C pelvic fractures combined with complex sacral fractures admitted between May 2014 and December 2015.There were 10 males and 11 females, with a mean age of 35.9 years (range, 14-59 years).Tile classification of pelvic fractures was type C1 in five cases, type C2 in four and type C3 in 12.Denis classification of sacral fractures was zone I in five cases, zone Ⅱ in seven and zone Ⅲ in nine.Twelve cases had neurological deficits.Operation time, intraoperative blood loss, bone healing time, pelvis vertical displacement and postoperative complications were recorded.Vertical displacement and functional outcome were assessed by Matta method and Majeed score respectively.Results All cases were followed up for (12.5±5.4)months (range, 7-26 months).Operation time was (108.0±49.4) min (range, 64-225 min).Intraoperative blood loss was 150-3 000 ml[400(225-500)ml].All fractures were healed at (19.0±4.6) weeks (range, 15-32 weeks).Vertical displacement of the pelvis was (8.76±5.46)mm (2.54-21.80 mm) before operation and (4.20±3.22)mm (0-12.57 mm) after lumbopelvic fixation (P<0.05), showing the reduction distance of-4.45-17.86 mm [4.09(1.74-5.58)mm].According to the Matta method, the results were excellent in 13 cases, good in six, and fair in two, with the excellent and good rate of 90%.Majeed score evaluation at last follow-up was 51-98 points and the results were excellent in nine cases, good in nine, fair in two and poor in one, with the excellent and good rate of 86%.Deep infection occurred in two cases who were cured by debridement and antibiotics, and the internal instruments of the two cases were removed after fracture healing.Screw loosening occurred in five cases with no evidence of screw breakage.Four cases complained of foreign body sensation and discomfort in sacral area due to the prominence of the iliac hardware.Four cases had limited range of motion of the lumbar spine, especially in anterior flexion range, and lumbar range of motion was recovered in three of them after removal of the internal fixator.Conclusion Lumbopelvic fixation can restore vertical stability of the pelvis, but removal of the internal fixator is suggested after fracture healing due to the high rate of screw loosening.

Objective:To compare the clinical outcomes of percutaneous screw fixation at the key points using a self-made calcaneal distraction device with traditional open reduction plate internal fixation for the treatment of patients with displaced intra-articular calcaneal fractures (DIACFs).Methods:A retrospective case-control study was made on clinical data of 60 patients (69 feet) with DIACFs admitted to First Affiliated Hospital of Chongqing Medical University between January 2015 and January 2019. There were 51 males and 9 females, with an average age of 47.2 years [(47.2±8.7)years]. According to the Sanders classification, there were 42 feet of type II, 15 feet of type III and 12 feet of type IV. According to the Essex-Lopresti classification, there were 43 feet of tongue type fractures and 23 feet of joint depression fractures. Another 3 feet were not applicable to this classification system. In Group A, 30 patients (35 feet) were treated by percutaneous reduction or reduction using tarsal sinus approach with the self-made calcaneal distraction device followed by percutaneous screw fixation. In Group B, 30 patients (34 feet) were treated by open reduction and internal fixation with plates using the traditional extended lateral approach. Waiting time for surgery, operation time, length of hospital stay, efficacy of reduction and fracture healing, American Orthopedic Foot and Ankle Society (AOFAS) score, Maryland score, visual analog scale (VAS), and incidence of surgical site related complications were compared between groups. The efficacy of reduction was evaluated by measuring the height, length and width as well as the B?hler angle of the calcaneus.Results:All patients were followed up for an average of 28.2 months [(28.2±11.3)months]. The waiting time for surgery in Group A was (3.4±1.3)days, significantly shorter than that in Group B [(6.9±1.9)days] ( P<0.05). The operation time was (91.7±10.3)minutes in Group A and (92.8±11.5)minutes in Group B ( P>0.05). The length of hospital stay in Group A was (7.0±1.4)days, significantly shorter than that in Group B [(12.7±1.7)days] ( P<0.05). At the final follow-up, all fractures were healed, with no reduction loss of fixation observed. The height of the calcaneus was (48.9±2.0)mm in Group A and (49.3±2.6)mm in Group B ( P>0.05). The length of the calcaneus was (83.2±2.9)mm in Group A and (83.5±2.7)mm in Group B ( P>0.05). The width of the calcaneus was (35.8±2.3)mm in Group A and (35.1±1.3)mm in Group B ( P>0.05). The B?hler angle of the calcaneus was (24.7±6.4)° in Group A and (25.9±5.8)° in Group B ( P>0.05). At the final follow-up, the AOFAS score was (87.1±8.5)points in Group A and (86.7±7.8)points in Group B, with the good and excellent rate of 89% (31/35) and 88% (30/34) respectively ( P>0.05). The Maryland score was (85.3±9.5)points in Group A and (84.9±9.5)points in Group B, with the good and excellent rate of 86% (30/35) and 85% (29/34), respectively ( P>0.05). The VAS was (2.3±1.5)points in Group A and (2.5±1.5)points in Group B ( P>0.05). No surgical site related complication was observed in Group A. While in Group B, there was one foot of superficial incision infection, three necrosis of the skin at the edge of the incision, and one deep infection ( P<0.05). Conclusions:For the treatment of DIACFs, percutaneous screw fixation at the key point using the self-made calcaneal distraction device can achieve the same clinical outcome as traditional open reduction plate internal fixation, but it has advantages like significant shorter waiting time for surgery, less invasiveness, faster recovery and lower incidence of incision-related complications. This method is especially suitable for patients with contraindications of open reduction and internal fixation.