Objective To observe the effects of oxaliplatin on proliferation in human hepatoma cell lines QGY in vitro and investigate the mechanism. To provide the theory foundation whether it can be used for the chemotherapy of hepatocellular carcinoma. Methods The inhibition of proliferation in QGY cell was estimated by MTT-test. Morphologic changes were observed under light microscope and electronic microscope. Distribution of cell cycle and apoptosis was analyzed using flow cytometry. The expression of cell cycle protein and apoptosis-associated gene protein was detected with immunohistochemical technique. Results Oxaliplatin could inhibit the proliferation of QGY cells and the inhibition depended on the exposure time and dose. The cells showed morphologic changes at the early stage of apoptosis under the light microscope: the shrunk and round cells, condensed cytoplasma and pycnosis nucleus. Apoptotic cells and apoptotic body could be found under the transmission electronic microscope. The analysis of cell cycle indicated that oxaliplatin blocked cells at S and G_2/M phases and the cells of G_0/G_1 phase reduced. When treated with oxaliplatin for 72 h, the expression of cyclin A and Bax were up-regulated, mutant type P53, Bcl-2 and Myc down-regulated, and Fas was not changed. Conclusion Oxaliplatin could inhibit proliferation of the hepatoma cell lines. Cell cycle blocked at S and G_2/M phase. The apoptosis were related to the up-regulation of Bax and down-regulation of mutant type P53, Bcl-2 and Myc. It could not induce apoptosis through the Fas approach.

Objective To investigate the role of matrix metalloproteinase-13 (MMP-13) in articular cartilage injury by observing the MMP-13 changes in articular cartilage in rat hindlimb after ischemia/reperfusion (IR). Methods Wistar rat model of left hindlimb IR was used. Fifty-six rats were randomly divided into sham operation group, 8-hour ischemia group, and groups that were reperfused for 3, 7, 14, 30 and 60 d after 8-hour ischemia. Articular cartilages of tibial plateau were taken to study MMP-13 and type Ⅱ collagen (COL Ⅱ) by immunohistochemical method (SP). The pathological changes of articular cartilages also were observed. Results Cartilage matrix was compact in sham operation group and 8-hour ischemia group. Articular facet became rough, cartilage matrix became looser, and chondrocytes were in disorder gradually after reperfusion, especially on day 30 and 60. MMP-13 of cartilages increased significantly in reperfusion groups (P

This paper summarizes 6 cases with multi-fracture of dental instruments in tooth root canal treated in our hospital from June 2011 to July 2013,the creation of a straight pathway,establishment of collateral bypass ,ultrasonic vibration,prevention of root perforation and secondary instrument fracture were emphasized,a reference in dealing with similar situations was provided.

Objective To explore the effect and safety of enhanced recovery after surgery (ERAS) in the surgical treatment of common bile duct stones.Methods According to random number table,48 patients with common bile duct stones were randomly divided into the ERAS group and the control group.The patients of the control group received the traditional perioperative management and laparotomy exploration of common bile duct.The patients of the ERAS group received the ERAS perioperative management and laparoscopic exploration of common bile duct.The preoperative and postoperative level of C reactive protein (CRP),time to out-of-bed activity,time to food taking,time to anal exsufflation,postoperative hospital stay,hospitalization cost and postoperative complications between the two groups were compared.Results Compared with the control group,the ERAS group had lower levels of CRP on the postoperative 1 day and 3 days[d1:(102.6±13.5) mg/L vs.(81.3±17.3)mg/L;d3:(71.8±15.3)mg/L vs.(41.2±11.2)mg/L,t=2.553,3.287,all P<0.05],had shorter time to out-of-bed activity[(3.2±1.8)d vs.(0.9±0.4)d],time to food taking[(4.3±1.9)d vs.(1.8±1.2)d] and time to anal exsufflation[(2.5±0.7)d vs.(1.2±0.3)d],and had shorter operative hospital stay[(7.3±3.2)d vs.(3.8±1.4)d]and less hospitalization cost[(7 200±800)RMB vs.(5 900±700)RMB] (t=5.561,4.319,3.765,2.351,1.671,all P<0.05).The incidence rate of postoperative complications of the ERAS group decreased markedly (61.91% vs.18.52%,x2=25.82,P<0.05).Conclusion ERAS management in the surgical treatment of common bile duct stones is safe and effective,which can enhance the recovery of the patients.

Objective To screen possible factors affecting prognosis of chondrosarcoma.Methods A total of 37 patients with chondrosarcoma,who had undergone surgical treatment from December 2005 to March 2008 in our hospital and had complete follow-up data and definitive pathological diagnosis,were enrolled in this retrospective study.There were 16 males and 21 females,ageing from eleven to eighty-four years (average,42.8 years).The univariate analysis of survival rate was performed with Kaplan-Meier method and tested with the Log-rank test.Chi-squared test or Fisher's exact test were used to analyze numeration data,and then the significant indexes after univariate analysis were performed multivariate analysis with COX regression model to screen the independent factors affecting prognosis.On the basis of literatures,8factors including gender,age,duration of disease,tumor site,Enneking stage,surgical approach,distant metastasis and local recurrence were analyzed.Results Statistical significance was found in Enneking stage,surgical approach and distant metastasis,which indicated that they were related to survival rate 3years after surgery.However,gender,age,duration of disease,tumor site,and local recurrence had no significant correlation with prognosis.After multivariate analysis of Enneking stage,surgical approach,distant metastasis,the results showed that Enneking stage and surgical procedure were the independent prognostic factors,while distant metastasis was not an independent prognostic factor.Conclusion Enneking stage and surgical approach are the independent prognostic factors for chondrosarcoma,which can be used to evaluate prognosis of chondrosarcoma.

Objective To investigate the mechanism of hypoxia regulate osteopontin (OPN) secreting by mature dendritic cells (mDCs). Methods CD14 + cells were enriched using anti-CD14 immunomagnetic beads, for inducing to mDCs, CD14 + cells were cultured with GM-CSF and IL-4 in hypoxia or normoxiain vitro. Concentration of OPN and TGF-β1 in supernatant were detected by sandwich ELISA, OPN mRNA detected by RT-PCR. Approach regulating function of A2 R in expressing of OPN by mDCs by using NECA (surrogate of adenosine), A2R agonist (CGS21680), A2R antagonist (SCH58261) and investigate role of TGF-β1 in this process by using rhTGF-β1 and anti-TGF-β1 Ab. Results Hypoxia inreased the level of OPN and OPN mRNA in mDCs, and this effect could be reversed by A2 R antagonist. Under normoxia,both NECA and A2R agonist (CGS21680) could upregulate the level of OPN and OPN mRNA in mDCs significantly, but this positive effect could be reversed by A2 R antagonist. A2 R played a role in regulating TGF-β1, and confirmed TGF-β1 involved in regulation of OPN by using rhTGF-β1 and anti-TGF-β1 Ab. Conclusion High adenosine induce the generation of TGF-β1 through the A2R on mDCs, and then TGF-β1 raise the OPN secreting by mDCs.

Adverse drug reaction induced by injection of traditional Chinese medicine(TCM) often occurs. Post-marketed re-evaluation of clinical safety in injection of TCM is indispensable,in order to solve the clinical safety problems. It is necessary to conduct Phase 0 clinical trials for containing toxic medicine and injection of TCM. Phase 0 clinical trials, involving very limited human exposure, and using microdose of drugs, are intended to collect the necessary safety and pharmacokinetic data in limited period. Microdose reflects allergies of injection of TCM. Phase 0 clinical trials provide a new method for post-marketed re-evaluation of safety in injection of TCM. Its use depends on whether there is a safety problem for injection of TCM,and the determination of initial dose and sample size are key questions in study design.
Clinical Trials as Topic ; Drug-Related Side Effects and Adverse Reactions ; Humans ; Injections ; Medicine, Chinese Traditional ; adverse effects ; Product Surveillance, Postmarketing

Objective To explore the treatment methods and prognosis of early infection and delayed infection after intramedullary nail fixation.Methods Data of 22 cases of postoperative infections after intramedullary nail from January 2013 to August 2017 were retrospectively analyzed.There were 18 males and 4 females aged from 20 to 72 years old,with an average age of 46.8 years.14 cases were tibias and 8 cases were femurs.In the early infection group,6 cases showed swelling,heat and pain in the affected area with drainage and pus.In the late infection group,12 cases showed sinus formation and 4 cases showed no sinus tract.According to whether the infection occurred within six weeks,it was divided into early infection and delayed infection groups.Of 6 patients in early infection group,there was 1 case of septic shock which underwent removal of intramedullary nails,debridement and antibiotic bone cement stick implantation.5 cases were retained intramedullary nail and underwent local debridement treatment.Late infection occurred in 16 patients.One patient with tibia infection was given partial dressing to heal the fracture.Then the intramedullary nail was removed and intramedullary debridement was performed.Two patients with poor general condition,the intramedullary nails were removed and debridement was performed.Calcium sulphate cement was implanted and fixed with external fixation.The remaining 13 cases were treated with debridement and antibiotic cement stick implantation.We compared the differences between early and late infections of internal fixation,infection control,fracture healing,and secondary fracture fixation.Results Of the 6 patients with early infection,1 patient with septic shock removed intramedullary nails to control infection.After infection controlled,the fracture was treated with intramedullary nailing.Of the 5 patients with retained intramedullary nails,2 patients' infection were controlled and 3 were uncontrolled.After removal of the intramedullary nails the infection was control.The success rate of retaining intramedullary nails was 33.3％ (2/6).Late infection occurred in 16 cases and infection was all controlled.The fractures healed in 22 patients.The fracture healing time of 6 patients with early infection was 2-6 months,with an average of 3.67±2.08 months.The fracture healing time of 16 patients with late infection was 2-4 months (average 3.2±0.79) months.Conclusion Patients with early bone infections after femoral and tibial intramedullary nail surgery may attempt debridement therapy with retained intramedullary nails,but the failure rate is high.If the intramedullary nail fails to remain,follow the treatment of patients with delayed bone infection.For patients with delayed bone infection,because the fracture has not yet healed,thorough debridement is used after the removal of internal fixation,then calcium sulfate or antibiotic bone cement stick should be implanted and fixed with external fixation.For the second phase,we may choose plate,intramedullary nail or external fixation to fix the fractures according to the soft tissue condition.All of the fixation methods could provide good fracture healing.

Objective:To investigate the efficacy of internal fixation maintenance after fracture-related infection (FRI).Methods:Retrospectively analyzed were the data of 81 patients with deep FRI after 6 weeks of internal fixation who had been treated with hardware maintenance at Department of Orthopedics, The Second Hospital Affiliated to School of Medicine, Zhejiang University between 2013 and 2021. They were 61 males and 20 females, aged from 11 to 73 years (average, 11 years). After admission, the patients received bacterial culture, thorough debridement, negative pressure suction, soft tissue repair, and local and intravenous antibiotics. If a joint was affected by FRI, its cavity was cleaned and drained. Infection control and fracture healing were regularly observed in all patients. A treatment was considered successful when the internal fixation was maintained until fracture union, and considered as unsuccessful when the internal fixation was removed before fracture union. Risk factors associated with treatment failure were identified from gender, age, smoking, diabetes, fracture type, methicillin-resistant Staphylococcus aureus (MRSA) infection, methicillin-susceptible staphylococcus (MSSA) infection, Pseudomonas aeruginosa infection, Escherichia coli infection, infection by two kinds of bacteria, negative bacterial culture, early infection (within 2 weeks) and local use of antibiotics.Results:All patients were followed up for an average of 30 months (from 6 to 84 months). Fracture union was achieved in 62 (76.5%) patients with infection control and internal fixation retained. Masquelet technique was used to treat bone defects in 2 patients; a muscle flap or skin flap was used to reconstruct soft tissue coverage in 11 cases; fracture union was achieved by antibiotics and dressing changes in 2 patients with sinus tract. Amputation was performed in one unsuccessful case due to uncontrollable infection, and internal fixation was changed to external fixation in the other 18 unsuccessful cases, of which 3 achieved final bone union after application of Masquelet technique, 7 achieved final bone union after application of bone transfer technique, and 3 achieved soft tissue coverage after reconstruction with flap technique. Pseudomonas aeruginosa infection, open fractures and FRI for more than 2 weeks were high risk factors for failure in internal fixation maintenance ( P<0.05). Conclusions:If internal fixation is still stable and effective, hardware maintenance should be tried first in the patients with FRI within 6 weeks after fracture internal fixation. Muscle flap or skin flap surgery should be performed as soon as possible to effectively control infection and promote fracture union in the patients with soft tissue defects after thorough and effective debridement. History of open fracture, Pseudomonas aeruginosa infection, and FRI for over 2 weeks may be risk factors for failure in internal fixation maintenance.

Accurate classification of the acetabular injuries and appropriate treatment plan are great challenges for orthopedic surgeons because of the irregular anatomical structure of the acetabulum and aggregation of important vessels and nerves around it. Letournel-Judet classification system has been widely applied to classify acetabular fractures. However, there are several limitations, including incomplete inclusion of fracture types, difficulty in understanding and insufficient guidance for surgical treatment, etc. Serious complications such as traumatic arthritis are common due to wrong classification and diagnosis and improper selection of surgical strategy, which brings a heavy burden to the society and families. Three-column classification, based on anatomic characteristics, has advantages of containing more fracture types and being easy to understand, etc. To solve the problems existing in the diagnosis and treatment process based on Letournel-Judet classification, achieve accurate diagnosis and treatment of patients with acetabular fractures, and obtain satisfactory prognosis, the Orthopedic Trauma Emergency Center of Third Hospital of Hebei Medical University and the Trauma Orthopedic Branch of the Chinese Orthopedic Association organized experts from relevant fields to formulate the Expert consensus on the accurate diagnosis and treatment of acetabular fractures based on three-column classification ( version 2023) in terms of principles of evidence-based medicine. Based on the three-column classification, 15 recommendations were proposed, covering the diagnosis, treatment, complication prevention and management, etc, so as to provide reference for accurate diagnosis and treatment of acetabular fractures.