Objective:To evaluate the follow-up clinical results of W-shaped acetabular angular plate for the treatment of acetabular posterior wall fractures through a direct posterior approach (DPA).Methods:Fifteen cases (10 males and 5 females, average aged 42.1±10.0 years) were involved in this study, with acetabular posterior wall fractures treated by using the W-shaped acetabular angular plate through a DPA between March 2017 and June 2019. Nine patients with fractures were injured by traffic accidents and the other 6 cases by falling. Based on the three-column classification for acetabular fractures, all of the cases belonged to posterior wall fractures (A2.1), which included 6 cases of simple fractures and 9 cases of comminuted fractures. The mean time interval between injury and surgery was 5.6±1.1 (range, 4-8) days. The DPA was adopted in all cases. The posterior wall fractures of the acetabulum were reduced and fixed with W-shaped acetabular angular plates. The reduction quality of the acetabulum was evaluated by X-ray and CT scan during follow-up visits according to the criteria proposed by Matta. The function of the hip joint was assessed by the Merle d'Aubigné-Posteal score modified by Matta.Results:The length of the surgical incision was 9.5±1.1 (range, 8-12) cm. The operation time was 45.3±10.1 (range, 35-75) mins. The amount of intraoperative blood loss was 248.0±94.7 (range, 100-380) ml. All the patients who were followed up for 20.5±6.3 (range, 16-38) months. All cases were evaluated according to Matta's reduction quality criteria, the satisfactory ratio of reduction was 100%. Among cases, 10 cases were matched the anatomic reduction, and the other 5 cases have belonged to satisfy. All cases of fractures had healed (the mean of healing time was 9.4±1.3 (range, 8-12 weeks). At the final follow-up visit, the mean of modified Merle d'Aubigne-Postel score was 16.9±1.6 (range, 13-18). Excellent clinical outcomes were obtained in 10 cases, good in 3 cases, and fair in 2 cases. One case had deep venous thrombosis of the lower extremities. The clots disappeared after anticoagulation treatment. One case had the heterotopic ossification, Brooker grade I, without any special treatment due to not affecting the hip joint activity in the follow-up visits. One patient had incision fat liquefaction and the wound healed after intensive dressing change. No internal fixation loosening or losing of fracture reduction was found at the follow-up visits.Conclusion:This study shows that using W-shaped acetabular angular plate for the treatment of acetabular posterior wall fractures through the DPA could obtain early satisfactory clinical outcomes.

Objective:To introduce ulnar shortening oblique osteotomy combined with arthroscopy technique for ulnar impaction syndrome and to evaluate the outcomes.Methods:From August 2012 to January 2015, data of 25 cases with ulnar impaction syndrome who were treated in our hospital with oblique osteotomy of the ulna and internal fixation were retrospectively analyzed. There were 14 males and 11 females with an average age of 32.5±4.9 years old (range, 18-62 years). All 25 cases had wrist triangular fibrocartilage complex (TFCC) injuries. Intraoperative arthroscopy was conducted to investigate the pathologic changes of the articular disk of the triangular fibrocartilage complex (TFCC), chondromalacia of the lunate and triquetrum, and tears of the lunotriquetral interosseous ligament (LTIL), debridement of the synovial membrane and the free edge of the central perforation of TFCC, to remove the cartilage from the lunate and triangular bone, and to perform oblique osteotomy of the ulna and internal fixation after repairing of TFCC ulnar tear. We evaluated the outcomes by means of comparing the postoperative values of modified Mayo and visual analogue scale (VAS).Results:There were 5 cases of IB, 5 of IIA, 7 of IIB, 4 of IIC, 4 of IID according to Palmer's classification. All 25 cases were followed-up for 24.6±1.9 months (range, 12-46 months). All patients achieved bone healing with an average of 14.0±1.9 weeks (range, 12-20 weeks). The mean value of preoperative ulnar variation was 3.8 ±1.5 mm which decreased to -1.5±0.5 mm after operation. The preoperative VAS was 7.8±0.7 which decreased to 1.3±1.5 at the latest follow-up. The modified Mayo value increased from 52.8±15.8 to 83.0±11.2. There were 19 cases with excellent wrist function, 5 good and 1 fair. The excellent-good rate was 96% (24/25). Grip strength value increased from 6.3±1.5 kg preoperative to 12.3±1.9 kg postoperative. There was no postoperative infection, delayed or nonunion of bone, but irritation of steel plate appeared in 10 patients, which disappeared after the removal of the steel plate.Conclusion:Arthroscopy combined with ulnar shortening oblique osteotomy technique for ulnar impaction syndrome can reduce wrist pain, increase hand grip strength, improve the activity of the wrist joint, and the clinical effect is positive.

Objective: To evaluate the outcome of free hypothenar perforator flap, with different vascular perforators, in fingerskin defects repairment. Methods: From April 2014 to September 2016, 15 cases of skin defects on finger were treated with hypothenar perforator flap, based on different vascular perforators.Patients had nerves, vessels, tendons or bone exposure.Defects ranged from 1.5 cm×3.5 cm to 2.0 cm×4.5 cm in size. Fivecases were treated with hypothenar perforator flap based on a cutaneous perforator branch of the ulnar artery, 8 cases were based on acutaneous perforator branch of the ulnar digital artery, 2 cases were based on branch of the superficial volar arch.Donor site was closed directly. Results: Vascular crisis occurred in 3 cases postoperatively, which were rescued by propertreatment. Other 12 transferred free flaps survived uneventfully.After averaged 13.5-month postoperative follow-up (ranging from 3 to 24 months), the appearance of transferred flaps was satisfactory. Flap texture was good with no obvious atrophy. All the fingers had good function.The sensation of flaps recovered to S3, and two-point discrimination was 8-9 mm. The donor site was healed with linear scar. Conclusions The hypothenar perforator free flap was relatively easy to practice.Constant vascular anatomy, the appearance, texture and good functional recovery after hypothenar free flap transferring, suggest this is achoice for repairing small skin defects on finger.

Objective: To compare the pedicled supraclavicular artery island flap (SCAIF) and the pectoralis major myocutaneous flap (PMMF) for oral reconstruction after cancer resection. Methods: This is a retrospective study from May 2007 to May 2017. Sixty-one patients from the Jiangxi University of Traditional Chinese Medicine and the First Affiliated Hospital of Nanchang University, were included. All the patients underwent oral squamous cell carcinoma resection and pedicled flap reconstruction. Sixteen patients were performed SCAIFs (group A), and 45 were performed PMMFs (group B). The flap survival rate, flap size, flap preparation time, the presence of scar hyperplasia, pigmentation and dysfunction (temporary or permanent) were compared between these two groups. Results: The survival rate of flaps in group A was 93.75% (15/16), and the survival rate of flaps in group B was 95.56% (43/45). There was no statistically significant difference in the survival rate of flaps, the average skin flap size or flap produce time between these 2 groups. There were no scar hyperplasia, pigmentation and dysfunction was observed in group A. However, scar hyperplasia (n=11), pigmentation (n=10) and dysfunction (n=12) occurred in group B. The difference was statistically significant (P<0.05). Conclusions This study suggests that SCAIF is more reliable, and brings more satisfied outcome, when compared with the PMMF.

Objective The study compared the clinical outcomes among cleavage stage embryo transfer,two-step embryo transfer and blastocyst transfer in frozen-thawed cycles.To provide the clinical guidance for the patients with repeated implantation failure(RIF) to make a appropriate embryo transfer protocol.Methods In this retrospective study,a total of 252 patients with RIF were undergoing the frozenthawed embryo transfer (FET) treatment.They were divided into cleavage stage embryo transfer group (group A),two-step embryo transfer group (group B) and blastocyst transfer group (group C) according to the transfer protocols.Groups were compared including implantation rate,clinical pregnancy rate,live birth rate,miscarriage rate,multiple pregnancy rate and ectopic pregnancy rate.Results (1) There were no significant differences among three groups in age,infertility duration,infertility type,endometrial preparation protocols and embryo resuscitation rate.The rate of optimal embryo after resuscitation of group B was lower than that of group A (72.46％ vs 81.50％),showing significant differences (P'＜ 0.0125),but no significant difference were found between group B and C (72.46％ vs 77.42％),A and C (81.50％ vs 77.42％) (P'＞ 0.0125).(2) The implantation rate of embryos in group C was significantly higher than that in group A (38.46％ vs 21.61％) (P'＜0.0125),and there were no significant difference between group B and C (26.85％ vs 38.46％),A and B (21.61％ vs 26.85％).The clinical pregnancy rate of group B was significantly higher than that of group A (62.50％ vs 45.09％) (P'＜0.0125),and there were no significant differences between the others.No statistically differences existed in regard to the live birth rate among three groups,but the group B than the group A (50.00％ vs 35.71％),the group B than the group C (50.00％ vs 34.62％) showed an increasing trend.(3) No statistically differences existed in regard to abortion and multiple pregnancy rate among three groups (P ＞ 0.05).No case of ectopic pregnancy occurred in group B and group C,while in the group A,there were 7 cases of ectopic pregnancy.Conclusions For RIF patients,two-step embryo transfer and blastocyst transfer are relatively safe and effective transplants in frozen-thawed cycles compared to cleavage embryo transfer.

Objective To investigate the influence of Addie injection combined with R -CHOP chemotherapy on immune function and quality of life in patients with non -Hodgkin's lymphoma.Methods A total of 76 patients with non-Hodgkin's lymphoma in the People's Hospital of Wenzhou from June 2015 to March 2017 were selected and randomly divided into the control group and the study group according to the digital table , with 38 cases in each group.The control group was treated with R -CHOP chemotherapy ,and the study group was treated with R -CHOP chemotherapy combined with Addie injection .After treatment,the clinical efficacy,toxic and side effects,immune function indicators ( CD3+,CD4+,CD8+,CD4+/CD8+) and quality of life ( KPS) score of the two groups were statistically analyzed.Results The total effective rate of the study group was 86.84％,which was higher than 65.79％ of the control group (χ2 =4.659,P<0.05).The incidence rates of diarrhea (18.42％),vomit and nausea(21.05％),bone marrow inhibition ( 23 .68％) and leukocyte reduction ( 21 .05％) in the study group were lower than those in the control group(42.11％,47.37％,47.37％,42.11％,χ2 =5.050,5.846,4.653,3.897,all P<0.05).There were no statistically significant differences between the two groups in CD 3+, CD4+, CD8+, CD4+/CD8+before treatment ( all P>0.05).After treatment,the CD3+,CD4+and CD4+/CD8+in the study group were higher than those in the control group,and the CD8+in the study group was lower than that in the control group , the differences were statistically significant(t=5.436,8.857,2.515,5.314,all P<0.05).After treatment,the scores of KPS of the two groups were higher than those before treatment(all P<0.05),and the KPS score of the study group was higher than that of the control group[(78.61 ±4.24)points vs.(70.04 ±4.10)points,t=8.957,P<0.05].Conclusion Addie injection combined with R-CHOP chemotherapy in the treatment of patients with non -Hodgkin's lymphoma can effectively improve the immune function of the patients ,reduce the incidence of side effects ,and improve the effect of treatment and the quality of life .

Objective To study the surgical techniques and the clinical curative ettect of the reconstruction of adjacent large finger pulps with the modified sensate free proximal ulnar artery perforator flap.Methods From February,2013 to May,2016,20 fingers in 10 patients with adjacent large finger pulp defects crossing the DIP joint were reconstructed by the modified senate free proximal ulnar artery perforator flap.All the pulps of every patient were recovered by 1 flap in the first stage and the artificial syndactyly of two digits was divided in 7 weeks after the flap transfer in the second stage.In order to reconstruct the sensation of two pulps in each patient,firstly both of the proximal and distal ends of the cutaneous nerve in flaps were dissected and anastomosed with the most lateral and medial palmar digital nerves of two adjacent fingers respectively,which were divided into 2 groups.Secondly the cutaneous nerve in the middle part of flap was cut and the two ends were anastomosed with the other two palmar digital nerves in the second surgery.There were 8 fingers in 4 patients with the index and middle finger pulp defects,12 fingers in 6 patients with the middle and ring finger defects.The flap size was from 5.0 cm×3.5 cm to 5.5 cm×4.0 cm,and the perforator artery was anastomosed with the palmar digital artery in 6 cases and with the joint branch of digital artery in 4 cases.Results Nine flaps survived uneventfully except the venous congestion was found in 1 flap which was salvaged successfully by acupuncture bleeding.Also,no congestion or ischemia of all the 20 pulp flaps occurred right after releasing the artificial syndactyly.The time of followed-up was from 11 months to 32 months with the average of 17 months after the second surgery.The static two point discrimination of the 2 groups of the sensate pulp flap was (7.3 ± 1.2) mm and (8.6 ±2.4) mm respectively.There was no significant difference between groups (P ＞ 0.05).These 20 pulp flaps were also assessed by the Semmes-Weinstein monofilament test with the result of diminished light touch in 14 pulps and diminished protective touch in 6 pulps.The total active motion in all 20 fingers was (248.0±4.5) °.No patients suffered cold intolerance and local pain but 1 had hypersensitiveness in the pulp flap.Conclusion The modified sensate free proximal ulnar arte~ perforator flap is a practical alternative for the reconstruction of two large adjacent pulps with satisfactory functional and aesthetic outcomes.

Objective: To compare the short-term and long-term outcome between robotic gastrectomy and laparoscopic gastrectomy. Methods: The clinical data of 517 patients who had received robotic gastectomy and laparoscopic gastrectomy between December 2011 and December 2013 at Department of General Surgery, Chinese People′s Liberation Army General Hospital was collected. After propensity score matching, 70 patients in robotic gastectomy and 70 patients in laparoscopic gastectomy were identified. Perioperative outcome and overall survival were compared between the two groups using t test, χ² test, Kaplan-Meier curve and Log-rank test, respectively. Prognosis factors were analyzed by Cox′s proportional hazards regression. Results: There were comparable baseline characteristics between patients in robotic group (RG) and those in laparoscopic group (LG). The conversion rate for RG and LG were 5.7% and 4.3% respectively (P=1.000). Compared with LG, RG had similar lymph node retrieval (25.5±7.2 vs. 24.5±8.3, t=0.770, P=0.443) and less blood loss ((147.0±96.8) ml vs. (188.0±111.2) ml, t=-2.326, P=0.021). There were also similar complications (χ²=0.233, P=0.629) and severity of complications (W=70.500, P=0.053). Although there tended to be early mobility, early flatus and less hospital stay for patients in RG group, the difference between RG and LG was not statistically significant. The 3-year survival rate was 72.9% and 60.0% for patients in RG and patients in LG (P=0.578). Multivariable analysis revealed gender (HR=2.529, 95% CI: 1.042 to 6.140, P=0.040), neoadjuvant chemotherapy (HR=0.272, 95% CI: 0.104 to 0.710, P=0.008) and vascular invasion (HR=2.135, 95% CI: 1.027 to 4.438, P=0.042) were independent prognostic factors. Conclusion Compared with laparoscopic gastrectomy, robotic gastectomy could achieve similar short-term and long-term outcomes.

Objective To evaluate the clinical outcome of the method of repairing donor site of foot after improved toe-to-thumb reconstruction utilizing superficial circumflex iliac artery perforator (SCIAP) chimeric flap.Methods Fourteen cases of thumb defect were recruited from April,2012 to January,2016.According to Gu Yudong's classification,5 cases met the criterion of type Ⅰ,4 cases met the criterion of type Ⅱ,and 5 cases met the criterion of type Ⅲ.For type Ⅰ,the thumb was reconstructed with the great toe wrap-around flap.For type Ⅱ and Ⅲ,the thumb was reconstructed by the combined tissue with mutual artery (great toe wrap-around flap,and the bonetendon tissue of the second toe).All the donor sites of foot were repaired utilizing SCIAP chimeric flap.Results All the reconstructed thumbs survived.Among 14 free flaps of donor site,1 case suffered venous crisis and survived after exploration and rescue surgery.Dorsal skin necrosis of the second toe was found in 1 case,which was healed by local skin flap transposition.All patients were followed-up ranged from 3 to 30 months (averaged at 16 months).In spite of slightly bloated,the color and texture of all the flaps' was satisfied,and the average healing time of the bone in the donor sites was 2.5 months.All patients did not feel painful and had no adverse effect when walking and running.Three months after the operation,5 slightly bloated flaps in the donor sites under went flap plastic and achieved better appearance.On the part of iliaca,there was only one inconspicuous linear scar without any discomfort.Conclusion Repairing donor site of foot after improved toe-to-thumb reconstruction utilizing SCIAP chimeric flap was an ideal method.Using this method,the reconstructed thumb can achieve good appearance and function,all the toes of donor site were reserved,and the disability of the donor site is minimized.

Objective To establish a high performance liquid chromatography method for the determination of matrine in Lefu oral liquid .Methods The HPLC method was performed on a Diamonsil Platisil NH2 column (4 .6 mm × 250 mm ,5μm) with the mobile phase of acetonitrile-isopropyl alcohol-3% phosphoric acid solution (84 ∶ 4 ∶ 12 ) . The flow rate was 1 .2 ml/min .The sample injection volume was 5 μl .The detective wavelength was 205 nm .Results The calibration curve of matrine showed good linear response ranged from 54 .50 to 872 .00 μg/ml with r=0 .999 1 .The average recovery of spiked samples for matrine was 99 .82% while the relative standard deviation for repetitions was 1 .12% .Conclusion The method was simple ,reliable and repeatable ,which could be used for the quantitative determination of matrine of Lefu oral liquid .