[Objective]To discuss and analyze the effect of the treatment of high-energy Pilon fractures.[Method]Twenty-four patients with R?edi-Allgower type Ⅱ and Ⅲ Pilon fractures(Ⅱ=14,Ⅲ=10) were treated by open reduction and internal fixation.Ten cases were combined with external fixation.Sixteen cases were treated by bone transplantation(spongy bone=10,big pieces of ilium=6).[Result]From June 2003 to December 2007,the restoration of fractures with Burwell-Charnley system was:excellent=16,good=8;the function of ankle joint with Mazur system was evaluated:excellent=12,good=10,fair=2.[Conclusion]In the time of treating Ruedi-Allgower type Ⅱ and Ⅲ Pilon fractures,the bone transplantation with big pieces of ilium is effective to solve the serious bone loss,strengthen the internal fixation and exercise ankle joint earlier.

Objective To discuss the technical factors of extrapleural locating in CT-guided percutaneous pulmonary biopsy. Methods 137 cases undervent CT-guided percutaneous pulmonary biopsy were retrospectively analyzed. The technical methods of operation,points and points for attention were analyzed. Results In this group the success rate of data manipulation was 98.5%. No serious complications of the operation were occured. Scan completed within 40-story biopsy rate was 71.5%. The needle into the target rate for the first time was 93.4%. Conclusion CT-guided biopsy could increase the detection rate of difficult lesions and patient satisfaction rate paying attention on thinking and practice in the preoperative preparation and intraoperative specific operations.

BACKGROUND: Autoallergic ligments is used widely in arthroscopic cruciate ligaments reconstruction. However, the therapeutic effect of the surgery is affected severely by the complication at drawing place of the autoallergic ligaments. OBJECTIVE: To explore the application and therapeutic effect of homologous ligaments in arthroscopic reconstruction of cruciate ligments. METHODS: A total of 60 patients who received homologous ligaments at the Second Department of Orthopaedics, The First Affiliated Hospital of Anhui Medical University from December 2006 to December 2006 were selected, including 42 males and 18 females, aged 20-42 years. Totally 46 cases had anterior cruciate ligament injury, and 14 cases had posterior cruciate ligament injury. All patients received arthroscopic cruciate ligaments construction under arthroscopy. Physical and clinical examination and Lysholm score had been performed prior to and at 6-12 months after construction. RESULTS AND CONCLUSION: A total of 57 cases (60 cases) were followed up 6-21 months. The incision healed well, without serve immunological rejection. Four cases had hematocele-of the articular cavity, which were regressed after puncturing of the articular cavity and packing with compression. All preoperative symptoms got better apparently. The Lysholm score was obvious elevated than that prior to operation (P < 0.05). The results demonstrated that reconstruction of cruciate ligaments with homologous ligments can recovery the stability and knee function, avoid the complications of autografts. It also has advantages in terms of easy operation, small injury and less complication.

Objective To investigate the association of COL4A2 gene polymorphism rs9521733 with lacunar stroke in Xinjiang Han populations.Methods A total of 406 Han lacunar stroke patients and 425 controls enrolled from the First Hospital of Xinjiang Medical University and the 7th Division Hospital of Xinjiang Production and Construction Corps between March 2016 and September 2017 were recruited in the study.Clinical data were collected from all subjects.The improved multiple ligase detection reaction method was used to analyze the genotypes of rs9521733 in the COL4A2 gene.SPSS 17.0 was used for data analysis.Results There was no statistically significant difference in genotype and allele frequency of rs9521733 between case group and control group.Stratification analyses showed that the CC genotype of rs9521733 was associated with a significant increase in risk of lacunar stroke in the group of age ≥≥60 years (adjusted OR =1.950,95％ CI 1.222-3.112,P =0.005).Conclusion The rs9521733 of the COL4A2 gene might be associated with a higher risk of lacunar stroke in the group of age ≥60 years.

Objective To analyze the blind area monitoring and independent image acquisition function of gastroscopic elves ( a real-time gastroscopic monitoring system) in gastroscopy. Methods A total of 38522 gastroscopic images from the database of Digestive Endoscopy Center of Renmin Hospital of Wuhan University were collected to train and validate the gastroscopic elves. Using computer to generate random numbers, 91 gastroscopic videos were selected to assess the position recognition accuracy of the gastroscopic elves, and 45 gastroscopic videos and matching gastroscopic images collected by endoscopists were selected to compare the coverage number and rate of gastroscopy sites between gastroscopic elves and endoscopists image acquisition. Two endoscopists entered the study to perform gastroscopies with or without gastroscopic elves. Forty-five gastroscopies respectively performed by the endoscopist A before and after usage of gastroscopic elves were collected, and 42 gastroscopies divided into 20 and 22 performed by the endoscopist B without use of gastroscopic elves in the same period were also collected. The coverage rate of gastroscopy sites was compared between the two endoscopists. Results The total position recognition accuracy of gastroscopic elves was 85. 125％ ( 1156/1358) . The coverage rate of gastroscopic sites for the endoscopist A was (76. 790±8. 848)％ and (87. 325±7. 065)％, respectively, before and after using gastroscopic elves, and the coverage rate in the same period for the endoscopist B was (75. 926 ±11. 565)％ and (75. 253 ± 14. 662)％, respectively. The coverage rate before using gastroscopic elves had no statistical difference between the two endoscopists (t=0. 324, P=0. 747). The coverage rate for the endoscopist A after using gastroscopic elves was higher than that before using gastroscopic elves ( t=6. 222, P=0. 001) , and that of the endoscopist B in the same period ( t'=3. 588, P=0. 002) . The coverage number and rate of gastroscopy sites for gastroscopic elves and endoscopists image acquisition were 20. 956 ± 3. 406 and ( 77. 613 ± 12. 613)％, and 15. 467 ± 2. 296 and ( 57. 284 ± 8. 503)％, respectively, with statistical differences ( t=11. 523, P=0. 000; t=11. 523, P=0. 000). Conclusion Gastroscopic elves can improve the coverage number and rate of gastroscopy sites, and is worthy of promotion in clinics.

Objective To make the cost-effectiveness analysis of pembrolizumab and platinum chemotherapy as the first-line treatment for advanced non-small cell lung cancer(NSCLC)in the population with tumor proportion score(TPS)≥1%of PD-L1,and provide some reference for the clinical use and future price negotiation of pembrolizumab.Methods Based on Pubmed database,the published RCT literatures of pembrolizumab were analyzed,and the survival data were extracted,combined with the treatment plan of a tertiary hospital,the Markov model were established to simulate the cost and health effectiveness of patients for twenty years,and the stability of the model was tested by one-way sensitivity analysis and probability sensitivity analysis.Results Twenty years later,the cost-effectiveness ratio of pembrolizumab group and chemotherapy group was ￥58 517.60/quality adjusted life month(QALM)and ￥41 213.08/QALM.Compared with the chemotherapy group,the incremental cost effective ratio(ICER)was ￥104 485.36/QALM.Conclusion When the willingness to pay(WTP)value was ￥30 902/QALM,the pembrolizumab therapy was not more cost-effective advantages than platinum chemotherapy,and the sensitivity analysis showed that the results of the model were relatively stable.

Objective:To investigate the effect of albumin to fibrinogen ratio on the prognosis of patients undergoing radical resection for colorectal cancer.Methods:Clinical and pathological data of 216 patients who underwent laparoscopic radical resection of colorectal cancer at the General Surgery Department of Taizhou People's Hospital from Aug 2015 to Jul 2017 were retrospectively analyzed. Albumin and fibrinogen results within 7 days before surgery was collected. The optimal cut-off point of AFR was determined by Youden index of ROC curve. Kaplan-Meier analysis, univariate and multivariate COX regression models were used to analyze the prognostic factors of OS and DFS.Results:The best postoperative OS threshold of AFR for patients undergoing laparoscopic radical resection of colorectal cancer was 9.43. Univariate analysis and multivariate COX regression analysis showed that age ≤65 years, TNM stage Ⅰ-Ⅱ, and AFR≥9.43 had better OS and DFS (all P<0.05). Conclusions:Preoperative AFR level had a good predictive value on postoperative survival of patients undergoing laparoscopic radical resection of colorectal cancer, and AFR<9.43 was an independent risk factor for postoperative OS and DFS.

Background and objective Neoadjuvant chemotherapy is a new development in the treatment of lung cancer. In recent years, cetuximab and celecoxib have been commonly used in this procedure. This study aims to explore the effect of cetuximab combined with celecoxib on apoptosis and KDR and AQP1 expression in lung cancer A549 cells. Method The cells were cultured in RPMI-1640 and then divided into four groups: control group, 1 nmol/L cetuximab group, 25 μmol/ L celecoxib group, and 1 nmol/L cetuximab+25 μmol/L celecoxib group. The treatment time was 48 h. The mRNA and protein expression levels of KDR and AQP1 were detected by RT-PCR and Western blot, respectively. The apoptosis, proliferation, and invasive ability of A549 cells before and after transfection were examined using flow cytometry, MTT, and transwell methods. Results Cetuximab and celecoxib inhibited the growth of A549 cells in a dose-dependent manner. Their combination produced a greater growth inhibition than when either was used alone (P<0.01). Cetuximab and celecoxib both induced the apoptosis of A549 cells, and their combination produced a higher apoptosis rate (P<0.01). Cetuximab in combination with celecoxib also induced G1 phase arrest and downregulated the expression of KDR and AQP1 in A549 cells (P<0.05). As a result, the invasion ability of the A549 cells was significantly decreased. Conclusion Cetuximab in combination with celecoxib can synergistically inhibit the growth of A549 cells and downregulate the expression of KDR and AQP1 in A549 cells. The combination of cetuximab and celecoxib is a potential strategy for lung cancer therapy.

Objective:To construct a real-time monitoring system based on computer vision for monitoring withdrawal speed of colonoscopy and to validate its feasibility and performance.Methods:A total of 35 938 images and 63 videos of colonoscopy were collected in endoscopic database of Renmin Hospital of Wuhan University from May to October 2018. The images were divided into two datasets, one dataset included in vitro, in vivo and unqualified colonoscopy images, and another dataset included ileocecal and non-cecal area images. And then 3 594 and 2 000 images were selected respectively from the two datasets for testing the deep learning model, and the remaining images were used to train the model. Three colonoscopy videos were selected to evaluate the feasibility of real-time monitoring system, and 60 colonoscopy videos were used to evaluate its performance.Results:The accuracy rate of the deep learning model for classification for in vitro, in vivo, and unqualified colonoscopy images was 90.79% (897/988), 99.92% (1 300/1 301), and 99.08% (1 293/1 305), respectively, and the overall accuracy rate was 97.11% (3 490/3 594). The accuracy rate of identifying ileocecal and non-cecal area was 96.70% (967/1 000) and 94.90% (949/1 000), respectively, and the overall accuracy rate was 95.80% (1 916/2 000). In terms of feasibility evaluation, 3 colonoscopy videos data showed a linear relationship between the retraction speed and the image processing interval, which indicated that the real-time monitoring system automatically monitored the retraction speed during the colonoscopy withdrawal process. In terms of performance evaluation, the real-time monitoring system correctly predicted entry time and withdrawal time of all 60 examinations, and the results showed that the withdrawal speed and withdrawal time was significantly negative-related ( R=-0.661, P<0.001). The 95% confidence interval of withdrawal speed for the colonoscopy with withdrawal time of less than 5 min, 5-6 min, and more than 6 min was 43.90-49.74, 40.19-45.43, and 34.89-39.11 respectively. Therefore, 39.11 was set as the safe withdrawal speed and 45.43 as the alarm withdrawal speed. Conclusion:The real-time monitoring system we constructed can be used to monitor real-time withdrawal speed of colonoscopy and improve the quality of endoscopy.

Objective:To establish a deep convolutional neural network (DCNN) model based on YOLO and ResNet algorithm for automatic detection of colorectal polyps and to test its function.Methods:Colonoscopy images and videos collected from the database of Digestive Endoscopy Center of Renmin Hospital of Wuhan University from January 2018 to March 2019 were divided into three databases (database 1, 3, 4). The public database CVC-ClinicDB (composed of 612 polyp images extracted from 29 colonoscopy videos provided by Barcelona Hospital, Spain) was used as the database 2. Database 1 (4 700 colonoscopy images from January 2018 to November 2018, including 3 700 intestinal polyp images and 1 000 non-polyp images) was used for establishing training and verifying the DCNN model. Database 2 (CVC-ClinicDB) and database 3 (720 colonoscopy images from January 2019 to March 2019, including 320 intestinal polyp images and 400 non-polyp images) were used for testing the DCNN model on image detection. Database 4 (15 colonoscopy videos in December 2019, containing 33 polyps) was used for testing the DCNN model on video detection. The sensitivity, specificity, accuracy and false positive rate of the DCNN model for detecting intestinal polyps were calculated.Results:The sensitivity of the DCNN model for detecting intestinal polyps in database 2 was 93.19% (602/646). In database 3, the DCNN model showed the accuracy of 95.00% (684/720), sensitivity of 98.13% (314/320), specificity of 92.50% (370/400), and false positive rate of 7.50% (30/400) for detecting intestinal polyps. In database 4, the DCNN model achieved a per-polyp-sensitivity of 100.00% (33/33), a per-image-accuracy of 96.29% (133 840/138 998), a per-image-sensitivity of 90.24% (4 066/4 506), a per-image-specificity of 96.49% (129 774/134 492), and a per-image-false positive rate of 3.51% (4 718/134 492).Conclusion:The DCNN model constructed in the study has a high sensitivity and specificity for automatic detection of colorectal polyps both in the colonoscopy images and videos, has a low false positive rate in the videos, and has the potential to assist endoscopists in diagnosis of colorectal polyps.