Objective To compare the clinical outcomes of percutaneous cannulated lag screws versus posterior buttress plate in the fixation for posterior malleolar fractures.Methods We reviewed the 167 patients who had been treated between January 2010 and December 2014 for ankle fracture involving larger than 25％ of the articular surface of the posterior malleolus.They received posterior malleolus fixation with percutaneous cannulated lag screws or with a buttress plate.In the cannulated screw group (84 patients),there were 47 males and 37 females,aged from 23 to 72 years (average,49.7 ±9.1 years),and 39 cases of type B and 45 ones of type C according to the Dennis-Webber classification.In the buttress plate group (83 patients),there were 38 males and 45 females,aged from 31 to 69 years (average,52.3 ± 8.3 years),and 45 cases of type B and 38 ones of type C according to the Dennis-Webber classification.At 6 and 12 months postoperation and the final follow-up,the ankle motion was evaluated using American Orthopaedic Foot and Ankle Society (AOFAS) score and range of motion (ROM).Results The average operation time for the cannulated screw group was significantly shorter than for the buttress plate group (Z =-9.145,P ＜ 0.001).No fracture nonunion,reduction loss or incision infection happened in either group.In the cannulated screw group,we detected malunion with a step-off beyond 2 mm in 5 patients,and penetration of one cannulated lag screw into the tibiofibular syndesmosis in 3 patients.In the buttress plate group,we detected toe flexion contracture in 4 patients,and uncomfortable feeling in ankle motion in 7 patients.At the final follow-up,X-rays and CT scans in the 2 groups showed no obvious post-traumatic osteoarthritis of the ankle.There were no significant differences between the 2 groups regarding the AOFAS scores at 6 and 12 months postoperation and the final follow-up(P ＞ 0.05);the AOFAS scores at the final follow-up for all the patients were significantly different from those at 6 and 12 months postoperation (P ＜ 0.05).At the final follow-up,there were no significant differences between the 2 groups regarding ROMs of dorsal flexion,plantar flexion,varus or valgus (P ＞ 0.05).Conclusions As there are no significant differences between the percutaneous cannulated lag screws and posterior buttress plate in AOFAS score and ROM of the ankle after fixation for posterior malleolar fractures,the 2 fixation methods can both achieve good clinical outcomes.Fixation with cannulated lag screws has advantages of indirect reduction and minimal invasion but also a disadvantage of uncertain quality of reduction;fixation with buttress plates has an advantage of anatomical reduction under direct vision but also shortcomings of relatively large invasion and high cost.

Objective To investigate the prognostic factors of gastrointestinal stromal tumors.Methods From Nov.1999 to Dec.2006,a total of 85 patients were diagnosed by postoperative pathology as gastrointestinal stromal tumors.The relationship between the prognosis of GIST and demographic factors、tumor location、operation style、preoperative metastasis、lymphadenectomy、grading of Fletcher were analyzed retrospectively.Results The 1 year、3 year and 5 year survival rate of these 85 patients were 94%,60%,57%respectively,Univariate analysis indicated that tumor location、operation style、grading of Fletcher and preoperative metastasis were significant predictors of survival(P<0.05),while demographics and lymphadenectomy were not statistically related with prognosis.Multivariate analysis showed that preoperative metastasis was the independent factor predicting the prognosis(P=0.020,β=4.226).Conclusion Radical surgical excision is still the therapy of choice for primary gastrointestinal stromal tumors.Preoperative metastasis is the independent factor predicting poor prognosis,therefore early diagnosis and treatment are very important for GIST.Fletcher grading is also a simple recalls to predict the prognosis of GIST.

OBJECTIVETo analyze the prognostic factors in elderly patients with acute myeloid leukemia (AML).

METHODSThe clinical data of 211 AML patients with age 55 years or over and treated in Shanghai Jiaotong University Medical School affiliated Ruijin Hospital from 2007 to 2011 were collected and analyzed. Multivariate and univariate analysis of clinical data were performed using a Cox regression model and log-rank test, including age, subtype, performance status, white blood cell count, serum LDH and albumin level, and treatment strategy.

RESULTSAcute promyelocytic leukemia (APL) patients had longer survival than other subtypes. To rule out the impact of APL on the prognostic analysis, we conducted multivariate and univariate analysis excluding APL patients. The significant parameters of the univariate analysis were age (P = 0.003), achieving remission (P < 0.01), performance status (P < 0.01), organ dysfunction (P < 0.01), increased WBC counts (P = 0.022), increased LDH level (P = 0.006) and low albumin level (P < 0.01). Multivariate analysis showed that only failure of achieving remission (P < 0.01), poor performance status (ECOG 3-4) (P < 0.01) and increased WBC counts (P < 0.01) were independent prognostic factors. The patients aged 70 years or over had poor overall survival, and no significant difference of OS was observed among patients with age between 55 and 69 years. For patients aged 55 - 69 years received either DA/IA or CAG treatments had longer survival than those with palliative treatments. For those aged 70 years or over, only patients with CAG treatment had significantly longer survival than palliative treatment. For the patients with age less than 70 years and achieving complete remission after induction, intermediate-dose cytarabine consolidation might not improve survival.

CONCLUSIONElderly AML patients should be treated individually. The intermediate-dose cytarabine consolidation might not improve survival of elderly AML patients.

Aged ; Aged, 80 and over ; Female ; Humans ; Leukemia, Myeloid, Acute ; diagnosis ; drug therapy ; Male ; Middle Aged ; Survival Rate

BACKGROUNDMost indices for evaluating a diagnostic test can be expressed as functions of sensitivity (SEN) and specificity (SPE). Practically, all existing methods suffer from the inability to weight sensitivity and specificity relative to their importance. In this paper, we developed a novel index, the weighted Youden index, that allows Youden index to be a combination of sensitivity and specificity with user-defined weights.

METHODSThe weighted Youden index Jw is defined as Jw = 2(w×SEN + (1-w)SPE)-1 (0 ≤ w ≤ 1). It has three properties: (1) the sum of the weights which are attached to sensitivity and specificity should be equal to 1; (2) the range of Jw should be within [-1, 1], which is the range of the Youden index J; (3) Jw should be equal to J when sensitivity and specificity have equal weights. According to the central limit theorem, we obtain the standard error of Jw, and propose a statistical inference method to compare two weighted Youden indices. The monotonicity of the test statistic was discussed.

RESULTSAn example of comparing two diagnostic tests for pheochromocytoma was used to demonstrate the weighted Youden index method. Weighted Youden index, the confidence interval for each test and the hypothesis test of comparing two independent diagnostic tests were presented. Assigning the weights is essential to the weighted Youden index approach.

CONCLUSIONThe weighted Youden index can broaden its applications in diagnostic test development and motivate further research in weighting sensitivity and specificity explicitly.

Diagnostic Tests, Routine ; Humans ; Models, Theoretical ; Sensitivity and Specificity

Ligustrazine, one of the major effective components of the Chinese traditional medicinal herb Ligusticum Chuanxiong Hort, has been reported plenty of biological activities, such as protect cardiovascular and cerebrovascular, neuroprotection and anti-tumor, et al. Because of its remarkable effects, studies on structural modification of ligustrazine have attracted much attention. Ligustrazine synthetic derivatives reported in recent decades are mainly derived from four primary intermediates (TMP-COOH, TMP-OH, TMP-NH2, HO-TMP-OH). To explore the neuroprotection activitiy of ligustrazine intermediates, six ligustrazine intermediates (2, 5, 8, 11, 12, 13) were synthesized and their protective effects against CoCl2-induced neurotoxicity in differentiated PC12 cells were studied. The target compounds were prepared via different chemical methods, including oxidation, substitution, esterification and amidation without changing the structure nucleus of ligustrazine. Compared with TMP (EC50 = 56.03 micromol x L(-1)), four compounds (2, 5, 12 and 13) exhibited higher activity (EC50 < 50 micromol x L(-1)) respectively, of which, compound 2 displayed the highest protective effect against the damaged PC12 cells (EC50 = 32.86 micromol x L(-1)), but target compounds 8 and 11 appeared lower activity (EC50 > 70 micromol x L(-1)). By structure-activity relationships analysis, the introduction of carboxyl, amino to the side chain of ligustrazine and appropriately increase the proportion of ligustrazine may contribute to enhance its neuroprotective activity, which provides a reference for the design, synthesis and activity screening of relevant series of ligustrazine derivatives in the future.
Animals ; Cell Differentiation ; drug effects ; Chemistry Techniques, Synthetic ; Cobalt ; toxicity ; Drugs, Chinese Herbal ; chemistry ; Neuroprotective Agents ; chemical synthesis ; chemistry ; pharmacology ; Neurotoxins ; toxicity ; PC12 Cells ; Pyrazines ; chemical synthesis ; chemistry ; pharmacology ; Rats

Objective To evaluate the feasibility and efficacy of percutaneous nephrolithotomy (PCNL)in treating renal calculi.Methods The data of 118 patients with renal calculi who had underg- one PCNL from July 2002 to August 2004 were retrospectively analyzed.There were 86 men and 32 women. The mean age was 39 years(range,7-68 years).Of the 118 cases,11 had pelvic calculi,16 had calyx cal- culi,35 had pelvocalyceal calculi,54 had staghorn calculi,and 2 had bilateral renal calculi.The mean stone size was 2.5 cm?1.5cm(ranged from 2.0 cm?1.0 cm to 4.5cm?4.0cm).Results Of the 118 ca- ses,112 underwent one-stage PCNL,and 6,two-stage PCNL.The procedure was performed by single tract in 114 cases,and by two tracts in 4 cases.Lithotomy was done by one session in 60 cases,by 2 sessions in 42 cases,and by 3 sessions in 16 cases.The total stone clearance rate was 81.4%.The mean operative time was 120 min,and mean hospital stay was 15 d.No blood transfusion was needed during operation,and only one patient experienced bleeding(about 500 ml)after 4 d postoperatively,and was cured by conservative treat- ment such as blood transfusion and anti-inflammation.No major complications were observed in other pa- tients.Conclusions PCNL has advantages of minimal trauma,less blood loss,fewer complications,and is safe and effective in treating renal calculi,especially for patients who will have the second procedure.

Objective To investigate the clinical value of multidisciplinary team collaboration (MDT)for the treatment of hip fractures in elderly patients.Methods A total of 157 elderly patients with hip fractures meeting inclusion and exclusion criteria were admitted into our department from 1st September 2015 to 31st December 2017.The patients were randomly divided into the traditional treatment group and the MDT group.The differences in treatment time,cost,postoperative outcomes and postoperative Harris hip function score were compared between the two groups.Results The preoperative length of stay,total hospitalization time and the time of antibiotic use after operation were shorter in the MDT treatment group than in the traditional treatment group (all P ＜0.05).Total costs of treatment and costs for bed,laboratory examinations,and nursing were lower in the MDT treatment group than in the traditional treatment group(all P＜0.05).The off-bed activity time after operation was earlier in the MDT treatment group with femoral neck fractures [(5.36 ± 1.56)d vs.(10.07±2.26)d,P =0.002]than in the traditional treatment group with intertrochanteric fracture patients [(30.26 ± 3.01) d vs.(42.28 ± 3.52) d,P =0.017].Harris hip function score was higher in the MDT treatment group than in the traditional treatment group at 3 and 6 months after surgery (P ＜ 0.05).Conclusions As compared with the traditional treatment mode,MDT treatment mode can shorten the preoperative stay in bed,the length of hospital stay after surgery and the off-bed activity time after operation,reduce hospitalization costs and postoperative complications,and can promote the recovery of hip joint function in elderly hip fracture patients.

Objective To compare the subjective satisfaction of the free radial forearm flap (FRFF) and anterolateral thigh flap (ALTF) of the donor site after surgical reconstruction for tongue cancer. Methods A total of 121 consecutive patients underwent FRFF or ALTF reconstruction after ablative surgery for untreated, primary tongue squamous cell carcinoma at Tianjin Stomatological Hospital and Peking University School and Hospital of Stomatology from August 2011 to October 2014 were enrolled in this study. The subjective satisfaction of the donor site, including sensibility, movement disabilities, cosmetics, social activities and general impacts on the quality of life (QOL), was assessed by a self-established donor site morbidity questionnaire from October 2016 to January 2017. Results Of the 121 patients, 34 died because of cancer or other diseases, 2 were excluded because of recurrence after reconstruction surgery, 11 lost to contact, and 74 (61.2％) completed the questionnaires finally, which included 39 patients in FRFF group and 35 patients in ALTF group. The scores for sensibility, cosmetics, general impacts on the QOL and composite score were significantly higher in ALTF group than those of FRFF group (P<0.05). No significant differences were found in the movement disabilities and social activities between the two groups (P > 0.05). Conclusion ALTF has the advantage of better results of donor site morbidity, less adverse effect on the general QOL, and higher subjective satisfaction.

Objective To investigate the changes and characteristics of body mass index (BMI) of low birth weight infants during catch-up growth within 24 months of life. Methods Using the birth cohort method, 126 low birth weight children (birth weight less than 2 500 g) among the registered and permanent born in Jiading District from January 2016 to December 2016, were enrolled in the study voluntarily.According to the calculation of birth weight and gestational week, 73 children were included in the preterm appropriate for gestational age group and 53 in the full-term small for gestational age group.105 children with gestational age of 37-41 weeks and birth weight of 2 500-3 999 g were included as the control group.The differences of BMI mean and standard deviation were compared between 0-24 months old in three groups, and the changes of BMI curve analyzed between 0-24 months old in boys and girls. Results ① There were 231 infants investigated, who were composed by 111 boys and 120 girls; ② The BMI of the two groups of low birth weight infants at birth and at 2 months old were lower than those of the control group.There was no significant difference between the BMI of preterm appropriate for gestational age group and the control group since the age of 4 months.The BMI of the term small for gestational age group was less than the other two groups between 4 and 18 months of age, the difference was statistically significant (P < 0.05);③ The BMI index of the three groups showed a rapid rise after birth.It peaked at 4-6 months of age, and the BMI value of 7-9 months of age began to fall.Preterm appropriate for gestational age group infants caught up with the BMI of normal-weight infants at 6 months of age.Until the age of 24 months, the BMI of small for gestational age group was still different from normal weight infants, but the difference between the three groups decreased.The rising curves of BMI between boys and girls were similar, but the peak of preterm appropriate for gestational age group girls was lengthened. Conclusion There is a significant catch-up growth for low birth weight infants aged 0-24 months, having a similar trend of normal infants in the late stage.It is necessary to deliver proper breeding education and intervention to the low birth weight infants in their early stages.

Objective To investigate the effect of exogenous kallikrein on apoptosis of the neurons aroundthe cerebralinfarctareain rats. Methods Thirty rats wjth cerebral infarction induced by middle cerebral artery occlusion(MCAO)were assigned randomly into 3 groups(n=10),namely the blank control group,saline group,and pAdCMV-HTK group.In the pAdCMV-HTK group,kallikrein gene was delivered into the cerebral ischemie lesion via a replication-defective adenovims using stereotaetic injection technique, and the expression of exogenous kallikrein was detected immunohistoehemically.TUNEL staining was performed to evaluate the neuronal apoptosis around the infarct area,and RT-PCR used to detect the mRNA expressions ofbcl-2,bax and caspase-3 in the brain tissues. Results At 24 h aftertreatment there were some HTK expressed cells found in group C and peal(at 72 h after treatment.While compare with group B and group C,there existed significant difference(112±6.1,68±4.2,59±3.9,P<0.05).At 72 h after treatment,the NSS of group C was significantly lower than that ofgruop B and A(6.70±0.16,8.13±0.16,7.93±0.20,P<0.05);7 days after the treatment,the difference was more significant(5.14±0.18,7.82±0.14,7.91±0.10,P<0.01).Apoptotic cells were mostly seen around the infarct area.The ratsinpAdCMV-HTK group showed significantly reduced number of cells positive for TUNEL staining as compared to those in the saline and blank control groups at 3 days(10.1±0.9,16.7±1.1,and 20.4±0.8,respectively)and 7 days after the treatment(15.2±1.2,33.6±1.3,and 28.8±1.7,respectively)(P<0.05).The mRNA levels ofbc1-2.bax and caspasc-3 were elevated in all the groups at 24 h,peaked at 72 h,and decreased gradually till 7 days alter the treatment.Compared with those in the other two groups，bcl-2 mRNA level in the pAdCMV-HTK group increased slightly P>0.05) while bax and caspase-3 mRNA levels decreased markedly(P<0.05) 72 h and 7 days after the treatment.Conclusion Kallikrein can inhibit neuronal apoptosis around the cerebral infarct and improve the neurological fimction of rats following cerebral infarction probably by reducing the expressions of such apoptotic factors as bax and caspase-3.