BACKGROUND:No method is ideal for treating traumatic avascular necrosis of talus up to now.Extracorporeal shock wave therapy(ESWT)is a micro-traumatic,simple,and effective method to treat musculoskeletal diseases;however,the therapeutic effect on necrosis of talus needs to be further studied.OBJECTIVE:To evaluate the therapeutic effect of liquid-electric extracorporeal shock wave on traumatic avascular necrosis of talus,and to explore new treatments of traumatic avascular necrosis of talus METHODS:A total of 34 patients with traumatic avascular necrosis of talus were selected from the Affiliated Hospital of Medical College of Chinese Armed Police Force from September 2004 to June 2009.The patients were randomly divided into ESWT and control groups,with 17 patients per group All patients were treated with pain point positioning combined with surface X-ray localization,theworking voltage of 8-10 kV,energyflowdensity of 0.12-0.16mJ/mm2,impact frequency of 40-50 times/min,and impact of 800-1000 times,once a week,for 3-5 cycles.Pain was evaluated with VAS before and after treatment,function of ankle was evaluated with AOFAS standards,and MRI of ankle was re-checked at 18 months after treatment to compare necrotic area before and after treatment.RESULTS AND CONCLUSION:VAS pain,function of ankle,and necrotic area of ankle in the ESWT group were significantly improved compared to those in the control group at 18 months after treatment(P<0.01).Activity of one case in the control group was limited by severe pain due to traumatic arthritis in the first 15 weeks after ankle arthrodesis surgery.This suggested that significant effect and fewer complications,for treating traumatic avascular necrosis of talus.

Nitrite oxidoreductase(NXR) is the key enzyme responsible for the oxidation of NO2-to NO3-in nitrite-oxidizing bacteria.Since NXR is a dissoluble enzyme,located at the inner side of the membranes of cells,its function is dependent on the electron transfer chain related to membranes.This paper reviews the advances in study on NXR,including the structure,catalysis mechanism and the impact of different factors.New techniques applied in recent studies and research prospects are also presented.

Objective:To evaluate the clinical efficacy of self-made Liangxue-Qingfei Decoction combined with conventional western medicine in the treatment of rosacea with excessive heat in lung and stomach. Methods:312 patients with rosacea in Longfu hospital from May 2017 to May 2019 were selected and randomly divided into two groups, 156 cases in each group. The control group was treated with Doxycyclane Hyclate Tablets combined with Metronidazole Gel The study group was additionally given self-made Liangxue-Qingfei Decoction on the basis of the control group. Both groups were treated for 4 weeks. Dermatology Life Quality Index (DLQI) was evaluated . The erythema index (EI) of lesion area was measured by multi-functional skin tester. The adverse reactions during the treatment were recorded and the clinical efficacy was evaluated. Results:The total effective rate was 80.8% (126/156) in the study group and 66.7% (104/156) in the control group, with statistically significance ( χ2=8.012, P=0.005). After the treatment, the scores of physiology, psychology, family, social activities, interpersonal and occupational restrictionsin, and treatment in the study group were lower than those in the control group ( t=17.942, 15.794, 19.465, 21.586, 31.375, 27.472, P<0.001); EI (619.69 ± 71.53 vs. 822.97 ± 89.47, t=32.348) was lower than that of the control group ( P<0.01). During the treatment, the incidence of adverse reactions was 4.5% (7/156) in the control group and 5.8% (9/156) in the study group, and there was no significant difference between the two groups ( χ2=0.439, P=0.514). Conclusion:The self-made Liangxue-Qingfei Decoction combined with routine western medicine therapy can effectively improve the clinical symptoms and quality of life of rosacea patients with lung and stomach excessive heat, improve the clinical efficacy with safety.

Objective:To explore the clinicopathological factors in node-negative colon cancer patients with synchronous liver metasta-ses and to improve the efficiency of follow-up and rate of early diagnosis for high-risk patients. Methods:Clinical data of 140 colon cancer patients who underwent operation from January 2008 to December 2012 in Beijing Cancer Hospital were analyzed. The high-risk variables associated with synchronous liver metastases were subjected to univariate and multivariate analyses. Results:Synchro-nous liver metastases developed in 13 out of the 140 node-negative colon cancer patients. Eight out of those 13 patients (61.5%) ex-hibited complications with incomplete colon obstruction, and 6 cases underwent surgical treatment for both primary tumor and liver metastases. Both univariate and multivariate analyses revealed that preoperative abnormal serum carcinoembryonic antigen levels (≥5 ng/mL) and vascular invasion were significant independent risk factors for synchronous liver metastases. Conclusion:The risk of syn-chronous liver metastases for colon cancer patients with negative lymph node is slightly high. Vascular invasion and abnormal preoper-ative CEA levels are significant independent risk factors for synchronous liver metastases. Specific examination of livers is necessary for the special cohort at the time of diagnosis or after operation to avoid misdiagnosis.

Objective To investigate the clinical efficacy of laparoscopy-assisted radical gastrectomy for gastric cancer.Methods The retrospective cohort study was adopted.The clinical data of 210 patients with gastric cancer who underwent laparoscopy-assisted radical gastrectomy at the Peking University Cancer Hospital between May 2009 and December 2012 were collected.Fifty-two,43 and 115 patients were respectively detected in stage Ⅰ,Ⅱ and Ⅲ of postoperative pathological stage.Laparoscopy-assisted radical distal,proximal and total gastrectomies were selectively performed according to the location and extent of tumors.(1) Overall treatment indicators were observed,including surgical procedure,with or without conversion to open surgery,operation time,volumes of intraoperative blood loss and transfusion,number of lymph node dissected,time to anal exsufflation,duration of hospital stay,occurrence of complications,radical degree of tumors of pathological examination.(2) Other indicators were observed,including pathological features of patients in stage Ⅰ,Ⅱ and Ⅲ [gender,age,body mass index (BMI),scores of American Society of Anesthesiologists (ASA),medicinal complication,location of tumors,degree of tumor differentiation and with or without vascular tumor thrombi],intraoperative and postoperative situations (surgical procedure,conversion to open surgery,operation time,volumes of intraoperative blood loss and transfusion,number of lymph node dissected,time to anal exsufflation,duration of hospital stay and radical degree of tumors),postoperative complications,reoperation,death within postoperative day 30 and during follow-up,3-and 5-year survival rates.(3) Evaluation criteria:stages and classification of tumors were evaluated according to the tumor node metastasis (TNM) classification of malignant tumours (Seventh Edition) published by American Joint Committee on Cancer (AJCC) and Union for International Cancer Control (UICC).Severity of complications was evaluated according to Clavien-Dindo classification.Patients were followed up by outpatient examination,telephone interview and correspondence once every half a year up to December 31,2015,abdominal / pelvic CT,chest X-ray and blood test were performed once every half a year within 2 years and once every year within 2-5 years postoperatively,and gastroscopy was performed once every year.Overall survival time was counted from operation date to end of follow-up or time of death.Measurement data with normal distribution were presented as x ± s and comparison between groups was analyzed using the ANOVA.Measurement data with skewed distribution were presented as M (range) and comparison between groups was analyzed using nonparametric test.Comparisons of count data were analyzed using the chisquare test.Survival curve was drawn by the Kaplan-Meier method,and survival analysis was done using the Logrank test.Results (1) Overall treatment:all the 210 patients underwent successful radical gastrectomy,including 100 undergoing distal gastrectomy,35 undergoing proximal gastrectomy and 75 undergoing total gastrectomy.There were 198 patients undergoing radical gastrectomy and 12 patients converted to open surgery.Operation time,volume of intraoperative blood loss,number of patients with blood transfusion and number of lymph node dissected were (258 ± 54) minutes,(103 ± 86) mL,19 and 29 ± 12,respectively.Postoperative recovery:time to anal exsufflation and duration of hospital stay were (3.8 ± 0.9) days and (17 ± 7) days.Fortyfive patients had postoperative complications and 2 were dead within 30 days postoperatively.R0 and R1 resections were respectively applied to 209 and 1 patients.(2) Comparisons among the patients with the different pathological stage:numbers of patients in stage Ⅰ,Ⅱ and Ⅲ were 9,17 and 36 with tumor located in the upper stomach,3,9 and 22 with tumor located in the middle stomach,40,16 and 47 with tumor located in the lower stomach,0,1 and 10 with tumor located in the cross-region stomach,30,23 and 23 in G1 and G2 of tumor differentiation,21,19 and 92 in G3 and G4 of tumor differentiation,7,13 and 69 with vascular tumor thrombi,respectively,with significant differences in above indicators among the patients in stage Ⅰ,Ⅱ and Ⅲ (x2 =25.990,32.928,35.027,P ＜ 0.05).(3) Intra-and post-operative comparisons among the patients with the different pathological stage:numbers of patients in stage Ⅰ,Ⅱ and Ⅲl were respectively 40,20 and 40 with distal gastrectomy,3,8 and 24 with proximal gastrectomy,9,15 and 51 with total gastrectomy,and number of lymph node dissected were 26 ± 9,29 ± 13 and 31 ± 12 in patients with stage Ⅰ,Ⅱ and Ⅲ,showing significant differences in above indicators among the patients in stage Ⅰ,Ⅱ and Ⅲ (x2 =25.730,F =4.336,P ＜ 0.05).(4) Numbers of patients with postoperative overall complications were 11,8 and 26 in stage Ⅰ,Ⅱ and Ⅲ,showing no significant difference (x2 =0.301,P ＞ 0.05).(5) Of 210 patients,203 were followed up for a median time of 43 months (range,1-80 months) with a follow-up rate of 96.67％ (203/210).Sixty-eight patients were dead till the end of follow-up,including 60 died of recurrence of tumor,2 died of surgical complications and 6 died of other causes.Postoperative 3-,5-year overall survival rates were 96.1％,87.8％,62.4％ and 92.9％,77.5％,52.7％ in patients with stage Ⅰ,Ⅱ and Ⅲ,respectively,with a significant difference (x2 =29.071,P ＜ 0.05).Conclusion Laparoscopy-assisted radical gastrectomy for advanced gastric cancer is at least equivalent to early gastric cancer in the safety,with the satisfactory long-term outcomes.

Objective To evaluate the clinical effect of long incision and reticular incision in the treatment of osteofascial compartment syndrome(OCS)in children.Methods The study involved 56 children with OCS who met failure of the conservative treatment.The injury sites included mainly the forearm and the leg.All the children underwent decompression by a small reticular incision procedure from January 2000 to May 2009.The fractures were treated with one stage reduction and fixation or second stage open reduction.Meanwhile,the study involved another 21 children(including 13 earthquake victims)who were treated with long incision for open decompression in the other hospitals before admission.All the wounds were healed by direct suture or dermatoplasty after 1-5 weeks of infection control.Bacterial culture was performed in all the wounds.The fractures were treated with secondary open reduction and fixation.Bacteria culture was done in all wounds.Results The reticular incisional wounds of 56 patients were healed free from dermatoplasty,with no infection or sensory dysfunction.Among 21 patients treated with long incision,the bacteria culture was positive in 16 patients(including 13 earthquake victims)and verve injury found in five patients(including two with radial nerve injury and three with peroneal nerve injury).Four patients with partial or complete cut-off of the verves were improved after repair by secondary operation.Direct suture of incisions was done in nine patients and skin graft performed in 12,with average healing time for three weeks.The patients were followed up for mean 5.6 years,which showed no claw hands,with overall satisfactory rate for about 98% and 95% respectively in two groups according to the probation standard of amputated finger function evaluation from the Hand Surgery Plant of Chinese Medical Association.Conclusions Both long incision and reticular incision procedures can be used early in the treatment of pediatric OCS,while the reticular incision procedure is more convenient and simple,with less complications.

Objective To explore the normal range of cingulate cortex volumes of Chinese adults of the Han nationality and its relationship with age, which provide morphological data for the construction of database for Chinese Standard Brain.Methods This is a clinical multi-center study.One thousand Chinese healthy volunteers ( age range = 18 to 70) recruited from 15 hospitals were divided into 5 groups, i.e.,Group A (age range = 18 to 30), B (age range=31 to 40), C (age range =41 to 50), D (age range =51 to 60), and E (age range =61 to 70).Each group contained 100 males and 100 females.All of the volunteers were scanned by MR using T1 weighted three-dimensional magnetization prepared rapid acquisition gradient echo sequence.Cingulate cortex volume (including bulk volume and the left/right volume) was measured semi-manually using 3D volume analysis software.Cingulate cortex volumes among age groups were compared by one-way ANOVA.Right and left cingnlate cortex volumes between sexualities were analyzed by paired samples t test.The relationship between cingulate cortex volume and age was analyzed by Pearson correlations and regression analysis.Results Cingulate cortex volumes of male and female were (20 347 ± 2504) and ( 19 432 ± 2184) mm3 respectively, and the male's was significantly larger than that of female's (two sample t'-test for independent samples, t'= 6.156, P < 0.05 ).Right and left cingnlate cortex volumes of male were ( 10 717 ± 1629) and (9630 ± 1498) mm3 respectively, and those of female's were ( 10 064 ± 1407 ) and ( 9368 ± 1441 )mm3 respectively.The volumes of cingulate cortex were significantly different between right and left in male or female ( t = - 12.960, - 8.511, P < 0.05 ),and right was larger than left.Bilateral cingulate cortex volume in male among group A, B, C, D and E[left: ( 10 132 ± 1291 ), ( 10 113 ± 1638), (9599 ± 1576), (9594 ± 1288), (8710 ± 1212) mm3 ; right:(11 212±1442), (11 096±1602), (11 040±1403), (10 633±1638), (9604±1522) mm3] had statistical differences (F = 16.738, 18.707, P < 0.01 ) ; and those in female among five age groups[left:(9689 ± 1426), (9652 ± 1676), (9347 ± 1500), (9098 ± 1225), (9053 ± 1233) mm3 ; fight: ( 10 558 ±1325), ( 10 266 ± 1463), ( 10 100 ± 1497), (9779 ± 1304), (9617 ± 1254) mm3] also had significant differences (F = 16.859,7.528,P <0.01 ).Bilateral cingnlate cortex volume in both male and female were negatively correlated with age ( r = - 0.330, - 0.324, - 0.169, - 0.243, P < 0.05 ), though the correlation coefficient is not high.Conclusions Cingnlate cortex volume could be accurately measured on the high-resolution MRI with 3D volume analysis software, which can provide morphological data for the construction of database for Chinese Standard Brain.The results may provide normal range for the diagnosis of the volumetric deficits of cingulate cortex.

Objective To measure the volume of hippoeampal formation(HPF) in healthy Chinese Han adults and provide database for researching on a variety of diseases associated with alteration of hippocampal structure. Methods This is a clinical multi-center study. One thousand Chinese healthy volunteers (age range = 18 to 70) recruited from 15 hospitals were divided into 5 groups, i. e. , Group A (age range = 18 to 30), B (age range =31 to40), C (age range =41 to 50), D (age range=51 to 60),and E (age range =61 to 70). Each group contained 100 males and 100 females. All of the volunteers were scanned by MR using T1 weighted three-dimensional magnetization prepared rapid acquisition gradient echo sequence. The margin of HPF were outlined manually for each side. Using multiple linear regression,relationships between hippocampal volume and sex, age, weight and height were analyzed respectively.Independent two sample t test was used to study the differences between male and female and between lcft and right. The differences of hippoeampal volume among age groups were analyzed by ANOVA. Results Hippocampal volume for left and right side were (4752 ± 659) and (5032 ± 660) mm3 respectively. The volume of HPF is significant correlated with gender and age, but without relevance to height and weight ( left and right r = 0. 283,0. 311, F = 30. 127,37. 050 ,P < 0. 01 ). The volumes of left and right hippocampus were (4897 ± 670), (5192 ± 667)mm3 respectively for men, and (4647 ± 624) and (4904 ± 630) mm3 for women. The right hippocampal volume was larger than the left ( t = 7. 030,6. 696, P < 0. 05 ). On both sides, men have larger hippocampus than that of women ( t = 6. 586,7. 326, P < 0. 01 ). The volumes of the left hippocampus among the five age groups in the male were (4981 ± 684), ( 5003 ± 609 ), (4976 ± 657 ),(4841 ± 631 ), (4631 ± 681 ) mm3 respectively, while the volumes of the right hippoeampus were (5340 ±647) ,(5276 ±582), (5264 ±620), (5133 ±661 ), (4894 ±699) mm3 respectively. Among age groups,the differences were statistically significant ( left and right F = 5. 737,7. 607, P < 0. 01 ). For male, there was significant difference of bilateral hippoeampus between the 18-30, 31-40, 41-50 years group and 61-70 years group ( P < 0. 05 ) and there was no significant difference among the other groups ( P > 0. 05 ).There was no significant difference of hippocampal among different groups in women (P > 0. 05 ).Conclusions With high-resolution MRI, the volume of the HPF was accurately measured, so as to provide the basic data for research of the hippocampus-related disease.

ObjectiveAnalyze preoperative clinical relevanted factors of acute type A aortic dissection with hypoxemia according to a group clinical data.MethodsFrom January 2011 to June 2011,we have collected 54 preoperative cases of acute type A aortic dissection,including 42 males,12 females,aged 28-73 years old,onset to treatment time is 0.4-14.0 days.General information:age,gender,time of onset,body mass index,hypertension,diabetes mellitus,smoking,drinking,heart ejection fraction,prothrombin time,quantitative fibrinogen,fibrinogen degradation products,D-dimer,C-reactive protein,procalcitonin,ICU time,length of hospital stay.According to the blood gas analysis of quiet state case without oxygen,with PaO2 ＜ ( 100-age ×0.33 ±5) mm Hg is for the hypoxemia group,equal or higher than this is no-hypoxemia group.ResultsNo-hypoxemia group has 14 cases,11 males,3 females,average aged (51.14 ± 14.24) years old,including 12 operation patients ( no death) and 2 no-operation patients(2 cases death).Hypoxemia group has 40 cases,31 males,9 females,average aged (50.53 ± 9.73 ) years old,including 33 operation patients(2 cases death) and 7 no-operation patients(7 cases death).There is no significant difference in age,gender,time of onset,hypertension,diabetes mellitus,smoking,drinking,cardiac ejection fraction,prothrombin time and fibrinogen.There is statistically significant on body mass index,fibrinogen degradation products,D-dimer,C-reactive protein,procalcitonin,ICU time and length of hospital stay time ( P ＜ 0.05 ).ConclusionPreoperative hypoxemia with acute type A aortic dissection is associated with obesity,excessive inflammation and activation of coagulation and fibrinclytic system,and hypoxemia may prolong the time of operative patients with acute type A aortic dissection in ICU and hospital.

Objective To investigate the effect of adenosine A2A receptor on pituitary-adrenal axis response in acute phase of moderate craniocerebral trauma.Methods Eighteen adenosine A2A receptor knock-out mice in a C57BL/6 background and another eighteen their wild-type littermates were divided into normal control group and craniocerebral trauma for 4 hours group,and craniocerebral trauma for 24 hours group according to random number table,with siμ mice per group.Plasma levels of adrenocorticotropic-hormone (ACTH) and corticosterone at hours 4 and 24 postinjury were determined using ELISA method.Results At 4 and 24 hours,brain water content in wild-type mice [(80.950 ± 0.184) ％,(82.178 ± 0.255)％ respectively] was higher than that in gene knock-out mice [(80.006 ± 0.199)％,(81.091 ± 0.295)％ respectively,P ＜ 0.01].Besides,brain water content in both wild-type and gene knock-out mice increased after injury (P ＜ 0.01).Plasma levels of ACTH and corticosterone were higher in geneknock-out sham mice than in wild-type sham mice [(120.214 ± 2.472) ng/L vs (91.767 ±7.395) ng/L,(27.814 ±0.888) μg/L vs (11.430 ±0.644) μg/L respectively,P ＜0.0l].At 4 and 24 hours,plasma levels of ACTH [(174.776-± 5.040) ng/L,(189.613 ± 4.802) ng/L respectively] in geneknock-out mice showed a higher increase than those in wild-type mice [(119.594 ± 6.945) ng/L,(124.93-± 11.001 7) ng/L respectively,P ＜ 0.05].Moreover,plasma levels of corticosterone [(40.138 ±-0.805) μg/L] at 4 hours and [(37.440-0.485)μg/L] at 24 hours in gene knock-out mice showed a same result as compared with that in wild-type mice [(19.702 ± 0.804) μg/L,(17.602 ± 0.743) μg/L respectively,P ＜ 0.05].Conclusions Knock-out of adenosine A2A receptor increases the release of ACTH and corticosterone in acute stage of moderate craniocerebral trauma and promotes pituitary-adrenal stress response.This may provide a novel explanation for the neuroprotective effect of A2A receptor deficiency.