Objective To assess the efficacy of double-level bone transport for treatment of extensive post-infectious tibial bone defects.Methods From January 2010 to May 2014,12 consecutive patients suffering from massive postinfectious tibial bone defects were treated by the Ilizarov technique of double-level bone lengthening.The study population included 8 males and 4 females,with mean 40.9 years (range,16-65 years).Mechanisms of initial injury included motor-vehicle injury in eight patients,explosive injury in two and crush-related injury in two.After bony resection for infection,skin defect was 8.7 cm ×5.8 cm (range,4.5 cm × 2.0 cm-20.0 cm × 10.0 cm) and bone defect averaged 11.0 cm (range,6.0-20.0 cm).All patients were treated with a double-level transport (three distal-to-proximal,six both-ends-to-center and three proximal-to-distal).Three patients were candidates for flap coverage before bone transport because of large wounds,one patient had direct closure of the wound after tibial partly shortening,and the remaining patients kept the wound open during bone transport.Bone and functional results were evaluated according to the criteria given by Association for the Study and Application of the Method of Ilizarov (ASAMI).Results After removal of the apparatus,follow-up was (30.0 ±5.6) months (range,12-36 months).All patients achieved complete union and successful eradication of infection.Mean bone transport time was (55.4 ± 26.2)d (range,30-125 d),with the lengthening index of (5.0 ± 0.6) d/cm (range,3.9-6.3 d/cm).Wound union time was (3.6 ± 1.4) months (range,1.5-6.0 months).Mean consolidation time of the distraction gap was (10.9 ± 3.8)d (range,4.0-18.0 d).Mean union time of the docking site was (8.4 ± 3.8)months (range,3-16.5 months).Mean external fixation time was (12.5 ±4.1)months (range,5-18 months),and mean external fixation index was (1.2 ± 0.3) months/cm(rang,0.8-2 months/cm).According to the ASAMI,bony results were excellent in seven patients (58％) and poor in five (42％);functional results were excellent in nine patients (75％) and good in three (25％).Conclusion Double-level bone transport is an effective method that can reduce bone transport time and external fixation time.

Objective To observe the curative effect of internal compression in the treatment of intra-articular fracture of the calcaneus by anatomical plate with compression bolt through the sinus tarsi approach.Methods Forty-nine patients with 62 calcaneal fractures treated with anatomical plate with compression bolt through sinus tarsi approach from September 2006 to May 2009 were enrolled in the study.According to Sanders classification,there were 39 patients with type Ⅱ fractures,20 with type Ⅲ fractures and three with type Ⅳ fractures.The axial and lateral view X-ray radiographs and the axial,semi-coronal and sagittal computed tomography (CT) images of the heel were taken before and after operation.The reduction of posterior articular surface of calcaneus and calcaneal shape was observed and the width,height,length,B(o)hler' s angle and Gissan' s angle were measured on the radiographs,respectively.Partial weight bearing was allowed 12 weeks after operation and full weight beating was allowed 16 weeks after operation.The anatomical plates were removed 8-15 months after operation.The Maryland hindfoot score system was applied to evaluate the function of the hindfoot postoperatively.Results All the patients were followed up for 7.5-23 months (average 10.6 months),which showed no wound infection.The reduction of the posterior facet was nearly anatomical (less than 3 mm articular displacement) in all patients and the shape of the calcaneus was satisfactory.The width,height,length,B(o)hler' s angle and Gissan' s angle were improved significantly in all patients (P ＜0.01 ).According to Maryland hindfoot scoring system,29 feet scored 90-100 points (excellent),18 feet scored 80-90 points (good),10 feet scored 70-80 points (moderate) and 5 feet scored 60-70 points (poor).A total of 40 patients (82％) were able to return to their original occupations at mean 9.1 months ( 6.0-12.9 months ) after the injury.Conclusion The anatomical plate with compression bolt internal fixation through sinus tarsi approach is an ideal method for the treatment of displaced intra-articular calcaneus fracture.

Objective To compare the clinical effectiveness of external fixation,expert tibial nail (ETN) and minimally invasive percutaneous plate osteosynthesis (MIPPO) in the treatment of AO type 43A tibial fractures.Methods The clinical data of 102 patients with AO type 43A tibial fracture were retrospectively analyzed who had been treated from June 2010 to June 2014.They were 68 men and 34 women,from 18 to 71 years of age (average,36 years).By AO classification,there were 36 cases of type A1,45 ones of type A2,and 21 ones of type A3.External fixation was used in 30 cases,MIPPO in 42,and ETN in 30.The 3 groups were compared in terms of operation time,blood loss,fracture healing time,complications and functional evaluation according to American Orthopaedic Foot and Ankle Society (AOFAS) criteria for middle and fore foot.Results The operation time in external fixation group (72.7 ± 16.1 min) was significantly less than in MIPPO group (101.5±15.1 min) and ETN group (115.0±11.2 min) (P ＜0.05).The blood loss and fracture healing time in external fixation group were (320.6 ±40.8 mL) and (160.6 ± 25.0 days),significantly greater than in MIPPO group (125.5 ± 27.3 mL and 120.3 ± 20.2 days)and ETN group (124.2±25.4mL and 125.5±25.6 days) (P ＜0.05).The total complication rate in external fixation group (53.3％,16/30) was significantly higher than in MIPPO group (9.5％,4/42) and ETN group (10.0％,3/30) (P ＜ 0.05).The total AOFAS excellent to good rate in external fixation group (66.7％,20/30) was significantly lower than in MIPPO group (88.1％,37/42) and ETN group (90.0％,27/30) (P ＜ 0.05).However,there were no significant differences between MIPPO and ETN groups concerning all the above outcome indicators (P ＞ 0.05).Conclusions For AO type 43A tibial fractures,internal fixation should be the first choice.Both MIPPO and ETN can lead to good clinical efficacy.However,in cases where internal fixation is not suitable,external fixation with distal lateral tibial nails at the Chaput tuberosity can obtain satisfactory ankle function.

Objective To investigate the clinical efficacy of semi-open cancellous bone grafting for infected bone defect combined with soft tissue defect of lower limb.Methods A retrospective case control study was conducted to analyze the clinical data of 26 patients with infected bone defect combined with soft tissue defect of lower limb admitted to the Third Hospital of Hebei Medical University from March 2010 to August 2017.There were 16 males and 10 females,aged 16-65 years [(39.6 ± 12.8)years].The bone defect area before bone grafting was 1.4-6.0 cm [(3.3 ± 1.2) cm].The surface soft tissue defect of bone graft granules was 2.3 cm × 1.1 cm-8.5 cm × 5.0 cm after bone grafting.If the defect was segmental defect of more than 6 cm,the defect was firstly reduced by bone transport.When the defect was near the docking point,the bone defect was repaired by open bone grafting.If the defect was located at the metaphyseal end of the calcaneus or tibia,stage Ⅰ or stage Ⅱ open bone grafting was performed after debridement.After bone grafting,antibiotic-containing cement sheets were used to cover the wound in 14 patients (semi-open group),and vacuum sealing drainage (VSD) devices were used to cover the wound in 12 patients (VSD group).The time of granulation tissue covering bone graft granules,wound healing time,bone defect healing time,material cost and complications (wound infection and necrosis of bone graft granules) were compared between the two groups.The limb function was evaluated according to Paley score.Results All patients were followed up for 12-40 months [(19.3 ±7.2) months].In the semi-open group and VSD group,the time of granulation tissue coverage was 22.2 days (15.0-44.0) days and 20.2 days (15.0-44.0) days (P ＞ 0.05);wound healing time was 3.1 months (1.5-5.5) months and 3.1 months (1.5-6.5) months (P ＞ 0.05);bone defect healing time was (5.5 ± 2.2) months and (5.9 ± 2.4) months (P ＞ 0.05);the cost of covering wound materials was (2 056.1 ± 23.4) yuan and (5 555.3 ± 1 105.5) yuan respectively (P ＜ 0.05).No wound infection occurred in either group.Two patients in the semi-open group and one patient in the VSD group had bone graft granules surface necrosis (P ＞0.05).According to Paley's functional score,the results were excellent in 12 patients and good in two in the semiopen group,compared with excellent in 11 and good in one in the VSD group (P ＞ 0.05).Conclusion For infected bone defect combined with soft tissue defect of lower limb,semi-open bone grafting can simplify the nursing of wound,prevent wound infection,promote wound healing and fracture healing.It has similar therapeutic effect with VSD,but its treatment cost is significantly reduced.

Objective To investigate the mechanism of circadian clock protein Bmal1(Bmal1)on renal injury with chronic periodontitis,we established an experimental rat periodontitis model.Methods Twelve male Wistar rats were randomly divided into control and periodontitis groups(n=6,each group).The first maxillary molars on both sides of the upper jaw of rats with periodontitis were ligated by using orthodontic ligature wires,whereas the control group re-ceived no intervention measures.After 8 weeks,clinical periodontal parameters,including probing depth,bleeding index,and tooth mobility,were evaluated in both groups.Micro-CT scanning and three-dimensional image recon-struction were performed on the maxillary bones of the rats for the assessment of alveolar bone resorption.Histopatholo-gical observations of periodontal and renal tissues were conducted using hematoxylin-eosin(HE)and periodic acid-Schiff(PAS)staining.Renal function indicators,such as creatinine,albumin,and blood urea nitrogen levels,and oxida-tive stress markers,including superoxide dismutase,glutathione,and malondialdehyde levels,were measured using bio-chemical assay kits.MitoSOX red staining was used to detect reactive oxygen species(ROS)content in the kidneys.The gene and protein expression levels of Bmal1,nuclear factor erythroid 2-related factor 2(Nrf2),and heme oxygenase-1(HO-1)in rat renal tissues were assessed using real-time quantitative polymerase chain reaction(RT-qPCR)and immuno-histochemical staining.Results Micro-CT and HE staining results showed significant bone resorption and attachment loss in the maxillary first molar region of the periodontitis group.Histological examination through HE and PAS staining revealed substantial histopathological damage to the renal tissues of the rats in the periodontitis group.The findings of the assessment of renal function and oxidative stress markers indicated that the periodontitis group exhibited abnormal levels of oxidative stress,whereas the renal function levels showed abnormalities without statistical significance.Mito-SOX Red staining results showed that the content of ROS in the renal tissue of the periodontitis group was significantly higher than that of the control group,and RT-qPCR and immunohistochemistry results showed that the expression levels of Bmal1,Nrf2,and HO-1 in the renal tissues of the rats in the periodontitis group showed a decreasing trend.Conclu-sion Circadian clock protein Bmal1 plays an important role in the oxidative damage process involved in the renal of rats with periodontitis.

Objective This study aims to explore changes in uncoupling protein 2(UCP2)in experimental periodonti-tis-associated renal injury induced by ligation and investigate the effect of UCP2 on renal injury induced by periodontitis.Methods Twelve Wistar male rats were randomly divided into two groups:control and periodontitis groups.A periodon-tal model was built by ligating the maxillary first molars area with 0.2 mm orthodontic ligature wire.After 8 weeks,the in-traoral condition of the rats was observed and periodontal clinical indices such as gingival bleeding index(BI),periodontal probing depth(PD),and tooth mobility(TM)were detected.The maxillary bone was scanned by Micro CT to observe the alveolar bone resorption.The tissue mineral density(TMD),bone mineral density(BMD),bone volume fraction(BV/TV),trabecular thickness(Tb.Th),trabecular bone separation(Tb.Sp)were recorded,and the distance from the enamel bone boundary to the alveolar crest(CEJ-ABC)of the maxillary first molar was measured.The oxidative stress indexes such as malondialdehyde,glutathione(GSH),and superoxide dismutase(SOD)were detected using frozen rat kidney tissue.The gene expression of UCP2,nuclear factor erythroid 2-related factor 2(Nrf2),and peroxisome proliferator-activated receptor gamma coactivator-1α(PGC-1α)was observed by quantitative real-time polymerase chain reaction(qRT-PCR)test.The gingival tissue of the rats was used for immunohistochemical staining to observe the expression of the UCP2 protein.The fixed rat kidney tissue was used for hematoxylin-eosin(HE),periodic acid-schiff(PAS),MitoSOX Red,JC-1,and immu-nohistochemical staining to observe the renal histopathology,the level of reactive oxygen species(ROS),the level of mito-chondrial membrane potential,and the expression of UCP2,Nrf2,and PGC-1α protein.Rat serum was collected to detect renal function indices,namely,blood urea nitrogen(BUN),creatinine(Cre),and albumin(Alb).Results Compared with the control group,the periodontitis group showed red,swollen,and soft gingival tissue,with gingival probing bleeding,periodontal PD increased,tooth loosening,alveolar bone resorption,decreased TMD,BMD,BV/TV,and Tb.Th indices,and increased Tb.Sp index,CEJ-ABC,and gingival UCP2 protein expression.Compared with the control group,the levels of MDA and ROS in the kidney tissue of periodontitis rats and the gene and protein expression of UCP2 increased,and the levels of MMP,GSH,and SOD and the gene and protein expression of Nrf2 and PGC-1α decreased.Renal functional indi-ces,namely,BUN,Cre,and Alb,were not significantly different between the two groups.Conclusion UCP2 may play a role in renal injury induced by periodontitis through oxidative stress.

OBJECTIVE:To investigate the status quo of knowledge-attitude-practice(KAP)of medication in residents,and to explore potential risk factors that may affect medication. METHODS:By approximate random sampling,online(wenjuanxing)and offline method (5 communities of Chengdu city) were used to collect general information (gender, age, monthly income, residence,medical insurance,education level,working condition,occupation)of the residents aged 19 year-old above and conduct KAP investigation during Jul.-Aug. 2017. Multiple linear regression analysis was used to analyze the influence of residents'general information on KAP. RESULTS:A total of 517 online and offline valid questionnaires were obtained, including 200 offline questionnaires were sent out and 184 valid questionnaires were returned with recovery rate of 92％. Average scores of medication knowledge,attitude and practice were (71.4 ± 32.3),(33.7 ± 14.0),(60.7 ± 19.4),which all reached"good"in the evaluation standard of questionnaire results. The results of multiple linear regression showed that elderly and low education level were the significant influential factors of residents'lack of medication knowledge. The male,elderly,low income and low education level were the influential factors of poor drug use behavior. The residents with poor attitudes towards medication were low income and low educated population. CONCLUSIONS:The average risk of residents'medication in China is low,but it is still necessary to strengthen medication education for special people. It is requisite to focus on the elderly,the low education level,the low income population and the male residents.

Objective To investigate the mechanism mediating the regulatory effect of lncRNA MAGI2-AS3 on cisplatin(DDP)resistance in non-small cell lung cancer(NSCLC).Methods MAGI2-AS3 and miR-1269a expression levels were detected by qRT-PCR in DDP-sensitive lung cancer cell lines(A549 and H1299)and their resistant counterparts(A549/DDP and H1299/DDP).In A549 and H1299 cells with MAGI2-AS3 silencing and A549/DDP and H1299/DDP cells overexpressing MAGI2-AS3,the effects of 20 μmol/L DDP on cell viability and apoptosis were examined with CCK-8 assay,colony formation assay,flow cytometry and Western blotting,and the changes in epithelial-mesenchymal transition(EMT)were assessed with wound healing and Transwell assays.The interaction between MAGI2-AS3,miR-1269a and PTEN was predicted using GEPIA,StarBase and miRDB and verified with luciferase reporter gene assay and radioimmunoprecipitation(RIP)assay.A miR-1269a mimic and pcDNA3.1-PTEN plasmid were used to perform the rescue assay.Results MAGI2-AS3 expression was significantly downregulated in lung cancer tissues(P<0.05)in association with a poor prognosis(P<0.05).In the two DDP-resistant lung cancer cell lines,MAGI2-AS3 expression was significantly lowered as compared with the sensitive cells.Silencing MAGI2-AS3 significantly enhanced cell viability and promoted EMT of A549 and H1299 cells irrespective of DDP treatment,and also decreased DDP-induced apoptosis of the cells.In A549/DDP and H1299/DDP cells,MAGI2-AS3 overexpression strongly repressed cell viability and EMT irrespective of DDP treatment and promoted DDP-induced cell apoptosis.Luciferase reporter gene and RIP assays confirmed the binding of MAGI2-AS3 with miR-1269a and the binding of miR-1269a with 3'-UTR domain of PTEN.The rescue assay demonstrated that MAGI2-AS3 acted as a sponge for miR-1269a to promote PTEN expression and downregulate AKT phosphorylation,thus inhibiting EMT and promoting DDP-induced apoptosis of A549/DDP cells.Conclusion MAGI2-AS3 enhances DDP sensitivity of NSCLC by targeted regulation of the miR-1269a/PTEN/AKT signaling axis.

Objective To investigate the mechanism mediating the regulatory effect of lncRNA MAGI2-AS3 on cisplatin(DDP)resistance in non-small cell lung cancer(NSCLC).Methods MAGI2-AS3 and miR-1269a expression levels were detected by qRT-PCR in DDP-sensitive lung cancer cell lines(A549 and H1299)and their resistant counterparts(A549/DDP and H1299/DDP).In A549 and H1299 cells with MAGI2-AS3 silencing and A549/DDP and H1299/DDP cells overexpressing MAGI2-AS3,the effects of 20 μmol/L DDP on cell viability and apoptosis were examined with CCK-8 assay,colony formation assay,flow cytometry and Western blotting,and the changes in epithelial-mesenchymal transition(EMT)were assessed with wound healing and Transwell assays.The interaction between MAGI2-AS3,miR-1269a and PTEN was predicted using GEPIA,StarBase and miRDB and verified with luciferase reporter gene assay and radioimmunoprecipitation(RIP)assay.A miR-1269a mimic and pcDNA3.1-PTEN plasmid were used to perform the rescue assay.Results MAGI2-AS3 expression was significantly downregulated in lung cancer tissues(P<0.05)in association with a poor prognosis(P<0.05).In the two DDP-resistant lung cancer cell lines,MAGI2-AS3 expression was significantly lowered as compared with the sensitive cells.Silencing MAGI2-AS3 significantly enhanced cell viability and promoted EMT of A549 and H1299 cells irrespective of DDP treatment,and also decreased DDP-induced apoptosis of the cells.In A549/DDP and H1299/DDP cells,MAGI2-AS3 overexpression strongly repressed cell viability and EMT irrespective of DDP treatment and promoted DDP-induced cell apoptosis.Luciferase reporter gene and RIP assays confirmed the binding of MAGI2-AS3 with miR-1269a and the binding of miR-1269a with 3'-UTR domain of PTEN.The rescue assay demonstrated that MAGI2-AS3 acted as a sponge for miR-1269a to promote PTEN expression and downregulate AKT phosphorylation,thus inhibiting EMT and promoting DDP-induced apoptosis of A549/DDP cells.Conclusion MAGI2-AS3 enhances DDP sensitivity of NSCLC by targeted regulation of the miR-1269a/PTEN/AKT signaling axis.

OBJECTIVE： To explore the role of clinical pharmacists in medication therapy management （MTM）. METHODS： Referring to the practice model of MTM in the United States， taking a noninfectious chronic disease （obesity diabetes mellitus） patient as an example， clinical pharmacists of endocrinology specialty carried out MTM according to five processes， such as patient information collection， medication therapy review， the formulation of medication-related action plan （MRP）， interventions related to direct communication with physicians or advising patients to consult relevant medical service personnel， record and follow-up. RESULTS： The information of patients collected by clinical pharmacists included past medical history， family history， allergy history and medication history， etc. It was the top priority MRP for this patient to identify inappropriate hypoglycemic drug therapy， obesity-induced obstructive sleep apnea-hypopnea syndrome and hyperlipidemia. For obesity patients with type 2 diabetes mellitus， clinical pharmacists recommend that patients changed insulin drugs to non-insulin drugs， and liraglutide was recommended. In view of the poor control of blood lipid level， fenofibrate was recommended for patients on the basis of oral administration of simvastatin. The patient’s attending physician agreed with the above suggestion and adjusted the prescription. Clinical pharmacists provided medication education for the patients about the importance of each drug， control of total energy intake， balanced diet and physical exercise. The follow-up results after 6 months showed that blood glucose （fasting blood glucose 5-7 mmol/L， postprandial blood glucose 8-10 mmol/L） and blood lipid （total cholesterol 4.80 mmol/L， triglyceride 1.60 mmol/L， low density lipoprotein 3.05 mmol/L） of the patient were effectively controlled and body weight was reduced by 3 kg， but the improvement of lifestyle was poor， mainly due to the nature of his work. Clinical pharmacists once again communicated with him and emphasized the importance of proper physical exercise. The patients agreed to continue the follow-up. CONCLUSIONS： Clinical pharmacists can provide professional consultation and service for patients with chronic diseases by means of MTM service mode， which has certain value for improving medical quality.