Objective To investigate the clinical efficacy of buttress plating for patients with posterior pilon fracture.Methods From April 2012 to January 2015,12 patients with posterior pilon fracture of the distal tibia were treated in our hospital.They were 7 men and 5 women,30 to 56 years of age (average,41.2 years).According to the CT classification by Haraguchi et al.,5 cases belonged to type I,3 to type Ⅱ and 4 to type Ⅲ.All the patients underwent open reduction and internal fixation with buttress plate via either a posterolateral approach or a dual posterolateral-posteromedial approach.All the patients were available for follow-up.The clinical outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and the visual analogue scale (VAS).The radiological evaluation was performed using the osteoarthritis-score (OA-score).Results The patients obtained an average follow-up of 21.2 months (range,from 12 to 30 months).Bone fractures united after an average of 15 weeks (range,from 13 to 19 weeks).The time for full weight walking averaged 16 weeks,ranging from 15 to 23 weeks.The ankle plantar flexion ranged from 36° to 42° (average,40.4°);the ankle dorsal extension ranged from 38° to 44° (average,42.6°).At the final follow-ups,the AOFAS scores ranged from 82 to 97 (average,88.2);the OA-score ranged from 0.6 to 0.8 (average,0.71);the VAS scores during rest,active motion and weight-bearing walking ranged from 0.5 to 0.8 (average,0.66),from 0.6 to 0.9 (average,0.82) and from 1.2 to 1.8 (average,1.41),respectively.No fracture malunion,implant loosening,pain or stiffness of the affected ankle was observed at the final follow-ups.Conclusion Buttress plating for posterior pilon fractures can lead to satisfactory clinical outcomes,because it ensures rigid fixation which in turn enables earlier postoperative mobilization.

BACKGROUNDIn recent years, many investigations have showed that COX-2 inhibitors not only inhibit the growth of tumor cells but also enhance the cytotoxicity of anticancer drugs, such as NS-398, a selective COX-2 inhibitor. But the effect of NS-398 combined with chemotherapy agent cisplatin on growth of lung adenocarcinoma cells and its mechanism are still unknown. The aim of this study is to investigate the effect of NS-398 combined with cisplatin on proliferation of human lung adenocarcinoma cell lines, and to explore their mechanisms.

METHODSSynergistic effect of NS-398 and cisplatin on proliferation of human lung adenocarcinoma cell lines was detected by MTT growth assay, and data were analyzed by SPSS general linear models procedure to determine the IC₅₀ of each drug alone. Combined index (CI) was analyzed to determine the combined effect of drugs. Apoptosis and cell cycle distribution were detected by fluorescence staining of Acridine orange (AO) and Ethidium bromide (EB) and flow cytometry.

RESULTSThe various concentration of NS-398 in combination with cisplatin resulted in the reduction of IC₅₀ of cisplatin by 48.25%-62.44% in A549 cells, and by 43.34%-69.61% in SPC-A-1 cells. The CI of NS-398 and cisplatin in the two cell lines ranged from 0.4 to 0.9, which indicated that they acted in slight synergistic to synergistic pattern. The apoptotic rate at 24h and 48h in the combined groups was significantly higher than those of the control groups, and the S-phase cell fractions at 48h and 72h were obviously higher than those of the control groups. There was a positive correlation between apoptotic rate and S-phase cell fraction in the combined groups (r=0.882,P= 0.01).

CONCLUSIONSNS-398 can improve growth inhibition of cisplatin on lung adenocarcinoma cells, and the two agents act in synergistic way. This synergistic effect may be related to apoptosis pathway.

BACKGROUNDRecent studies have shown that NS-398, a highly selective COX-2 inhibitor, can enhance the inhibition effects of cisplatin on adenocarcinoma cell proliferation, but the mechanism is still unknown. The aim of this study is to explore the mechanism about the synergistic effects of NS-398 and cisplatin to human lung adenocarcinoma cell line.

METHODSDifferentially expressed proteins were separated in human lung adenocarcinoma cells treated with NS-398 and/or cisplatin by immobilized pH gradient-based two-dimensional gel electrophoresis (2-DE), then 19 out of obtained proteins were identified by peptide mass fingerprint (PMF) based on matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF-MS) and database searching.

RESULTSThere were 22 down-regulated proteins and 2 up-regulated proteins in NS-398+cisplatin combination group compared with control groups. Finally six proteins were identified, in which some were cytokeratins, some were associated with proliferation and apoptosis, and the others were involved in metabolism of tumor cells.

CONCLUSIONSThe down-regulation of HSP90 and triosephosphate isomerase may be related to the synergistic effects of NS-398 and cisplatin on human lung adenocarcinoma cells.

Objective:To evaluate the mid-term results of fenestrated/branched endovascular aortic repair (f/b EVAR) for the treatment of thoracoabdominal aortic aneurysms. M ethods The clinical data of 105 thoracoabdominal aortic aneurysm patients treated with f/b EVAR at the Department of Vascular Surgery of Nanjing Drum Tower Hospital from 2018 to 2019 were retrospectively analyzed. Results:There were 43 cases of thoracoabdominal aortic aneurysm and 62 cases of thoracoabdominal aortic aissection.A total of 336 branch arteries were reconstructed,and technical success rate was 94.3%. 100 cases (95.2%) were followed-up, 6 cases (5.7%) received reoperation interventions, and 11 cases (10.5%) died. During the follow-up period, 69 cases had complete imaging data. Based on the recent CT date of the thoracoabdominal aorta, 58 patients hael positive aortic remodeling and 11 patients hael negative and indeterminate remodeling; there were 31 cases (29.5%) of endoleaks, including 7 cases (6.7%) of type Ⅰb endoleaks, 8 cases (7.6%) of type Ⅱ, 1 case (0.95%) of type Ⅲa, 13 cases (12.4%) of type Ⅲc endoleaks and 2 cases (1.9%) of type Ⅳ. Conclusions:The mid-term follow-up results were satisfactory for TAAA treated with f/b EVAR. Internal leakage remains key point for f/b EVAR.

OBJECTIVETo analyse the heritabilities of serum luteinizing hormone(LH), follicle-stimulating hormone (FSH), testosterone (T) and estradiol (E2) in twin boys, and to study the genetic contributions to gonadotropin-gonadal axis.

METHODSA total of 51 pairs of male twins, 35 monozygotic (MZ) and 16 dizygotic(DZ) aged 5 to 11 years, were investigated. Serum gonadotropin and sex hormone were measured by radioimmunoassay. The twin zygosity was verified by determination of short tandem repeat amplified fragment length polymorphism systems. The genetic analysis was performed using intraclass correlation coefficient method.

RESULTSThe intraclass correlation coefficient was greater in the MZ twins than in the DZ twins. The estimated heritabilities were respectively LH 0.51, FSH 0.32, T 0.81, E2 0.41.

CONCLUSIONGenetic factors are major determinants of gonadotropin-gonadal axis in boys.

Child ; Child, Preschool ; Gonadal Steroid Hormones ; blood ; Gonadotropins ; blood ; Humans ; Male ; Radioimmunoassay

Objective To explore the efficacy and safety of different antiplatelet drugs combined with rivaroxaban in patients with lower extremity arteriosclerosis obliterans.Methods The clinical data of patients with lower extremity arteriosclerosis obliterans who were symptomatic and underwent surgical treatment at the Vascular Surgery Department of Nanjing Drum Tower Hospital from January 2018 to December 2021 were retrospectively analyzed.According to the different antiplatelet medications taken by patients,patients were categorized into aspirin group,clopidogrel group and cilostazol group.Baseline data of patients were collected,and patients were followed up and the incidence of major adverse cardiovascular events,major adverse limb events,major bleeding and clinically related non-major bleeding events were compared in different groups.Results A total of 632 patients were included in the study.There was no significant difference in the incidence of major adverse cardiovascular events,major adverse limb events,major bleeding and clinically related non-major bleeding events after the baseline data was balanced by inverse probability of treatment weighting.The results of subgroup analysis were generally consistent with those of the overall study.Conclusion The combination of clopidogrel or cilostazol with rivaroxaban may serve as a novel option for dual antithrombotic therapy in patients diagnosed with lower extremity arteriosclerotic obliterans.