OBJECTIVETo explore clinical outcomes of talus neck fracture treated with mini-plate internal fixation through dual-incision approaches.

METHODSFrom August 2010 to February 2013,18 patients with closed talus neck fractures were treated (10 males and 8 females, aged from 31 to 66 years old with an average of 38.2 years old) with mini-plate internal fixation through dual-incision approaches. According to Hawkins classification, 12 cases were type II and 6 cases were type III. All cases were evaluated with X-ray and 3D CT scan preoperatively to define type and comminuted degree of fractures. Mini-plate fixation with dual-incision approaches was performed after swelling was resolved. X-ray films were taken during following up regularly. Functional evaluation was carried out according to Visual Analogue Scale (VAS), the ankle and hind-foot score of American Orthopedic Foot and Ankle Society (AOFAS). Complications were also recorded.

RESULTSSixteen patients were followed up with an average time of 22.6 months (ranged, 17 to 46 months). No wound infection, skin and flap necrosis or implant failure were found. Traumatic arthritis in subtalarjoint was found in 1 patient. Preoperative VAS (5.94±1.12) was decreased to postoperative (1.06±1.06) (t=27.13, P<0.05). The average AOFAS score was 88.7510.19 at the latest following up; and 11 cases obtained excellent results, 3 good and 2 moderate.

CONCLUSIONMini-plate fixation with dual-incision approaches for talus neck fracture especially for talus neck comminuted fracture, an effective method, could obtain stable fixation, decrease complications.

Adult ; Aged ; Ankle Fractures ; surgery ; Bone Nails ; Female ; Follow-Up Studies ; Foot Injuries ; surgery ; Fracture Fixation, Internal ; instrumentation ; methods ; Fractures, Closed ; surgery ; Humans ; Male ; Middle Aged ; Talus ; injuries ; surgery

OBJECTIVETo explore the clinical effect of interference screw and flexor hallucis longus tendon as augmentation material in repair of chronic Achilles tendon rupture.

METHODSFrom September 2010 to June 2012,26 patients with chronic Achilles tendon rupture were treated, including 18 males and 8 females with an average age of 44.2 years old (20 to 66 years old). All patients were unilateral damage. MRI showed the Achilles tendon.ends' distance was 6.0 to 9.0 cm. The postoperative complications were observed. The curative effect was assessed by American Orthopedic Foot and Ankle Society and Leppilahti score.

RESULTSAll the 26 patients were followed up for 18 to 68 months (means 30.4 months). No neurological injury and infection of incision occurred, all patients were stage I incision healing. The shape and function of the ankle were recovered well. The average AOFAS score increased from 52.27±12.30 preoperatively to 90.92±6.36 postoperatively. Leppilahti Achilles Tendon Repair score increased from 34.23±12.86 preoperatively to 90.00±5.10 postoperatively.

CONCLUSIONThe flexor hallucis tendon transfer with an interference screw technique for repairing the chronic Achilles tendon rupture of type IV of Kuwada had advantages of simple operation, quick recovery, firm tendon fixation, and less complications.

Achilles Tendon ; injuries ; physiopathology ; surgery ; Adult ; Bone Screws ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Range of Motion, Articular ; Reconstructive Surgical Procedures ; instrumentation ; methods ; Rupture ; physiopathology ; surgery ; Tendon Injuries ; physiopathology ; surgery ; Tendon Transfer ; Treatment Outcome ; Young Adult

Objective To evaluate the role of NF-κB in astrocytes in the spinal dorsal horn in a rat model of neuropathic pain induced by paclitaxel.Methods Twenty 6 year old male SD rats weighing 180-200 g were randomly divided into 2 groups ( n =10):control group (group C) and neuropathic pain group (group NP).Neuropathic pain was induced by intraperitoneal injection paclitaxel of 2 mg/kg every other day for 4 times in group NP.While the equal volume of normal saline was given instead of paclitaxel in group C.Body weight,mechanical pain threshold and heat pain threshold were determined before and at 1,7,14 d after administration.The animals were sacrificed and the spinal dorsal horn were removed for determination of NF-κB p65 expression in astrecytes by immunofluorescence analysis at 14 d after administration.Results There was no significant difference in body weight between the two groups( P ＞ 0.05).Compared with group C,mechanical pain threshold and heat pain threshold were significantly decreased 7 and 14 d after administration,the expression of NF-κB p65 in astrocytes in the spinal dorsal horn was up-regulated in group NP( P ＜ 0.05 or 0.01 ).Conclusion Activation of NF-κB in astrocytes in the spinal dorsal horn may play an important role in neuropathic pain induced by paclitaxel in rats.

Objective To evaluate the clinic efficacy of sufentanil and remifentanil by target- controlled infusion (TCI) combined with propofol in patients undergoing endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA).Methods Sixty patients,ASA Ⅰ ～ Ⅱ,undergoing elective EBUS-TBNA were randomly divided into group S ( sufentanil group),group R (remifentanil group) and group SR (sufentanil + remifentanil group),each group were twenty patients.The anesthesia of all groups is propofol intravenous anesthesia with 2％ lidocaine topical anesthesia,to controll BIS between 50 and 60 during surgery.Heart rate(HR),mean arterial pressure(MAP) pulse oxygen saturation( SpO2 ) and respiratory rate (RR) were recorded and compared 5mins after entering room(T0),30mins after the beginning of surgery(T1 ) and after surgery(T3).Arterial blood gas and the times of cough during surgery were also recorded and compared in all groups.The use of propofol and lidocaine,the wake-up time,satisfaction with anesthesia and adverse reactions in 6 hrs after surgery were also obtained.Results ( 1 ) RR decreased distinctly in group R and PaCO2 increased distinctly in group S and group R compared with that of group SR (P ＜0.05) during surgery.(2)The times of cough and the wake-up time lessened distinctly in group R and group SR compared with that of group S ( P ＜0.05 ).(3) The use of propofol and lidocaine,satisfaction with anesthesia and adverse reactions in 6 hrs after surgery were similar in all groups ( P ＞ 0.05 ).Conclusion Sufentanil compounded remifentanil by TCI combined with propofol is a safe and feasible anesthesia option for EBUS-TBNA,which provides better efficacy,high satisfaction and less side effects compared with using alone of sufentanil and remifentanil respectively.

AIM:To evaluate the repeatability of axial length (AL) and anterior chamber depth (ACD) obtained by A scan ultrasonography, and to compare AL and ACD obtained by A scan with those obtained by IOL Master.METHODS:Two hundred and fifty-seven cataract eyes of 170 patients were included.IOL Master and A scan were performed for each eye.Five measurements of IOL Master and 3 measurements of A scan were obtained.All the tested eyes were divided into 5 groups according to AL obtained by A scan:Group A (2129mm, 21 eyes).Cronbach's Alpha coefficient and intraclass correlation coefficient (ICC) were applied to evaluate the repeatability of AL and ACD obtained by A scan.Paired t test and Pearson correlation coefficient were used to analyze the differences and correlations of AL and ACD obtained by the 2 devices, respectively.Bland-Altman plots were presented to analyze the agreements of AL and ACD obtained by the 2 devices.RESULTS:All the Cronbach's Alpha and ICCs of AL and ACD values were more than 0.98.The differences of AL values between A scan and IOL Master were-0.11±0.08mm in Group A,-0.15±0.10mm in Group B,-0.19±0.15 mm in Group C,-0.29±0.16mm in Group D and-0.45±0.29mm in Group E, respectively (all P<0.01).The differences of ACD values between A scan and IOL Master were-0.10±0.16mm in Group A,-0.06±0.13mm in Group B,-0.06±0.13mm in Group C,-0.19±0.10mm in Group D,-0.18±0.21mm in Group E, respectively (all P<0.01).In all groups, the AL and ACD values obtained by A scan and IOL Master presented good correlations (all r>0.89, all P<0.01).CONCLUSION:The AL and ACD values in cataract eyes obtained by A scan were repeatable.The AL and ACD values obtained by A scan were smaller than those obtained by IOL Master.With the increase of AL values, the differences of AL values between A scan and IOL Master increased.

Objective To compare the effect of thoracoscopic and laparoscopic surgery with conventional thoracic surgery on esophageal cancer and its influence on pulmonary function. Methods Ninety?four patients with esophageal cancer treated in the Second Affiliated Hospital of Chengdu Medical College from March 2010 to March 2016 were selected and were divided into the control group ( 54 cases) and the study group ( 40 cases) according to operation methods. The control group received traditional thoracotomy. The study group received thoracoscopic and laparoscopic surgery. The operation and pulmonary function indexes were compared. Results The operation time of the patients in the study group was significantly longer than that in the control group ( (218. 1±35. 8) min vs. (192. 3±40. 1) min,t=3. 23,P<0. 05). Intraoperative blood loss of the patients in the study group was significantly less than that in the control group ( (286. 4±83. 5) ml vs. (343. 7 ±96. 7) ml,t=3. 01,P<0. 05) . The number of lymph nodes cleared of the patients was significantly higher in the study group ( (18.0±5.4) node vs. (15.5±4.6) node,t=2.42,P<0.05).Thoracic drainage of the patients in the study group was significantly less than that in the control group ( (650. 3±61. 3) ml vs. (1153. 5 ±133. 7) ml,t=22. 12,P<0. 05). Chest tube pull out time in the study group was significantly earlier than that in the control group ( (5. 1±1. 3) d vs. (8. 0±1. 8) d,t=8. 65,P<0. 05). First exhaust time in the study group was significantly earlier than that in the control group ( (33. 2±6. 7) h vs. (40. 7±7. 3) h,t=5. 10,P<0. 05). Hospital stay in the study group was significantly shorter than that in the control group ( ( 13. 8 ± 2. 8 ) d vs. (18. 2± 3. 6) d, t=6. 42, P<0. 05) . Postoperative complications occurred in 4 cases in the study group, accounting for 10%, significantly lower than that in the control group, 15 cases, 27. 8%, the difference was statistically significant (χ2=4. 50,P<0. 05) . VC,FEV1 and MVV in the study group were significantly higher than those in the control group ( VC:( 81. 5 ± 15. 6 )% vs. ( 42. 3 ± 8. 1 )%;FEV1: ( 85. 7 ± 9. 1 )% vs. ( 43. 6 ±6. 8)%;MVV:(76. 0±8. 9)% vs. (48. 3±7. 6)%,t=15. 83,25. 68,16. 24,P<0. 05). 3?year survival rate of the study group and the control group were 45. 0% (18/40) and 44. 4% (24/54),respectively. There was no significant difference between the two groups (χ2 = 0. 01, P> 0. 05 ) . Conclusion Thoracoscopic and laparoscopic surgery for esophageal cancer has the advantages of small trauma,rapid recovery and low incidence of complications and obvious protective effect on pulmonary function. It is safe and feasible.

Objective To investigate the interrelation between nuclear DNA content and the expressions of cyclin D1 and P53 in carcinogenesis of breast carcinoma induced by 7,12 dimethylbenz(a)anthracence(DMBA) in rats. Methods Animal model of breast carcinoma was replicated by gastric perfusion of DMBA at 20 mg/100 g. Nuclear DNA content was detected with image analysis instrument and the expressions of cyclin D1 and P53 at every stage of carcinogenesis of breast carcinoma induced by DMBA in rats observed by Sp immunohistochemical staining. Results In mammary gland tissue at grade Ⅰ, grade Ⅱ and grade Ⅲ atypical hyperplasia of breast carcinoma, there was overepression of cyclin D1(3/20, 6/20 and 11/20, respectively). The overexpression of cyclin D1 was detected to be present in grade Ⅰ, grade Ⅱ and grade Ⅲ breast carcinoma (7/9, 1/4 and 0/7, respectively). The overexpression of P53 was detected to be present in grade Ⅰ, grade Ⅱ and grade Ⅲ breast carcinoma (1/9, 1/4 and 6/7, respectively). Conclusion Nuclear DNA content reflects the state of cell proliferation. Cyclin D1 overexpression participates in the carcinogenesis of breast carcinoma, which may be the early event in breast carcinoma. P53 expression is associated with the development of breast carcinoma, which may be the late event in breast carcinoma. The expression of cyclin D1 is negatively correlated with P53 overexpression.

Objective To investigate the relationship between clinical and pathological features in order to observe estrogen and progestin receptor(ER and PR) expressions in bilateral primary breast cancer(BPBC). Methods ER and PR expressions in 29 cases of BPBC from 1990 to 2003 and the clinical and pathological features were analyzed retrospectively. Results ER and PR positive expressions were 53 2% and 41 2% in unilateral breast cancer, but 69% and 51% in first primary cancer of BPBC, and 65% and 41 3% in second primary cancer of BPBC, respectively. Invasive lobular carcinoma(ILC) was 11 6% in unilateral breast cancer and 34 4% in first cancer of BPBC and 41.3% in second primary cancer of BPBC. Status of lymph nodes in unilateral breast cancer was similar to that in BPBC. Conclusion There is higher ER expression in BPBC than that in unilateral breast cancer. ILC is significantly related to the carcinogenesis of BPBC. The status of lymph nodes is not related to BPBC.

Objective To investigate the significance of microsatellite instability(MSI) and expressions of cyclin D1 and P53 in 7,12 dimethylbenz(a)anthracene (DMBA) induced breast carcinoma in rats. Methods Animal model of rat breast carcinoma was duplicated in 30 female Wistar rats by gastric irrigation of DMBA at the dose of 200 mg/kg. Eight microsatellite loci(D1Mitl4, D1Mgh2, D1Mgh6, D3Mit3, D3Mgh9, D5Mitll, D5Mgh5 and D7Mgh1) were selected for the examination of MSI of breast carcinoma by PCR analysis. S P immunohistochemical staining was used to study the expressions of cyclin D1 and P53 in DMBA induced breast carcinoma in rats. Results Of the 27 cases of breast carcinoma, there were 2 cases of MSI at 8 loci, 9 cases with P53 overexpression and 12 cases with cyclin D1 overexpression. All these were associated with histological grading. Conclusion MSI is infrequent in breast carcinogenesis in rats. Cyclin D1 overexpression may be the early event but P53 protein overexpression may be the late event in breast carcinoma.

Objective To study the expressions of estrogen receptor(ER)and progesterone receptor(PR)in elderly patients with breast cancer,and the correlation between their expressions and clinicopathological characteristics.Methods The expressions of ER and PR in 110 elderly patients with breast cancer(over 60 years old)from 1995 to 2004 were detected,and their clinical and pathological features were analyzed retrospectively.Another 110 patients aging 30 to 59 years with breast cancer served as control.Results Breast cancer in aged and non-elderly group had similar pathohistological types,but the aged had more tumors with low-grade malignant types.ER and PR were found to be over-expressed in elderly patients but not in the control.No obvious correlation was seen with clinical pathological stages.The expression levels of ER and PR in 0-3 positive nodes group was higher than ≥4 positive nodes group.Conclusion Elderly patients and non-elderly patients have similar pathohistological types of breast cancer.The former have higher expressions of ER and PR,and their expressions are associated with axillary lymph node status.