Objective To explore the treatment method and clinical effect of LARS artificial ligament in treatment of combined anterior cruciate ligament(ACL) and posterior crueiate ligament (PCL) injuries of the knee under arthroscope. Methods Thirteen cases of ACL and PCL injuries were reconstructed with LARS ligament. The patients were followed up for 12-36 months. The International Knee Documentation Committee (IKDC) and Lysholm knee score scale were used for functional evaluation. In the meantime, KT-1000 was employed to check anterior and posterior laxation of the knee. Results No knee infection or limitation of knee extension occurred. Knee flexion was 105° -125° (average 117°). At termination of follow up, 10 cases (77%) was graded as A and 3 (23%) as B according to IKDC. KT-1000 examination at 25° flexion showed that the difference of anterior laxation was less than 2 mm in 12 cases and 3-5mm in 1. KT-1000 examination at 70°flexion showed that the difference of anterior laxation was less than 2mm in 12 cases and 2-4 mm in 1. The Lysholm score was (63.8±2.9) points (49459 points) before operation and (91.1 ±2.7) points (88-95 points) at follow up, with statistical difference (P ＜0.01). Conclusion Reconstruction of ACL and PCL by using LARS ligament under arthroscope is a kind of minimally invasive, safe and effective method to treat ACL and PCL injuries of the knee, with good short term outcome.

Objective To establish an HPLC method for content determination of Ginsengnoside Rg1, Ginsengnoside Rb1 and Notoginsenoside R1 inTianqi Tongjing Capsule.Methods An Agilent ZORBAX SB-C18 column (4.6 mm × 250 mm, 5μm) was used. The mobile phase was composed of acetonitrile (A) and water (B) with gradient elution (0-20 min, 19%→21%A;20-50min, 21%→36%A) at a flow rate of 1.0 mg/mL;the wavelength of detector was 203 nm;the temperature of the column was 25℃.Results The calibration curves of Ginsengnoside Rg1, Ginsengnoside Rb1 and Notoginsenoside R1 showed good linearity within the range of 0.442 4-3.981 6μg (r2=1.000 0), 0.524 8-3.673 6μg (r2=0.999 4) and 0.203 2-1.016μg (r2=0.999 2), respectively. The average recoveries (n=9) were 99.49%, 99.02% and 99.98%, and RSD were 2.44%, 2.45% and 2.14%, respectively.Conclusion The method is simple, reliable, rapid and with good repeatability, and can effectively control the quality ofTianqi Tongjing Capsule.

Background:Matrix metalloproteinase-9(MMP-9)is known to play a key role in tumor invasion and metastasis by mediating the degradation of extracellular matrix. It has been revealed that neutrophil gelatinase-associated lipocalin ( NGAL)is capable of protecting MMP-9 from degradation and thereby preserving its enzymatic activity. Aims:To explore the MMP-9 and NGAL levels in peripheral blood of gastric cancer patients and their clinical significance. Methods:Serum levels of MMP-9 and NGAL were determined by ELISA in 76 gastric cancer patients and 50 healthy controls. Correlations of serum MMP-9 and NGAL levels with clinicopathological features of gastric cancer were analyzed,and their diagnostic performance for screening gastric cancer was evaluated by ROC curve. Results:Serum levels of MMP-9 and NGAL in patients with gastric cancer were significantly higher than those in healthy controls(P<0. 01),and either of them was positively correlated with the TNM stage of gastric cancer. Furthermore,MMP-9 was correlated with lymph node metastasis and serosal invasion,while NGAL was correlated with distant metastasis. However,tumor differentiation was not correlated with either MMP-9 or NGAL. By ROC curve,608. 19 ng/mL and 14. 71 ng/mL were identified as the cutoff value of serum MMP-9 and NGAL,respectively,for screening gastric cancer. Sensitivity and specificity of MMP-9 were 64. 5% and 90. 0%,and those of NGAL were 85. 5% and 90. 0%,respectively. When parallel test was taken,the sensitivity would be increased to 94. 7% and specificity being 82. 0%. Conclusions:Serum levels of MMP-9 and NGAL are elevated and associated with tumor progression in patients with gastric cancer. Both of them might be used as potential markers for screening,disease assessment and prognosis prediction of gastric cancer.

AIM The proofs of evidence-based medicine of Qingkailing Injection's effect on viral hepatitis are lack in spite of the wide use of Qingkailing Injection in medical practice.This study aims to use Meta-analysis to evaluate its clinical effect and safety.METHODS Such databases as CNKI,VIP and Wanfang were searched for randomized controlled trials related to Qingkailing Injection in treatment of viral hepatitis,which were published officially between 1996--2016.Revman 5.3 software was used to conduct Meta-analysis for the effective rate,rate of adverse reaction,the decrease rate of ALT,AST and TBIL of Qingkailing Injection.Meanwhile,subgroup analysis was conducted to the clinical effect of doses [＜ 0.5 mL/(kg · d),0.5-0.67 mL/(kg · d),＞0.67 mL/(kg · d)],treatment courses (≤ 14 d,＞ 14 d),manufacturers (Beijing University of Chinese Medicine Pharmaceutical Factory,Shenwei Pharmaceutical Company,Shanxi Taihang Pharmaceutical Company),year (1996 to 2002,2003 to 2009,2010 to 2016).RESULTS Fourteen studies were included according to the criterion.The results of Meta-analysis showed that the total effective rate,the decrease rate of ALT,AST and TBIL in Qingkailing Injection group were significantly higher than those in the control group (P ＜ 0.05).Whereas,no significiant differences were found between Qingkailing Injection group and the control group of its rate of adverse reaction (P ＞ 0.05).Subgroup-analysis showed that the effective rate of Qingkailing in doses subgroup,treatment courses subgroup,manufacturers subgroup and year subgroup were significantly higher than those of the control group.CONCLUSION Qingkailing Injection has obvious benefit in the treatment of viral hepatitis,which can reduce the activity of ALT and AST,also can reduce the content of TBIL.But we should pay attention to the prevention of allergic reaction in the clinical use.

Objective: To investigate the effects of probiotics, lactitol of different concentrations, and their combination on intestinal microbiota in mice. Methods: Fifty C57BL/6J mice were divided into blank control group, probiotics group, lactitol of standard concentration group, lactitol of high concentration group, and combination of probiotics and lactitol group, 10 mice in each group, with no intervention, gavaged with 1×10⁹ colony-forming units(CFU)/d probiotics, with lactitol of standard concentration (6.6 g·kg^-1·d^-1), with lactitol of high concentration (10.0 g·kg^-1·d^-1), with probiotics (5×10⁸ CFU/d) and lactitol (3.3 g·kg^-1·d^-1) for two weeks, respectively. The feces before gavage and one week and two weeks after gavage were collected. And intestinal mucosa samples were also collected at two weeks after gavage for 16S rRNA sequencing. Alpha diversity analysis, principal component analysis (PCA) and taxonomy were used for analysis of the changes of microbiota. Results: The results of alpha diversity analysis showed there was no statistically significant difference in feces between before gavage and at one week after gavage (P=0.552, 0.062). The results of alpha diversity analysis and PCA indicated that there was no statistically significant difference in intestinal microbiota between lactitol of standard concentration group and lactitol of high concentration group (P=0.270 and 0.085). One week and two weeks after gavage, compared lactitol of standard concentration group and lactitol of high concentration group with blank control group and probiotics group, Akkermansia in feces both increased (one week after gavage, 0.114 3 vs. 0.003 9 and 0.013 1, 0.071 3 vs. 0.003 9 and 0.013 1; P<0.01, P=0.001 and P=0.001, 0.005; two weeks after gavage, which was 0.094 0 vs. 0.030 5 and 0.018 9, 0.142 4 vs. 0.030 5 and 0.018 9; P=0.044, 0.016 and 0.001, <0.01). Compared combination of probiotics and lactitol group with lactitol of standard concentration group and high concentration group, Bacteroides in feces increased (one week after gavage, 0.115 9 vs. 0.037 5 and 0.041 6, P=0.013 and 0.015; two weeks after gavage, 0.058 0 vs. 0.023 2 and 0.014 4, P=0.047 and 0.009). The increase of Lachnospiraceae appeared earlier in combination of probiotics and lactitol group (at one week after gavage). Two weeks after gavage, compared with that of blank control group, lactitol of standard concentration group and high concentration group, Lachnospiraceae in feces of probiotics group increased (all P<0.05). Compared with that of probiotics group, Akkermansia of mucosa in lactitol of standard concentration group increased (0.018 0 vs. 0.001 8, P=0.012). Akkermansia of mucosa in lactitol of high concentration group also increased compared with that of blank control group and probiotics group (0.037 0 vs. 0.010 0 and 0.001 8, P=0.002, <0.01). Comparing combination of probiotics and lactitol group with blank control group, lactitol of standard concentration group and lactitol of high concentration group, and comparing probiotics group with lactitol of high concentration group, Mucispirillum in mucosa all increased (0.040 0 vs. 0.014 8, 0.013 7 and 0.009 9, 0.019 6 vs. 0.009 9; P=0.041, 0.040, 0.018 and 0.011). Conclusions Supplementary probiotics, lactitol and combination of them all have obvious regulative role in mucosal flora of mice. Exogenous probiotics can not easily colonized in the intestine. Lactitol can obviously promote the proliferation of Akkermansia in feces and intestine.

Objective To evaluate the activity of the cerebral glymphatic system during recovery in ischemic stroke(IS)patients with motor dysfunction,and to explore its association with motor function scores and corticospinal tract(CST)integrity via.Methods A total of 20 patients with IS(stroke group)and 20 healthy volunteer(control group)were recruited.There was a single lesion located at the left cerebral hemisphere in the stroke group.Demographic and clinical data of all participants were recorded.All participants underwent brain MRI scans,including diffusion tensor imaging(DTI)and T2WI.Diffusion tensor image analysis along the perivascular space(DTI-ALPS)index at lateral ventricle level,fractional anisotropy(FA)and axial diffusivity(AD)of CST were calculated and the differences of each index between the two groups were compared.The correlation between DTI-ALPS index and Fugl-Meyer score and integrity of CST were analyzed in stroke group,respectively.Results The DTI-ALPS index in the stroke group was significantly lower than that in the control group(t=-3.88,P＜0.001).The DTI-ALPS index in the stroke group was positively correlated with motor function score(P=0.019),motor function grading(P=0.024)and sensory score(P=0.048),respectively.The DTI-ALPS index was negatively correlated with FA(r=-0.60,P=0.009)and AD(r=-0.67,P=0.002)of healthy side CST.Conclusion The decrease of DTI-ALPS index in patients with IS indicates the damage of cerebral glymphatic system.DTI-ALPS index may be a potential MRI biomarker for motor dysfunction in patients with IS,and a new idea is proposed for the study of the pathophysiological mechanism of IS.

Objective To explore the application value of Fast Dixon technique in MR hip joint scanning.Methods Fifty young volunteers were recruited to perform axial and coronal MR scans of the hip joint.The scanning sequence was Fast Dixon T2WI sequence and conventional Dixon T2WI sequence.A double-blind five-point scale was used to subjectively evaluate the image quality of the two types sequences.The signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)of the axial image were measured at the maximum level of the bladder display.Results In the scores of"good contrast between surrounding tissue and femoral head signal"and"overall image quality",the Fast Dixon T2WI sequence was better than the conventional Dixon T2WI sequence,and the difference was statistically significant(P<0.05).There was no significant difference in the average scores of"whether bladder artifacts affected the diagnosis"and"whether the fat suppression effect was good"between Fast Dixon T2WI sequence and conventional Dixon T2WI sequence(P>0.05).In the objective image quality evaluation,the SNR and CNR of Fast Dixon T2WI sequence were better than those of conventional Dixon T2WI sequence,and the difference was statistically significant(P<0.05).Conclusion The image quality score of the hip joint of young volunteers with Fast Dixon T2WI sequence combined with multiple averaging excitation technique is significantly higher than that of conventional Dixon T2WI sequence.The Fast Dixon T2WI sequence can increase the effect of inhibiting fat and motion artifacts without increasing the scanning time,and the joint face ratio is good.Fast Dixon technique can replace the traditional Dixon technique,thus becoming an optimal choice for hip joint MR scanning.

Objective:To evaluate the clinical results of miniplates combined with reconstruction plate in treating comminuted posterior wall acetabular fractures.Methods:A retrospective case series study was conducted for 27 patients with comminuted posterior wall acetabular fractures treated in General Hospital of Central Theatre Command of PLA from October 2015 to June 2019. There were 18 males and 9 females, at age of 23-61 years［（45.9±10.9）years］. All patients were treated by using miniplates combined with the reconstruction plate. The operation time, intraoperative blood loss, intraoperative blood transfusion, length of hospital stay and time of fracture healing were recorded. The reduction quality was evaluated according to Matta radiographic standard at 2 days postoperatively. The modified Merle D'Aubigné-Postel score was adopted to evaluate the hip function at 3, 6 months postoperatively and the final follow-up. Postoperative complications were observed, and heterotopic ossification was assessed by Brooker grading standard.Results:All patients were followed up for 12-48 months［36（24, 36）months］. The operation time was 123-242 minutes［（165.4±29.8）minutes］; the intraoperative blood loss was 170-550 ml［（358.3±111.3）ml］; nine patients required intraoperative blood transfusion of 300-500 ml［（377.8±66.7）ml］. The length of hospital stay was 12-29 days［（21.4±4.7）days］. The fracture healing time was 12-24 weeks［（16.3±3.0）weeks］. According to Matta radiographic standard, the reduction quality was excellent in 21 patients, good in 3 and poor in 3 at 2 days postoperatively, with the excellent rate of 89%. The modified Merle D'Aubigné-Postel score was 9-16 points［（13.1±1.9）points］at 3 months postoperatively, was 10-18 points［（15.4±2.0）points］at 6 months postoperatively, and was 12-18 points［（16.9±1.8）points］at last follow-up（ P<0.01）. The modified Merle D'Aubigné-Postel score between 3 months and 6 months was significantly different（ P<0.01）, and the difference between 6 months and the follow-up was statistically significant（ P<0.01）. The modified Merle D'Aubigné-Postel score was graded as excellent in 0 patient, good in 7, fair in 11 and poor in 9 at 3 months postoperatively, with the excellent rate of 26%; graded as excellent in 3 patients, good in 19, fair in 2 and poor in 3 at 6 months postoperatively, with the excellent rate of 81%; graded as excellent in 18 patients, good in 5, fair in 3 and poor in 1 at the last follow-up, with the excellent rate of 85%（ P<0.01）. No iatrogenic sciatic nerve injury, deep vein thrombosis or wound infection occurred after operation. No hardware loosening or loss of reduction occurred during the follow-up. The post-traumatic arthritis was identified in 2 patients. The avascular necrosis of femoral head was observed in 1 patient and thereafter underwent total hip replacement. The heterotopic ossification occurred in 3 patients, among which 2 patients were graded as Brooker class I and 1 as class II, but there was no adverse effect on hip function. Conclusions:Miniplates combined with reconstruction plate in the treatment of comminuted posterior wall acetabular fractures have reliable fixation effect and attain good reduction, high fracture healing rate, less complications and satisfactory functional recovery.

Objective To investigate the significance of computed tomography(CT)and 3.0 T magnetic resonance imaging(MRI)in intensity-modulated radiotherapy(IMRT)for esophageal carcinoma. Methods Thirty-five patients newly diagnosed with esophageal carcinoma who received radical radiotherapy in our hospital from November 2013 to April 2015 were enrolled as subjects. Target volume was delineated on the CT images and MRI images(T2-weighted and diffusion-weighted fusion images). The MRI-and CT-based IMRT plans were designed using the same dose prescription and dose constraints for organs at risk(OAR). The target volume,prescribed dose,and doses for OAR were compared between the two plans. Results In the two plans, dose distribution and planning parameters met the clinical requirement. The length of lesion,gross tumor volume (GTV),and planning target volume(PTV)defined by 3.0 T MRI were significantly smaller than those defined by CT(P=0.00,0.03,0.03). There were no significant differences in the D 2%,D 98%,D 50%,homogeneity index,or conformity index for primary GTV(PGTV)and PTV-PGTV between the two plans(all P>0.05). Compared with the CT-based plan,the 3.0 T MRI-based plan had a significantly smaller mean dose to the lungs and an insignificantly smaller actual dose to the lungs(P=0.00;P>0.05).There were no significant differences in maximum doses tolerated by the spinal cord or heart between the two plans. Conclusions In terms of target volume delineation and dosimetric parameters, both CT-and 3.0 T MRI-based plans meet the clinical requirement. The 3.0 T MRI-based plan may provide potential benefits for some OAR due to a smaller target volume compared with the CT-based plan.

Objective To investigate the correlations between gastric Helicobacter pylori (Hp) infection and colorectal polyps or cancer.Methods Among patients who finished colonoscopy exams in Peking Union Medical College Hospital (PUMCH) between May 2012 and May 2017,3 483 patients were diagnosed with colorectal polyps,135 patients with newly diagnosed colorectal cancer.A total of 1 925 healthy subjects were enrolled as normal controls.Gastric rapid urease tests (RUT) were done in all patients.General clinical data,RUT results,sizes and numbers of polyps,cancer location were analyzed.Results The proportion of Hp infection in patients with colorectal polyps was 31.5％,higher than that in healthy controls.The odds ratio (OR) of Hp infection in polyp group was 1.17 (95％CI 1.04-1.32) after age and gender were adjusted.The Hp infection rate in patients with polyps over or equal to 1 cm was significantly higher than that in patients with polyps smaller than 1 cm.Patients with more than 1 polyps presented a higher rate of Hp infection than patients with only 1 polyp.Hp infection rate in patients with colorectal cancer was 36.3％,with the adjusted OR 1.56 (95％CI 1.06-2.30).The location of colorectal cancer was not correlated with Hp infection.Conclusions Gastric Hp infection is more common in patients with colorectal polyps than in healthy controls.Polyps ≥1 cm,multiple polyps and colorectal cancer are correlated with higher rates of Hp infection.Cancer location is irrelevant to Hp infection.