BACKGROUND: Conventional means in treatment of distal tibiofibular syndesmosis disruption include plaster cast or splint immobilization as external fixation and internal fixation using screws, and bone bolts or plates;however, some disadvantages such as unstable fixation and uncertain fixation exist.OBJECTIVE: To observe the primary clinical curative effect of newly self-developed fixation, Hook-plate fixation (HPF), for distal tibiofibular syndesmosis disruption and its biochemical characteristics of HPF.DESIGN: Self-control observation.PARTICIPANTS: We recruited 23 patients with sustaining abruption of lower tibiofibular ligament union with fibular fracture who received treatment in the Department of Orthopedics, Affiliated Hospital of Yangzhou University Medical College, between October 2001 and March 2004. According to the Lauge-Hansen classification system, there were 11 cases of supination-lateral rotations, 7 cases of pronation-lateral rotations and 5cases of pronation-abductions. Among them 14 had bimalleolar fractures and 9 had trimalleolar fractures.METHODS: HPF was used on the 23 patients with distal tibiofibular syndesmosis disruption. Radiographs were taken routinely. Talocrural joint function exercise was recommended at week 1 and partial weight bearing was allowed 2 months later. Functions were evaluated according to modified Mazur's criteria (excellent, good, fair and poor).MAIN OUTCOME MEASURES: ①Healing time and function ev aluation after operation for distal tibiofibular syndesmosis disruption. ② Adverse events and side effectsRESULTS: Totally 23 patients entered the result analysis, with the mean of 11 months' follow-up. ①Results of healing time and function evaluation in the patients after operation for distal tibiofibular syndesmosis disruption: The healing time of fracture ranged from 12 to 18 weeks: 16 cases were excellent, 5 good, and 2 fair. ② Adverse events and side effects:There was no separation of the tibiofibular space, the distance between medial malleolus or lateral malleolus and anklebone was symmetrical.There was no mobilization or rupture of the internal fixation after operation.CONCLUSION: HPF is applied in treating distal tibiofibular syndesmosis disruption. It causes no postoperative complications, and can recover the ankle joint function with stable internal fixation and good biomechanical features.

Carcinoma, Hepatocellular ; diagnosis ; surgery ; therapy ; Hepatectomy ; Humans ; Liver Neoplasms ; diagnosis ; surgery ; therapy

Objective: To evaluate the long-term efficacy and prognostic factors of childhood acute lymphoblastic leukemia (ALL) enrolled in Shanghai Children's Medical Center-Acute Lymphoblastic Leukemia-2005(SCMC-ALL-2005) multicenter study. Methods: Between May 2005 and December 2014, 1 497 newly diagnosed ALL patients were enrolled and treated in 5 hospitals of SCMC-ALL-2005 study group, using risk-stratified SCMC-ALL-2005 protocol. Risk group classification and treatment intensity were based on clinical features, genetic abnormalities, early response to treatment and levels of minimal residual disease (MRD). Kaplan-Meier method was used to generate overall survival (OS) and event-free survival(EFS) curves. Cox proportional hazards models were used for multivariate analyses. Results: The patients were followed up to December 31, 2016, the median follow-up time was 69 months (24-141 months). The 5-year and 10-year OS rates were (80.0±1.0)% and (76.0±2.0)%. The 5-year and 10-year EFS rates were (69.0±1.0)% and (66.0±2.0)%. The 5-year and 10-year relapse rates were (23.0±1.0)% and (25.0±2.0)%. The 5-year OS and EFS for low risk (LR), intermediate risk (IR) and high risk (HR) were (91.1±1.4)% and (83.3±1.8)%, (79.2±1.5)% and (68.9±1.7)%, (52.9±4.4)% and (30.0±3.8)%, respectively. MRD negative status (<0.01%) on day 55 was seen in 792 patients (82.8%) and positive MRD on day 55 was associated with poor prognosis (OR=1.9, 95%CI: 1.3-2.7, P=0.001). Twenty-four HR patients received allogeneic hematopoietic stem cell transplantation and 17(70.8%) of them were alive and in remission. A total of 164 severe adverse events occurred, 46 of them died, treatment-related mortality was 3.1%. Conclusions In this large sample research, the overall outcome for multi-center SCMC-ALL-2005 study was favorable. This helps to promote the standardized treatment of childhood ALL to the whole country. MRD results on day 55 of induction therapy have important prognostic and therapeutic implications.