The development of multidrug resistance (MDR) to chemotherapy remains a major trouble in the treatment of tumors,and the mechanisms of MDR are complicated.The classic mechanisms involve the overexpression of multidrug resistance-associated protein,inhibition of cell apoptosis,abnormality of enzyme system and gene repair.Studies in recent years have shown that the mechanisms of MDR are also closely related with tumor stem cells,tumor microenvironment and abnormality of signal transduction pathways.

A random sample survey was conducted in 17 community medical institutes in 4 districts in Beijing.Among an effective sample of 385 residents.47.5％ (n =183)of community residents chose community medical institutes for first contact care while 52.5％ (n =202) opted for class other hospitals.Residents with lower education levels tended to choose community medical institutes (P =0.01).And those with chronic diseases preferred to choose communities (P=0.00).

Objective:To raise awareness of acute myeloid leukemia (AML) combined with lymphoblastic lymphoma (LBL) in children.Methods:The clinical characteristics, diagnostic methods, treatment plans and prognosis of a child with AML combined with LBL who was admitted to the First Affiliated Hospital of Zhengzhou University in April 2016 were retrospectively analyzed, and the relevant literature was reviewed.Results:The patient was an 11-year-old boy with fever, abnormal hemogram and cervical lymph node enlargement as clinical manifestations. A biopsy of the cervical lymph node was performed and the patient was diagnosed as T-lymphoblastic lymphoma (T-LBL). After the bone marrow morphology, immunology, cytogenetics and molecular biology (MICM) classification examination, the diagnosis was AML. The patient met the diagnostic criteria of two diseases at the same time, and thus he was confirmed as AML combined with T-LBL. AML chemotherapy regimens were given, and the patient achieved complete remission and disease-free survived.Conclusions:AML with LBL is extremely rare in children. The diagnosis mainly depends on MICM classification examination of bone marrow and pathological examination of lymph nodes. There is currently no standard treatment scheme, and the prognosis is extremely poor. AML chemotherapy followed by bridging hematopoietic stem cell transplantation is the best treatment option for these patients.

Objective To investigate the clinical effect of homeopathic reduction with minimally invasive adjustable plate in treatment of sacral fractures.Methods A retrospective case-control study was conducted to assess the data of 89 patients with sacral fractures treated from January 2013 to January 2015.There were 49 males and 40 females,with a mean age of 37.8 years (range,18-70 years).Denis classification was type Ⅰ in 24 patients,type Ⅱ in 48,and type Ⅲ in 17.Patients were divided into three groups according to fixation methods:homeopathic reduction with minimally invasive adjustable plate group (Group A,n =30),sacroiliac screw group (Group B,n =31) and iliolumbar rod group (Group C,n =28).Operation time,blood loss,intraoperative radiographic time,and complications were recorded.Reduction quality was assessed using the Matta criteria.Bone healing was evaluated based on X-ray appearance.Functional outcome was evaluated using the Majeed score at last tollow-up.Results Operation time was significantly lower in Group A [(109.3 ± 14.4) min] and Group B [(114.2 ± 17.7) min] than Group C [(126.8 ± 15.7)min] (P ＜ 0.05),but there was no significant difference between Groups A and B (P ＞ O.05).Blood loss was significantly lower in Group A [(433.3 ± 121.3)ml] and Group B [(461.3 ± 130.8)ml] than Group C [(785.7 ±205.0)ml] (P ＜0.05),but there was no significant difference between Groups A and B (P ＞ 0.05).Radiographic time was (5.6 ± 1.9) s in Group A,(13.4 ± 3.1)s in Group B,and (8.4 ± 2.5)s in Group C,showing significant difference among the three groups (P ＜ 0.05).Excellence rate of Matta score in Group A [70％ (21/30)] and Group C [86％ (24/28)] was higher than that in Group B [32％ (10/31)],but the there was no significant difference between Group A and C (P ＞ 0.05).Fracture healing was found in all patients and no nonunion was observed.Excellent rate of Majeed score in Group A [80％ (24/30)] and Group C [82％ (23/28)] was higher than that in Group B [54％ (17/31)],but the there was no significant difference between Groups A and C (P ＞0.05).Complication rate in Group B [29％ (9/31)] and GroupC [29％ (8/28)] were higher than that in Group C [3％ (1/30)],but the there was no significant difference between Groups B and C (P ＞ 0.05).Conclusion For sacral fractures,homeopathic reduction with minimally invasive adjustable plate can reduce operation time and intraoperative radiographic time,improve reduction rate and lower incidence of complications.

OBJECTIVE: To investigate a new way to yield plenty of high purity olfactory ensheathing cells (OECs) and its biocompatibility with appropriate scaffolds. METHODS: OECs were prepared from neonatal Wister rats and co-cultured with poly [LA-co-(Glc-alt-Lys)] (PLGL). Its contact angle, adherent rate, and activity rate were tested. RESULTS: The contact angle of poly (D, L-lactic acid) (PDLLA) (84.5 degree+/-1.5 degree) was significantly higher than that of PLGL (52.6 degree+/-0.8 degree), the adherent rate of PLGL (80%) was significantly higher than that of the PDLLA (57%), and the activity rate of PLGL (88%) was much higher than that of the PDLLA (76%). CONCLUSION PLGL possesses better hydrophilicity and biocompatibility than PDLLA, and it can provide a better cell growth circumstance which is helpful for the effective treatment of nerve injury.
Animals ; Animals, Newborn ; Biocompatible Materials ; Cells, Cultured ; Lactic Acid ; chemical synthesis ; pharmacology ; Nerve Regeneration ; Olfactory Bulb ; cytology ; Polyglycolic Acid ; chemical synthesis ; pharmacology ; Polylactic Acid-Polyglycolic Acid Copolymer ; Rats ; Rats, Wistar ; Spinal Cord Injuries ; physiopathology ; Tissue Engineering ; methods ; Tissue Scaffolds ; chemistry

OBJECTIVETo explore significance of serum soluble CD163(sCD163) and soluble CD25(sCD25) in diagnosis and guiding treatment of children with hemophagocytic lymphohistiocytosis (HLH).

METHODData of 42 cases of children with HLH, 32 cases of non-HLH children with infection presented to First Affiliated Hospital of Zhengzhou University pediatric clinic and ward were collected from December 2013 to December 2014. Twenty-four healthy children were enrolled into a normal control group in the same period.Peripheral venous blood specimens (3 ml) were taken from the children with HLH after fasting before treatment, two weeks after treatment and eight weeks after treatment.Peripheral venous blood specimens (3 ml) were also taken from children of non-HLH infected group and normal control group after fasting at the initial visit. Serum sCD163 and sCD25 levels in the peripheral blood in three groups were determined by ELISA. According to cause of disease, children with HLH were divided into infection-related HLH, tumor-related HLH, primary HLH and others; relationship between serum sCD163 and sCD25 level and cause of disease was analyzed.

RESULTSerum sCD163 of HLH group ((6 094 ± 2 769) µg/L) and serum sCD163 of non-HLH infection group ((2 174 ± 950) µg/L) were significantly higher than that of normal control group ((777 ± 256) µg/L), F=71.396, P<0.05), and the differences among groups were statistically significant (P<0.05); serum sCD25 of HLH group ((41 963 ± 31 821) ng/L) and serum sCD25 of non-HLH infection group ((6 700 ± 4 105) ng/L) were significantly higher than that of normal control group ((2 440 ± 1 870) ng/L, F=37.513, P<0.05).There was no statistically significant difference between the non-HLH infection group with the normal control group (P>0.05), and the difference between the remaining groups was statistically significant (P<0.05). And serum sCD163 and sCD25 level of HLH group had a positive linear correlation, and Pearson correlation coefficient r=0.742 (t=7.000, P<0.05). The difference of serum sCD163 and sCD25 level among the different cause of disease in HLH group was significant (P<0.05).Pairwise comparison showed that serum sCD163 and sCD25 level of tumor-associated HLH group significantly increased as compared with infection-associated HLH group (P<0.05), but the difference was not statistically significant between the other groups (all P>0.05). Serum sCD163 and sCD25 level of HLH group before treatment, 2 weeks and 8 weeks after treatment showed a statistically significant tendency of decrease (P<0.05). Seen from the ROC curve, when sCD163 cut-off point was 2 359.08 µg/L, the diagnostic sensitivity was 83.3%, and specificity was 83.9%.When sCD25 cut-off point was 14 901.024 ng/L, the diagnosis sensitivity was 76.2%, and specificity was 98.2%.

CONCLUSIONSerum sCD163 and sCD25 levels may be used for diagnosis of HLH.Dynamically monitoring of serum sCD163 and sCD25 level can help to determine deterioration of HLH and guide treatment.

Antigens, CD ; blood ; Antigens, Differentiation, Myelomonocytic ; blood ; Case-Control Studies ; Child ; Enzyme-Linked Immunosorbent Assay ; Humans ; Interleukin-2 Receptor alpha Subunit ; blood ; Lymphohistiocytosis, Hemophagocytic ; blood ; diagnosis ; therapy ; ROC Curve ; Receptors, Cell Surface ; blood ; Sensitivity and Specificity

Osteofascial compartment syndrome (OFCS) is clinically common and is well known to orthopedic surgeons.Clinicians attach great importance to OFCS because of its severe clinical consequences,and decompression of fascial compartment is often performed in emergency treatment.This article reviews the literature on the threshold of fascial compartment decompression proposed by many scholars in the past and discusses the problems in the clinical diagnosis of acute compartment syndrome,especially the inconsistent pressure thresholds as the indication for emergency decompression surgery.By observing calf fractures patients with tension blister,we found that the pressure of fascia decreased sharply upon the appearance of blisters.Meanwhile,the swelling gradually subsided as well as the clinical manifestations of pain and parasthsia.In view of the uncertainty of various thresholds of fascial decompression and self-decompression,the concepts of myofascial self-release law and muscle-swelling syndrome were first proposed.The author believes that when intracompartmental pressure rises to a point,some unknown mechanisms of fascia can achieve self-decompression.Therefore,no compartment syndrome will take place.We also emphasize that the ' muscle-swelling syndrome'should be strictly distinguished from the soft tissue necrosis caused by crush syndrome and acute limb vascular injury,so as to provide more precise treatment.We believe that without external restrictions such as casts,splints and compression bandages,the muscle-swelling syndrome can achieve self decompression by releasing the pressure in the compartment through tension blisters,and there is no need for fasciotomy.

Objective: To evaluate the possibility of transverse sacroiliac screw placement in different segments of the sacrum. Methods: Data of 80 pelvic CT scans (slice thickness ≤1.0 mm) archived in CT department of the Third Hospital of Hebei Medical University from September 2016 to October 2017 were retrospectively collected. Mimics software was used to rebuild the pelvis three-dimensional model. According to whether the sacral 1(S₁) segment could place the transverse sacroiliac screws or not, all the sacrums were divided into normal group (n=55) and dysmorphic group (n=25). Simulation the S₁, sacral 2(S₂) transverse sacroiliac screw placement in 3-Matic software. Analysis whether there was any difference in maximum diameter and length of S₂ transverse sacroiliac screw between the normal group and the dysmorphic group. The pelvic CT data of the dysmorphic group were measured, and the optimal tilt angle and length of the oblique S₁ screw were obtained. The feasibility of transverse sacroiliac screw insertion in sacral 3(S₃) segment was evaluated.t-test, rank sum test, and χ² test was used to analyze data, respectively. Results: In the dysmorphic group, the largest diameter of the S₁ transverse screw was (4.9±1.6)mm, and the normal group was (13.6±3.6)mm (t=-15.07, P=0.00). In the dysmorphic group, the largest diameter of S₂ transverse screw was (13.8±3.0)mm, and was (12.4±2.2)mm in the normal group(t=2.11, P=0.04). There was no significant difference in the length of S₂ transverse sacroiliac screw between the two groups (t=0.47, P=0.64). In the dysmorphic group, the anterior vertebral height of S₁ was (23.1±4.0)mm, which was significantly higher than that of the normal group ((14.1±4.2)mm)(t=9.01, P=0.00). The angle of S₁S₂ in the dysmorphic group was 10.9°(3.8°, 17.6°), which was significantly larger than that of the normal group (2.0°(1.0°, 2.0°) (Z=-4.03, P=0.00). In the dysmorphic group, the incline angle of the oblique S₁ sacroiliac screw was (35.6±6.2)°, the anteversion angle was (37.2±4.4)°, and the mean screw length was (90.2±4.7)mm. In the dysmorphic group, the placement rate of S₃ transverse sacroiliac screw was 48.0%, and that of the normal sacral group was 9.1%. Conclusions There is often dysmorphic in the sacrum in patients with large S₁ anterior vertebral height and S₁S₂ angle. Sacral dysmorphic patients with posterior pelvic ring injury may be treated with S₁ pedicle oblique sacroiliac screws. S₃ transverse sacroiliac screws should be carefully placed, especially for the absence of sacral dysmorphic in patients.

Objective: To explore the clinical outcome an anatomic quadrilateral surface plate for both-column acetabular fractures through the Stoppa combined with iliac fossa approach. Methods: A retrospective study of the patients with both-column acetabular fractures treated with an anatomic quadrilateral surface plate through the Stoppa combined with iliac fossa approach from November 2015 to June 2017 was performed. Nineteen patients including 16 males and 3 females met the inclusion criteria. The mean age of included patients was 49.11 years (range, 25-68 years). There were 8 cases of fall injury, 7 cases of car accident injury and 4 cases of crushing injury. There were 11 cases of C1 type injury, 7 cases of C2 type, and 1 case of C3 type according to Tile classification. Patients included in this study were both-column acetabular fractures according to Letournel-Judet classification. There were six cases associated with posterior wall detachment. Minimally Stoppa combined with iliac fossa approach was performed to manage the displaced fragments. First, the anteromedially displaced iliopubic fragment was managed with a reconstruction plate through iliac fossa approach. Then, the medially displaced ischiadic fragment could be fixed with an anatomic quadrilateral surface plate through the Stoppa approach. The reduction quality was assessed by postoperative radiographs and CT scans according to the criteria proposed by Matta. The function of hip joint was assessed by the Merle d'Aubigné-Posteal score modified by Matta. Results: The average operation time and blood loss were 115.26 min (range, 90-160 min) and 534.21 ml (range, 300-1000 ml), respectively. The mean length surgical incision was 18.82 cm (range, 16-20 cm). Average follow-up time was 19.84 months (range, 12-28 months). According to Matta criteria of reduction quality, anatomic reduction was obtained in 14 cases, and satisfactory reduction was gained in 3 cases, while unsatisfactory reduction was found in 2 cases (satisfactory rate=89.47%). All fractures healed well and mean healing time was 3.32 months (range, 3-5 months). The mean Merle d’Aubigné-Posteal score modified by Matta was 16.95 (range, 13-18), including 12 cases of excellent, 4 cases of good, and 3 cases of fair (satisfactory rate=84.21%). Intraoperative injury of lateral femoral cutaneous nerve developed in a case and obturator nerve damage occurred in another patient, respectively. Relevant symptoms were totally disappeared after two months’ conservative treatment (including neurotrophic therapy combined with adduction exercise of the affected thigh). Iliac fossa hematoma occurred in a case and relevant symptom was eliminated after puncture. Conclusion Satisfactory clinical outcome of both-column acetabular fractures could be obtained by the anatomic quadrilateral surface plate through the Stoppa combined with iliac fossa approach.

Objective:To compare clinical characteristics of orthopedic trauma patients between the patients during pandemic of corona virus disease 2019 (COVID-19) and those beyond the pandemic period and analyze the factors influencing fracture site changes during pandemic of COVID-19.Methods:A retrospective case-control study was made on data of 1 048 patients with fractures hospitalized in Third Hospital of Hebei Medical University treated from January 20, 2020 to February 25, 2020 (pandemic period group) and from January 31, 2019 to March 9, 2019 (beyond pandemic period group). There were 232 patients in pandemic period group, including 121 males (52.2%) and 111 females (47.8%), with age range of 1-100 years [(47.9±26.3)years]. There were 816 patients in beyond pandemic period group, including 454 males (55.6%) and 363 females (44.5%), with age range of 1-96 years [(47.3±23.9)years]. Fracture sites were compared between the two groups. Age, sex, occupation, cause of injury, history of basic medical diseases, location of fracture, residence, marital status and other factors among the patients with low limb fractures and other fractures in pandemic period group were analyzed using the Logistic regression analysis.Results:Incidence of limb fractures in pandemic period group (69.4%, 161/232) was significantly higher than that in beyond pandemic period group (59.8%, 488/816) ( P<0.05), while the incidence of whole-body multiple fractures in pandemic period group (8.2%, 19/232) was significantly lower than that in beyond pandemic period group (13.6%, 111/816) ( P<0.05). Univariate analysis showed that female, middle or older age, farmers, low-energy injury, basic medical disease, staying at home were risk factors for limb fracture during pandemic ( P<0.05). Multivariate Logistic regression analysis showed low-energy injury ( OR=8.264, P<0.01) was an independent risk factor for limb fracture during pandemic. Conclusions:Compared with the beyond pandemic period, some location of fracture is changed and incidence of limb fracture is increased during pandemic. Low energy injury is an independent risk factor of limb fracture during the pandemic.