Objective To analyze the results of distal tibial pilon fractures treated with delayed open reduction and internal fixation. Methods From September 1997 to May 2001, 26 pilon fractures were stabilized temporarily by application of plaster splint, bandage, calcaneal traction (closed fracture) or unilateral external fixations (open fracture) immediately after injury. There were 19 males and 7 females with an average age of 37.6 years ( 15 to 58 years). Of 26 cases, 6 were open fractures and 20 close fractures, 18 of which were associated with fibular fracture. According to Ruedi-Allgower classification, the fractures were classified as typeⅠin 2, typeⅡin 15, and typeⅢ in 9. The conditions of soft tissue were divided into mild close injury without tension vesicle in 8, and severe injury with tension vesicle or open wound in 18. The definitive internal fixations were performed on an average of 10.2 days (range, 7 to 15 days) after injury as soon as the soft tissue recovered. The final outcomes of treatment were evaluated based on clinical rating and radiographic results. Results All patients were available for follow-up at an average of 3.8 years (range, 2 to 5.5 years) after surgery. All fractures healed at an average of 12.7 weeks (range, 8 to 29 weeks) postoperatively. There were 9 excellent(34.6%), 12 good (46.2%), 3 fair (11.5%), and 2 poor (7.7%) results according the ankle score of Teeny and Wiss. The results were significantly affected by the type of fracture and the severity of soft tissue injury, the excellent and good rate was 88.2% in typeⅠandⅡ, and 66.7% in typeⅢ; the total excellent and good rate was 100% in the patients with mild soft tissue injury, and 72.2% in the patients with severe soft tissue injury. The complications including 2 wound superficial infection and 1 skin necrosis, occurred in 3 patients(11.5%), which were successfully treated by local dressing changes. The incidence of osteoarthritis were found in 16 patients (61.5%) showed by X-ray films, but the radiographic manifestations did not correspond well with the clinical score. Conclusion This two-stage treatment protocol for pilon fracture has some advantages of fewer complications and good function.

Objective To assess the risks of complications of loop colostomy and loop ileostomy.Methods The databases of Medline,Embase,Cochrane Library,Google Scholar and Wanfang were retrieved to identify the published studies comparing the advantages between loop colostomy and loop ileostomy.All the articles retrieved were published before April 15,2011.The incidence of complications was analyzed by Meta-analysis.The data were analyzed by the Z test and the heterogeneity of the data was analyzed by the Q test.Results Five randomized controlled trials and 8 non-randomized controlled trials with 1752 cases were included in the Meta-analysis.Compared with loop ileostomy,loop colostomy was associated with significantly increased risk of stoma prolapse ( OR =3.46,95％ CI:1.81-6.63,P ＜ 0.05 ).There were no significant differences in the incidences of stoma hemorrhage and stenosis,wound infection,stoma necrosis,parastoma dermatitis and hernia between patients who received loop ileostomy and those who received loop colostomy.Compared with loop ileostomy,loop colostomy was associated with increased risk of wound infection following stoma closure(OR =3.44,95％ CI:1.95-6.05,P ＜0.05).Compared with loop colostomy,loop ileostomy was associated with increased risk of postoperative bowel obstruction following stoma closure(OR =0.43,95 ％ CI:0.20-0.91,P ＜ 0.05 ).There was no significant difference in the risk of anastomotic leak between loop ileostomy and loop colostomy.Conclusion Compared with loop ileostomy,loop colostomy is associated with increased risk of stoma prolapse and wound infection after stoma closure,while a higher risk of bowel obstruction following stoma closure is observed after loop ileostomy.

Objective To investigate the expressions of vascular endothelial growth factor-C (VEGF-C) and vascular endothelial growth factor-D (VEGF-D) and their relationship with lymph node metastasis in gastric cancer. Methods Eighty patients with gastric cancer had been admitted to our department from January 2005 to December 2005, including 48 with local lymph node metastasis and 32 without local lymph node metastasis. Ten specimens of normal gastric mucosa from patients with gastric ulcer were used as control. The expression of VEGF-C and VEGF-D in serum and tissues were detected. Results The senun levels of VEGF-C and VEGF-D in patients with gastric cancer were significantly higher than those in the control group (χ2= 8.39, P < 0.05). The positive rate of the VEGF-C expression in the sermn of patients with gastric cancer was influenced by the lymph node metastasis (χ2 = 7.01, P < 0.05). The positive rates of the expressions of VEGF-C and VEGF-D in the gastric cancer tissue were 53% (42/80) and 63% (50/80), which were significantly higher than those in the normal gastric mucosa (χ2 =6.44, 6.58, P <0.05). The positive rate of the VEGF-C expression in the tissue of patients with gastric cancer was influenced by the lymph node metastasis (χ2=11.25, P <0.05). Conclusions The expression of VEGF-C is closely related to lymph node metastasis of gastric cancer. The serum levels of VEGF-C can be used as biologic markers in detecting lymph node metastasis of gastric cancer preoperatively.

Objective To compare the prognosis of sentinel node-positive breast cancer patients forgoing axillary lymph node dissection.Methods A systematic literature search (Medline,Embase,Cochrane Library)ended in April 2014 was performed to identify all eligible articles.Two reviewers independently screened and extracted data.RevMan5 was used for statistical analysis.Results A total of 1026 abstracts were retrieved and 18 clinical controlled studies finally included,the total number of patients were 47 894,7389 had micrometastases in sentinel lymph node,35 217 had macrometastases in sentinel lymph node and 5288 had positive sentinel lymph node regardless of micrometastases or macrometastases.For patients with MIC,the 5-year axillary recurrence rate,5-year disease free survival and 5-year overall survival had no significant difference between patients who only received sentinel lymph node biopsy and patients who received further axillary lymph node dissection,(OR =1.78;95％ CI:0.72-4.39,P=0.21),(OR =0.76,95％CI:0.56-1.04,P=0.08),(OR=0.77,95％CI:0.43-1.40,P=0.39).For patients with MAC,the 5-year axillary recurrence rate had no significant difference between patients who only received sentinel lymph node biopsy and patients who received further axillary lymph node dissection,(OR =1.21;95％ CI:O.76-1.91,P =0.42).For patients with positive sentinel lymph node regardless of micrometastases or macrometastases,the 5-year axillary recurrence rate and 5-year overall survival had no significant difference between patients who only received sentinel lymph node biopsy and patients who received further axillary lymph node dissection,(OR =1.29;95％ CI:0.92-1.80,P =0.14),(OR =0.96,95％ CI:0.64-1.45,P =0.84).Conclusions Among patients with limited positive SLN of breast cancer,patients forgoing ALND compared with ALND did not have obvious affect on long-term survival.

Objective To explore the correlation between the enhancement pattern of hepatocellular carcinoma (HCC) on contrast-enhanced ultrasound (CEUS) and its tumor differentiation on histopathology. Methods HCC lesions (n=259) from 224 patients were retrospectively evaluated with CEUS and histopathological examination. CEUS was performed with SonoVue. The characteristics of blood perfusion and parameters of the time-intensity curve (TIC) were analyzed by ACQ soft?ware. Histopathological diagnoses were decided base on Edmonson grading system. Results Pathologic grading of HCC was not related to the arrival time(P>0.05);The washing-out time point and the enhancement time point and peak time point all appeared earlier in poorly differentiated HCC group, than those in moderately differentiated HCC group than those in well differentiated HCC group(P<0.01);The enhancement time point and the expurgation time point are shorter in poorly differ?entiated HCC group than those in moderately differentiated HCC group than those in well differentiated HCC group. All dif?ferences were with statistical significance. The mode of arterial perfusion in early stage was divided into 3 types:spider web type, radiative type and mixed type. The well differentiated HCC group mainly presented as radiative type ( 28/49, 47.14%). But the most of poorly differentiated HCC group mainly present as spider web type(88/127, 69.29%). The mix type was more common in moderately differentiated HCC group(49/83, 59.03%). Conclusion CEUS show different features of TIC pa?rameters and blood perfusion in different pathological stages of HCC lesions so it can serve as a method to assess the biologi?cal behavior of hepatocellular carcinoma.

ObjectiveTo modify the technique of whole small bowel transplantation in rats to improve the survival.MethodsOne hundred and six SD rats served as donors and recipients to establish a homogeneous and orthotopic model of small bowel transplantation without fistula.Anastomosis of aorta and vein was done with three- cuff technique,the vena mesenterica superior of recipient was done under a surgical microscope.End-to-end anastomosis was performed between donor proximal small intestine and receptor jejunum,and also between the remote and receptor ascending colon.Surviving more than 3 days after surgery was defined as the operation was successful.ResultsThe operation was successfully carried out in 48 cases with the survival rate of 90.6％ (48/53).The average warm ischemic time was 0 minute,and the average cold ischemic time was(30 ±2.48)min.The survival rate( ＞7 d) was 97.9％ (47/48).ConclusionsOn the basis of three-cuff technique,the survival of SBT was greatly improved.When the vena mesenterica superior of recipient was done under a surgical microscope,the surgical training time was shortened.

Objective To study the temporal and spatial expression of Nanog in developing primordial germ cells(PGCs) of mouse.Methods Immunofluorescence technique was taken to qualitatively analyze the expression of Nanog in PGCs of 7.5days(post-coitus days)-15.5days mouse embryo.A further quantitative analysis of Nanog expression change in PGCs of 11.5days-15.5days mouse embryo was done by using SSEA-1 and Nanog double labelling immunofluorescence staining with confocal microscopy.Results The PGCs in mouse allantois,hindgut,dorsal mesentery and genital ridge were Nanog positive.Both of the highest positive ratio and the highest fluorescence intensity appeared in PGCs of 11.5days mouse embryo.For the female mice,Nanog expression drops dramatically after 12.5days,and for the male mice,a noticeable decline of Nanog expression was occurred after 13.5 postcoitus days.Conclusion\ Nanog expresses stably in the proliferating PGCs.The down-regulation of its expression may be related with the differentiation of PGCs.

Objective To compare the clinical eficiency of gemcitabine plus oxliplatin and gemeitabine alone for advanced pancreatic cancer.Methods The histologic or cytologic confirmed 60 cases of pancreatic cancer were randomly divided into control Gemcitabine plus oxaliplatin group(GEMOX)with gemcitabine alone group(GEM)treatment,each 30 Cases.Results 54 patients were enrolled.The general remission rates(CR+PR)were 68.0 % in GEMOX group and 37.9 %in GEM group respectively.There was significant statistical diference between two group(P

Objective To explore the correlation between liver volume variation of posthepatitic cirrhosis patients and the severity of the disease. Methods One hundred and eleven patients with normal livers and 74 posthepatitic cirrhosis patients underwent volume CT scan. The relation between normal liver volume and body height, body weight and body surface area was studied by linear regression and correlation method, the standard liver volume equation was deduced. The change ratio of liver volume in cirrhotic patients was calculated and compared with Child classification. Results The mean normal liver volume of Chinese adults was (1 225.15?216.23) cm~3, there was a positive correlation between liver volume and body height, body weight 〔liver volume (cm~3)=12.712?body weight (kg)+450.44〕 and body surface area 〔liver volume (cm~3)=876.02?body surface area (m~2)-297.17〕. The mean liver volume of Child A, B and C patients were (1 077.77?347.01) cm~3, (1 016.35?348.60) cm~3 and (805.73?208.85) cm~3 respectively. The liver volume and liver volume index was significantly smaller in Child C patients than those in Child A and B patients (P

AIM:Studies on totipotential stem cells using primordial germ cells (PGCs) have the same application prospect as embryonic stem cells, especially for the animals difficult to isolate embryonic stem cells from blastula. In vitro culture condition of embryo germ cells is the key to control this. This study designs a method to effectively amplify PGCs of mice in vitro and establishes an effective culture method of PGCs. METHODS: Experiments were carried out in the Department of Histology and Embryology of Chongqing Medical University and Key Laboratory of Biochemistry and Molecular Pharmacology from October 2006 to August 2007. ①Clean Kunming pregnant mice (embryos 0.5 dpc) were provided by Animal Experimental Center of Chongqing Medical University. Experimental procedures met the animal ethical standards. ②Allantois and surrounding tissues of 8.5 day post coitum (dpc) embryos, the hindhut and surrounding tissues of 9.5 dpc and 10.5 dpc embryos, the gonadal ridges and surrounding tissues of 11.5 dpc and 12.5 dpc embryos were collected and digested with 0.25%pancreatin-0.02%EDTA, then the cells were cultured in the plastic petridishes which are pretreated with 0.1% gelatine. The formation ratio of primary and the first passaged Embryonic germ (EG) clones were compared among those different time points. The SSEA-1 positive ratio of isolated cells was compared between the two days by immunohistochemical method. The assays of clone numbers counting and MTT were used to compare the different proliferation ability of PGCs from the 11.5 dpc and 12.5 dpc embryos. The effects of expanding PGCs from 11.5 dpc and 12.5 dpc embryos by those two ways above were compared. The EG clones were analyzed by the expression of alkaline phosphatase and the immunologic marker SSEA-1,the undifferentiated marker Nanog and the differentiation ability in vitro were also tested. RESULTS:①The formation ratio of primary and the first passaged EG clone from 11.5 and 12.5 dpc embryos was higher than that from 8.5 to 10.5 dpc embryos and efficiency of expansion was increased (P 0.05). On the third day, the number of the primary EG clones from 11.5 dpc embryos was higher than that from 12.5 dpc embryos (P 0.05), but the two groups had different characteristics. ④The EG clones have representative morphology with high level of alkaline phosphatase activity and SSEA-1, Nanog expression, which can differentiate into the cystic embryoid body. CONCLUSION: 11.5 dpc and 12.5 dpc mouse embryos, especially 11.5 dpc embryos are the optional time points to expand PGCs efficiently. Co-culturing with the tissue and isolating the gonadal ridges both of these two ways are practicable.