BACKGROUND:Ankle joint fracture is a common fracture in the clinic. Proportion of Danis-Weber B fracture was large. Anatomic reduction and suitable internal fixator of lateral mal eolus are the key for successful repair. OBJECTIVE:To analyze the anatomic reduction effect of anatomic plate combined with hol ow screw fixation for inner and outer side fracture of the ankle joint. METHODS:A total of 32 patients with Danis-Weber B ankle fracture, who were treated from March 2010 to October 2013, were retrospectively analyzed. Plate and screw were used for internal fixation of lateral mal eolus. Double thread compression screw was used for fixation of medial mal eolus. American Orthopaedic Foot and Ankle Society (AOFAS) Ankle Hindfoot Scale and Kofoed Ankle Rating scale were utilized to assess ankle function. Visual Analogue Scale was applied to evaluate the improvement in the degree of pain after repair. Radiographic analysis was conducted within a fixed position on the line for biomechanical level after internal fixation. RESULTS AND CONCLUSION:Al patients were fol owed up for 6-24 months. Al cases had bony union. AOFAS score, Kofoed score and visual analogue scale were significantly better at 6 months post-treatment than pre-treatment (P<0.05). Radiographic results revealed good alignment and contraposition fol owing internal fixation. Only one patient suffered from infection, and others did not have any adverse reactions. These results indicate that anatomic plate and hol ow screw fixation for the treatment of the medial mal eolus and lateral mal eolus fractures of ankle joint can exert their characteristics and biomechanical advantage, so fracture reached anatomical reduction of the ankle.

BACKGROUND:Unilateral support plate in the treatment of complex tibial plateau fractures easily formed eccentrical y brace, and easily led to angular deformity. The outer support plate alone is prone to knee varus deformity. OBJECTIVE:To compare the clinical and imaging effects with the outer locking plate combined with inner support plate fixation and double support plate using dual lateral incision in the repair of complex tibial plateau fracture. METHODS:We retrospectively analyzed the clinical data of 86 patients with complex tibial plateau fractures from March 2009 to November 2013. According to the different fixations, patients were divided into two groups. Outer locking plate combined with inner support plate group:lateral locking plate fixation for complex and comminuted fractures, and support plate was used in the inner side. Double support plate group used internal and external support plates. Patients were fol owed up for 2 years after the surgery. Clinical and imaging effects of two different fixations were compared. RESULTS AND CONCLUSION:Wounds were stage I healing in al the fol ow-up patients. Bone healing was conducted. No significant difference in operation time, time of tourniquet and intraoperative blood loss was detectable between both groups (P>0.05). Postoperative fol ow-up demonstrated that ful load time was significantly earlier in the outer locking plate combined with inner support plate group than in the double support plate group (P<0.05). No significant difference in fracture healing time, hospital for special surgery score, range of knee motion and postoperative tibial plateau angle, posterior slope angle and postoperative 1 year tibial plateau angle, posterior slope angle was detected between the two groups (P>0.05). These data confirmed that dual lateral incision double plate fixation in the repair of tibial plateau fractures had wel clinical and imaging features. Compared with the double support plates, outer locking plate combined with inner support plate has superiority in ful load time.

Objective To determine the effect of omental flap wrapping of pancreaticoduodenectomy on postoperative pancreatic fistula and intra-abdominal bleeding in patients undergoing pancreaticiduodenectomy through meta-analysis of published studies.Methods Articles about whether omental flap wrapping could prevent postoperative pancreatic fistula and intra-abdominal bleeding were searched in databases of MEDLINE,PUBMED and EMBASE.14 English article were found and according to including and excluding criteria,4 eligible articles with a total of 2971 patients were selected.Random effects model was used to analyze odds ratios and 95％ confidence intervals (CIs).Results 1129 patients were in omental wrapping group,and 1842 patients in nonomental wrapping group.Omental roll-up during pancreaticoduodenectomy could not prevent postoperative pancreatic fistula (OR =0.81,95 ％ CI 0.40～1.63,P＞0.05) or postoperative abdominal bleeding (OR=0.67,95％ CI 0.28～1.59,P＞0.05).The sensitivity analysis showed the pancreatic fistula rate was lower in the nonomental roll-up group than that in the omental roll-up group (OR=1.24,95％ CI 1.03～1.50,P＜0.05).Conclusions Omental wrapping can not decrease the risk of pancreatic fistula and abdominal bleeding after pancreaticoduodenectomy.Further randomized controlled trials are needed to identify the effect of omental wrapping technique for pancreaticoduodenectomy.

Objective To investigate the augmentation plating for femoral fractures and postoperative femoral nonunion. Methods A retrospective analysis was conducted of 60 patients with femoral fracture or postoperative femoral nonunion who had been treated with augmentation plating from January 2008 to July 2015. They were 36 males and 24 females, aged from 15 to 79 years ( average, 43. 4 years ) . Of them, 20 cases suffered nonunion following intramedullary nailing of femoral shaft fracture, 18 nonunion following lateral plating for femoral distal or lower fracture, and 22 femoral distal or lower fracture complicated with comminuted fracture of medial column. An incision ranging from 6 to 10 cm was made around the fracture ends for augmentative plating for all the patients. Autogenous iliac bone graft was performed in patients with atrophic nonunion or ob-vious gap after reduction of the comminuted fracture. Operation time, intraoperative bleeding, healing time, complications, and functionary recovery of the affected knee were recorded. Results The operation time averaged 121. 5 min and the intraoperative bleeding 356. 3 mL. All the patients were followed up for 12 to 36 months ( average, 16. 9 months ) . All the fractures and nonunions healed after an average time of 4. 2 months ( from 3 to 4 months ) . The time for initial partial weight-bearing averaged 4. 5 weeks ( from 2 to 6 weeks ) and the time for initial full weight bearing 3. 3 months ( from 2 to 4 months ) . Evaluation according to the Karlstrom and Olerud criteria at the last follow-up revealed 29 excellent, 24 good and 7 fair cases, yielding an excellent and good rate of 88. 3％. No infection, loosening, bending or breaking of internal implants, or refracture was noted during follow-ups. Conclusion Augmentation plating through a small incision can lead to fine outcomes for femoral fractures and postoperative femoral nonunion, because it makes up the deficient stability of original in-ternal fixation, reduces the dislocated bone blocks and provides bone grafting to improve defective local bone structure and defective osteogenesis.

To understand the possibility of schistosomiasis transmission on the East Route Project of the South-to-North Water Diversion Project, a survey of endemic status of schistosomiasis in Weishan Lake area was conducted. A cluster sampling of 2086 boatmen were screened with DDIA Kit, and the positive ones were examined with Kato-Katz technique. Meanwhile, a questionnaire survey about schistosomiasis control was carried out to collect the data about the boatmen's general information and knowledge , attitude and practice (KAP). The results showed there were no schistosomiasis patients. However, there exist potential risk factors for schistosomiasis transmission because of the bad hygiene habits and the poor knowledge of schistosomiasis prevention in boatmen.

OBJECTIVEStudy the effect of self-microemulsifying drug delivery system(SMEDDS) on the solubility and absorption of tanshinones to guide the selection of composition of tanshinone SMEDDS.

METHODThe solubility of tanshinones in the solution of SMEDDS was determined by UV-spectrometer and the absorption of tanshinone SMEDDS was determined by HPLC as the detection method.

RESULTThe solubility of tanshinones in solution of SMEDDS was 10 times in water and 2.5 times in micelle solution. The solubility of tanshinones in solution of SMEDDS was increased with the increasing of oil (MCT) in composition of tanshinone SMEDDS. The absorption constants (Ka) in SMEDDS and micelle solution was 0.479 h(-1) and 0.326 h(-1) respectively, and the absorption half life (t1/2) was 1.44 h and 2.12 h respectively. The absorption was increased with the oil increasing in composition of tanshinone SMEDDS.

CONCLUSIONSMEDDS can increase the solubility and absorption of tanshinones significantly and the increasing of oil content (MCT) in SMEDDS composition promote the dissolution and absorption of tanshinones.

Animals ; Diterpenes, Abietane ; Drug Delivery Systems ; methods ; Emulsions ; Intestinal Absorption ; drug effects ; Male ; Phenanthrenes ; chemistry ; pharmacokinetics ; Rats ; Rats, Sprague-Dawley ; Solubility

Objective: To investigate the clinical therapy for Gustilo type Ⅲ B、ⅢC open fractures with skin and soft tissue defects on the upper extremities. Methods: From July 2014 to July 2016, 19 patients with Gustilo type Ⅲ open fractures (type ⅢB 12 cases , type ⅢC 7 cases) and soft-tissue defects in upper extremity were admitted, including 14 males and 5 females , aged 22 to 59 years (average 42 ). All the cases were treated by staged treatment. In the first stage, early debridement, nerves, vessels and tendons repairment, fixation of the fractures, VSD for the wound were performed. One patient underwent amputation 5 days after first operation. All the other 18 patients received flap transplantion, including 10 anterolateral thigh perforator flaps, 3 latissimus dorsal muscular flaps and 5 free lateral arm flaps. Results: 8 patients were followed up for an average duration of 14.5 months(ranged from 7 to 23 months). Partial necrosis happened at the distal end of one anterolateral thigh perforator flap and healed with skin-grafting.1 flap encountered vascular complication which survived with 5cm-in-width skin necrosis at the distal end of the flap after successful surgical exploration. 1 case had superficial infection at wound. The wounds at donor sites were primarily healed except for 1 case with skin graft necrosis and superficial infection. All the other flaps survived completely. The patients received 2-6 operations each. The average hospital stay was 34 days (12-71 days). All Skin flap texture was soft and had varying degrees of pigmentation. The flap sensory recovery was S2 in 4 cases, S3 in 9 cases, S4 in 5 cases. 1 case had obvious scar hyperplasia. Conclusions Staged surgical treatment in Gustilo type Ⅲ open fractures with soft-tissue defects in upper extremity provide a high survival rate of flaps and satisfactory results. The treatment is well tolerate by patients.

Objective To explore the clinical application of antcrolateral thigh flap transplantation in repairing wound around the knee with descending genicular artery as the recipient vessel,when anterior or posterior tibial vessel could not be utilized.Methods From January,2015 to May,2017,free anterolateral thigh flaps obtained from anastomosis of descending genicular artery and great saphenous vein were transplanted to repair the skin soft tissue defect around the knee combined with tendon and bone exposure in 7 patients,after preoperative color Doppler sonography ultrasound (CDU) for precise positioning.There were 4 males and 3 females,with the flap area ranging from 18.0 cm×8.0 cm-38.0 cm×8.0 cm.All of the donor sites were sutured directly.Postoperative followedup was done termly.Results All the patients were followed-up for 6 to 14 months,with an average of 8.9 months.Typically,2 cases had large defect areas,with distal flap necrosis of 6.0 cm and 4.0 cm,respectively,which were resected and achieved secondary skin graft healing on the residual surface.Additionally,4 cases had completely survived flaps and achieved secondary skin graft healing on the residual surface.The remaining 1 case had completely survived flap,but the distal flap near the anteromedial tibia developed bone exposure as a result of the complicated osteomyelitis.As a result,the patient received gastrocnemius myocutaneous flap to repair the wound.Conclusion Anterolateral thigh flap transplantation in repairing skin soft tissue defect wound around the knee,with descending genicular artery as the recipient vessel,can achieve satisfactory clinical efficacy,which can serve as one choice for flap repair in wound around the knee.

Objective To investigate the clinical therapy of early internal fixation combined with perforator flap for forearm open fractures of Gustilo types Ⅲ B & Ⅲ C.Methods A retrospective study was conducted of the 45 patients with forearm open fracture of Gustilo type ⅢB or Ⅲ C who had been treated from July 2012 to October 2016 at Department of Traumatic Orthopaedics,The Ninth People's Hospital of Wuxi.They were 26 men and 19 women,aged from 20 to 61 years (average,41 years).Twenty cases were Gustilo type ⅢB and 25 Gustilo type ⅢC.By AO classification,8 cases were type A,21 ones type B,and 16 ones type C.The wound size ranged from 4 cm × 3 cm to 36 cm × 8 cm.Thirty-three patients were treated by primary internal fixation plus secondary transfer with a perforator flap,12 ones by secondary internal fixation plus transfer with a perforator flap.The period from injury to secondary flap transfer ranged from 5 to 20 days (average,12 days).In this series,36 anterolateral thigh perforator flaps,5 latissimus dorsal muscular flaps and 4 lateral arm flaps were transferred.Results All the 45 free flaps survived with no deep infection or osteomyelitis.Partial necrosis happened at the distal ends of 2 latissimus dorsal muscular flaps which were cured by skin graft.Postoperative circulatory crisis happened after transfer of an anterolateral thigh perforator flap which survived with 5 cm skin necrosis at the distal end after successful surgical exploration.Superficial wound infection happened in 12 patients with no deep or bone infection.All the patients were followed up for 12 to 36 months (average,18.5 months).All the flaps were soft in texture,with varying degrees of pigmentation.The sensory recovery was S2 in 8 flaps,S3 in 29 flaps,and S4 in 8 flaps.Obvious scar hyperplasis was observed at the donor site in 5 cases while no obvious scar hyperplasis was observed in the other 40 ones.All the fractures got united after 4 to 14 months (average,8.6 months).Nonunion happened in 2 patients who were treated with autologous iliac graft 8 months after operation.By Anderson criteria,the curative efficacy was assessed as excellent in 15 cases,as good in 21,as fair in 7 and as poor in 2,yielding an excellent to good rate of 80.0％.Conclusion Early internal fixation combined with perforator flap transfe is an effective strategy for treatment of forearm open fractures with soft tissue defects of Gustilo types Ⅲ B &Ⅲ C,due to its advantages of shortened treatment period,possibility for early rehabilitation,decreased complications and satisfactory functional recovery.

β-thalassemia is a single-gene genetic disease caused by β globin gene mutations leading to the fact that red blood cells are unable to form normal adult hemoglobin, and then patients develop hemolytic anemia. Current treatment regimens mainly include allogenetic hematologic stem cell transplantation, symptomatic regular blood transfusions and the use of iron removers to reduce iron load. Some severe patients have quite poor prognoses and deadly consequences if not treated timely. Genetically modified autohematopoietic stem cells can provide a new treatment option for patients with β thalassemia, which may achieve a long-term and stable increase in hemoglobin level through a single dose, making one-time cure β-thalassemia possible. This paper reviews the key elements of clinical trial design for β-thalassemia gene therapy from the aspects of efficacy evaluation endpoints, clinical trial design, enrollment population, and subject monitoring in order to provide a reference for pharma-therapeutic research and development enterprises.