BACKGROUND:The surgical treatment of thoracolumbar burst fracture combined with spinal cord injury is to relieve mechanical compression on the spinal cord and reconstruct spinal stability through internal fixation.This theory is derived from a lot of animal experiments and important biomechanical principles,but the available clinical data are stil scarce.OBJECTIVE:To investigate the efficacy of posterior decompression and screw internal fixation for the treatment of thoracolumbar fractures combined spinal cord compression,and to evaluate vertebral body height,kyphosis angle and neurological function.METHODS:A retrospective study was performed among 75 patients with thoracolumbar fractures combined spinal cord compression,who were recruited from Department of Orthopedics,the First People's Hospital of Shunde District of Foshan City,from January 2010 to February 2013.They underwent posterior decompression and internal fixation.The preoperative and postoperative kyphosis angle,vertebral height and neurological function were compared.RESULTS AND CONCLUSION:The preoperative kyphotic angle was (25.2±2.1)° and postoperative kyphotic angle was (8.8±2.3)°,with significant differences (P ＜0.05).Preoperative vertebral body height was (58.4±14.2)％and postoperative vertebral body height was (92.3±6.8)％.According to ASIA score,48 cases had slight impairment of neurological function,scores more than 40 points,and 45 of them had completely recovered walking ability,the recovery rate was 94％; the remaining 27 cases had moderate or severe neurological function impairment,scoring less than 40 points,and 15 of them appeared obvious recovery of neurological function,therecovery rate was 56％.Posterior decompression and internal fixation for treatment of thoracolumbar burst fracture combined with spinal cord injury can effectively restore the vertebral height and kyphosis,and improve significantly neurological function.

Objective To investigate the relationship between the methylation of CpG island of RUNX3 gene promoter and its expression in a human cutaneous malignant melanoma cell line A375, and to assess the role of RUNX3 gene methylation in the pathogenesis of human cutaneous malignant melanoma. Methods Cultured A375 cells were treated with various concentrations (0, 1, 5, 10, 20 μmol/l) of 5-azacyti-dine for 24 or 72 hours followed by another 5 days of culture. Then, methylation-specific PCR (MSP) was performed to evaluate the methylation status of RUNX3 promoter region, and Western-blot analysis to detect the protein expression of RUNX3 in A375 cells. Results The RUNX3 gene promoter region was hypermethylated in untreated A375 cells, along with the absence of protein expression of RUNX3. However, after the treatment with 5-azacytidine, the promoter region of RUNX3 gene was demethylated partly, and the expression of RUNX3 protein was restored in A375 cells. Further, the expression intensity was directly correlated with the concentration of 5-azacytidine. Conclusions The promoter hypermethylation of RUNX3 gene may be related to the silencing of RUNX3 gene expression in A375 cells, whereas 5-azacytidine can cause the demethylation of RUNX3 gene, reactivate the gene which has been inactivated by the promoter hypermethylation, and finally induce the re-expression of RUNX3 protein.

Objective To compare the distribution of collagen type Ⅲ and Ⅳ in mucosa of normal and carcinoma cardiac tissues and to analyze the influence of changed collagen on auto-fluorescence after canceration.Methods Using immunohistochemical technique with monoclonal anti-collagen typeⅢ and Ⅳ,the difference of distribution in extracellular matrix of two types collagen between normal and carcinoma tissues from 16 patients were measured with semi-quantitative score methods.Results In normal mucosa,the epithelial basement membrane showed an intense positive reaction for monoclonal anti-collagen Ⅳ and an intensively stained ring band was formed around the grand basement membrane.The collagen type Ⅲ formed ring-like structures apparently representative of fibriform collagen immediately adjacent to the epithelial basement membrane.In carcinomatous mucosa,immunoreaction of the carinomatous cell nest was negative,and only remnants of positively were seen at the site of the former membrane by collagen type Ⅳ.The change of collagen type Ⅲ was not apparent and the positive reaction in carcinomatous stroma was more intensity than in normal stroma.There was significant difference in distribution of collagen type Ⅲ and Ⅳ between the normal and carcinomatous tissues(P

Objective To investigate the clinical results of end-to-end invagination pancreaticojejunostomy.end-to-end invagination pancreaticojejunostomy and duct-to-mucosa pancreaticojejunostomy of pancreaticoduodencetomy of patients with pancreatic and periampullary carcinoma. Methods Fifty-two patients underwent different pancreaticoduodenectomy in our hospital from August 1995 to July 2006 were collected and analyzed retrospectively.The incidence of pancreatic leakage,operation time,the blood loss and the postoperative complications were analyzed. Results Twenty-five patients received end-to-end invagination pancreaticojejunostomy.Sixteen patients received end-toside invagination pancreaticojejunostomy.Eleven patients received end-to-side pancreaticojejunal mucosa-mucosa anastomosis.The operation time of the duct-to-mucosa pancreaticojejunostomy was shorter than the two of the others(4 ～7.15 h).The perioperative comphcations occurred in 18 cases and the long-term postoperative complications occurred in 10 cases.The average length of stay in hospital was(19.32 ±5.45)days.Two cases died during perioperative period. Conclusion End-to-eed invagination pancreaticojejunostomy,end-to-side invagination pancreaticojejunostomy and end-to-side pancreaticojejunal mucosa-mucosa anastomosis are all common anastomosis methods.Pancreatic leakage is a serious postoperative complication.The selection of anastomosis method is based on the condition during operation.

Objective To investigate the clinical and imaging features of pseudo subarachnoid hemorrhage(pseudo-SAH) in order to provide a theoretical basis for correct diagnosis and reducing misdiagnosis.Methods The clinical and imaging data of 5 patients with pseudo-SAH were retrospectively analyzed and summarized.Results Five pseudo-SAH patients had a history of unconsciousness,respiratory disorder,mechanical ventilation,hypoxemia and acidosis.Cranial CT showed diffuse cerebral edema and high density of cerebral fissure and cerebral ventricle,and there was no bloody cerebrospinal fluid via lumbar puncture.In the five patients,one improved,three died,and one gave up treating because of invalid treatment.Conclusions All patients have a history of hypoxic-ischemic encephalopathy before onset of pseudo-SAH.The clinical manifestation of pseudoSAH includes encephalopathy symptom such as unconsciousness,headache,seizure,etc.Cranial CT shows diffuse cerebral edema,high density of cerebral fissure and cerebral ventricle,and there is no bloody cerebrospinal fluid via lumbar puncture.Prognosis of pseudo-SAH is often bad.And most patients show critically illness and high mortality.

ObjectiveTo investigate the expression of the neutral cholesterol ester hydrolase 1 (NCEH1) gene in liver cancer tissue and human hepatoma cell lines and the effect of NCEH1 gene knockdown on the proliferation, apoptosis, invasion, and metastasis abilities of human hepatoma SMMC-7721 cells. MethodsLiver cancer tissue samples and adjacent tissue samples were collected from 32 patients with liver cancer who underwent surgical treatment in Guangzhou Red Cross Hospital Affiliated to Jinan University from January 2013 to June 2019, and quantitative real-time PCR was used to measure the relative expression level of the NCEH1 gene. Gene expression data of liver cancer samples up to September 2020 were downloaded from the ICGC database, and R software was used to analyze the data and obtain the expression level of the NCEH1 gene in each sample. The paired Wilcoxon signed-rank test and the Wilcoxon rank-sum test were used to investigate the differences between liver cancer tissue and adjacent tissue. Quantitative real-time PCR was used to measure the expression level of the NCEH1 gene in human hepatoma SMMC-7721, Bel-7402, HepG2, and Hep3B cells and normal human HL7702 liver cells. The lentivirus-mediated small interfering RNA (siRNA) technique was used to establish a human hepatoma SMMC-7721 cell line with NCEH1 gene knockdown, and the cells were divided into NCEH1 knockdown group (KD group) and negative control group (NC group); quantitative real-time PCR was used to measure the knockdown efficiency of the NCEH1 gene, and then MTT assay, flow cytometry with Annexin V-APC single staining, wound healing assay, Transwell assay, and Transwell chamber invasion assay were used to measure the proliferation, apoptosis, metastasis, and invasion abilities of SMMC-7721 cells in both groups. The t-test was used for statistical analysis of data between the two groups. ResultsThe mean expression level of the NCEH1 gene in liver cancer tissue was significantly higher than that in adjacent tissue (specimens from our hospital: Z=2.263, P=0.024; ICGC database: U=18 768, P＜0.001). SMMC-7721 cell line with moderate potential of invasion and metastasis had the highest expression level of the NCEH1 gene, followed by BEL-7402 and HepG2 cell lines with low potential of invasion and metastasis, and Hep3B cell line without the potential of invasion and metastasis had the lowest expression level. The KD group had a significantly lower expression level of the NCEH1 gene than the NC group (t=11.578, P=0000 3), and the knockdown efficiency of the NCEH1 gene was as high as 74.0%. Compared with the NC group, the KD group had a significant reduction in cell growth rate, a significant increase in apoptosis rate, and significant reductions in migration rate and the number of metastatic and invasive cells (t=32.100, 27.303, 9.51, 38.123, and 22.331, all P＜0.001). Conclusion There is a significant increase in the expression of the NCEH1 gene in liver cancer tissue and cell lines, and the NCEH1 gene can promote the growth, proliferation, invasion, and metastasis of hepatoma cells and inhibit their apoptosis, suggesting that it may be a potential therapeutic target for liver cancer.

Objective To compare the clinical outcomes of mini-invasive plate osteosynthesis ( MIPO ) and conventional open plating for complex fractures of midshaft clavicle. Methods The authors retrospec-tively reviewed the data of complex fractures of midshaft clavicle ( AO/OTA types 15-B2 and 15-B3 ) which had been treated with MIPO or conventional open plating between January 2010 to February 2016. Forty-one patients were treated with MIPO and 43 with conventional open plating. The 2 groups were compared in terms of incision length, hospital stay, bone union time, postoperative Constant score and Disabilities of the Arm, Shoulder and Hand ( DASH ) score, patients'satisfaction and complications. Results The average follow-up was 21. 2 ± 9. 2 months for MIPO group and 23. 1 ± 11. 8 months for conventional open plating group. The incision length ( 4. 3 ± 0. 5 cm ) , hospital stay ( 7. 7 ± 1. 9 d ) and union time ( 10. 6 ± 3. 2 w ) in the MIPO group were signifi-cantly shorter than those in the conventional open plating group ( 8. 4 ± 1. 3 cm, 9. 6 ± 3. 1 d and 12. 3 ± 3. 9 w, respectively ) ( P <0. 05 ) . The MIPO group had significantly lower incidences of hypertrophic scarring and dysesthesia in the area of incision but significantly higher patients'satisfaction than the conventional open plating group ( P <0. 05 ) . There were no significant differences in the Constant score or DASH score at 3 months, 6 months and the final follow-up ( P > 0. 05 ) . Conclusion In the treatment of complex fractures of midshaft clavicle, although both MIPO and conventional open plating can lead to similar functional outcomes, MIPO may be advantageous over conventional open plating in smaller surgical incision, more rapid fracture union, shorter hospital stay and higher patients'satisfaction.

Objective To evaluate the clinical outcomes of split fractures of humeral greater tuberosity treated by our self-designed new type of anatomical locking plate.Methods From September 2012 to February 2017,23 patients were treated for acute split fracture of the humeral greater tuberosity using our self-designed new type of anatomical locking plate.They were 13 males and 10 females with a mean age of 52.8 years (range,from 25 to 81 years).Of them,6 were beyond 60 years old, 12 had comminuted fracture,10 were complicated with glenohumeral dislocation,and 12 with rotator cuff tear.The patients were evaluated clinically with Constant-Murley score,visual analog scale (VAS),range of motion and complications at the last follow-ups.Results This series were followed up for 12 to 30 months (mean,23.2 months).All the fractures healed after an average time of 10.6 weeks (range,from 8 to 12 weeks).Their mean Constant-Murley Score was 92.1 points (range,from 70 to 100 points),giving an excellent and good rate of 95.7％ (22/23);their VAS scores averaged 0.8 points (range,from 0 to 4 points).Their forward flexion averaged 160.6°,abduction 157.8°,external rotation 46.4°,and internal rotation up to the T11 level,respectively.Their complications rate was 17.4％ (4/23).One case of axillary nerve injury,one case of relapse of glenohumeral dislocation at sports,and 2 cases of stiff shoulder were observed.Conclusion Split fractures of the humeral greater tuberosity can be successfully treated with our new type of anatomical locking plate which serves as a new alternative treatment.

Radiocarpal fracture-dislocation (RFD) is a rare injury normally associated with the destruction of bones, joints and ligaments. The improper diagnosis and treatment of RFD will cause severe complications and affect the long-term function of wrist joints. The difficulties of clinical diagnosis and treatment lie in the accurate diagnosis, identification and reconstruction of the structure of specific injury. As the foreign and domestic literatures are mainly case analyses or systemic case reports rather than large-scale reports, there still lacks a systemic knowledge of the standard diagnosis and treatment of RFD clinically, thus leading to problems such as missed diagnosed or misdiagnosed, improper application of treatment methods and incomplete reconstruction. Therefore, the authors reviewed relevant literatures about the features, diagnosis and treatment of RFD, in order to provide references for the clinical diagnosis and treatment of RFD.

Objective To explore the effect of decreased air pollutants concentrations on the incidence of Type 2 Diabetes Mellitus (T2DM). Methods A prospective cohort was designed in Tianjin where the air quality gradually improved from 2014 to 2018. A total of 5 077 community residents (18-90 years old) were recruited as the baseline population from 2013 to 2014. From 2014 to 2018 follow-up was carried out year by year to observe the new incidence of T2DM in the cohort. The HR and 95%CI (95% confidence interval) were calculated with the multiple Cox proportional hazard regression model to evaluate the effect of the decrease in the concentrations of SO₂, NO₂, and particulate matters with diameters <10μm and <2.5μm (PM₁₀, PM_2.5) on the incidence of T2DM. Results The cohort was followed up year by year from 2014 to 2018, with a cumulative follow-up of 25 385 person-years over the 5 years. At the same time, the air quality of Tianjin was significantly improved. Statistical analysis results after covariate adjustment revealed that the risk of T2DM in the population decreased by 0.172, 0.124, and 0.210 times, for a decrease of 10 μg/m³ in the annual average concentrations of SO₂, PM₁₀, and PM_2.5 each, respectively (SO2：HR=0.828，95%CI=0.757-0.907；PM₁₀：HR=0.876，95%CI=0.816-0.941；PM_2.5：HR=0.790，95%CI=0.694-0.899). Conclusion The implementation of environmental protection measures to improve air pollution could reduce the risk of T2DM in the population and control the increasing prevalence.