Objective To report the clinical results of treatment of tarsometatarsal joint injuries by close reduction and percutaneous screw fixation. Methods From January 2003 to June 2005, 26 cases of tarsometatarsal joint injuries were treated with close reduction and percutaneous screw fixation. They were 13 cases of middle column injury, seven cases of medial-middle column injury and six cases of three-column injury according to Myerson’ s classification. Results In this series all the wounds healed primarily with a mean operative time of 40 min ( 30 to 70 min) and a mean incision length of 5 mm. A mean follow-up of 11.4 months (ranging from 6 to 17 months) revealed a mean score of 87 according to American Orthopaedic Foot & Ankle Society (AOFAS) midfoot scoring system. All the patients returned to normal daily life after a mean time of 5.3 months (3 to 11 months). Conclusions Tarsometatarsal joint injuries can be treated well by close reduction and percutaneous screw fixation with less operative lesion and lower incidence of soft tissue complications. Reduction of the middle column with screw insertion along the direction of the Lisfranc ligament is the key to reestablishment of the stability of the tarsometatarsal joint complex.

Objective To investigate the effect of capecitabine on serum tumor necrosis factor α( TNF-α) , interleukin-6 ( IL-6 ) , vascular endothelial growth factor (VEGF) and tumor biomarker (CEA,CA19-9 and CA125)levels in patients with advanced gastric cancer (AGC) and its efficacy and adverse reactions.Methods One hundred and sixty-one AGC patients from October 2012 to October 2014 in the hospital were randomly divided into control group (n=78) and observation group (n=83).The control group were treated with cisplatin in combination with docetaxel, while the observation group were treated with capecitabine on the basis of control group.The efficacy, adverse reactions and serum levels of TNF-α, IL-6, VEGF and tumor biomarkers were compared between two groups.Results There was no significant difference in effective rate between observation group and control group (50.6%vs.43.6%,χ2 =0.793,P=0.373) and disease control rate (78.3%vs.69.2%,χ2 =1.720,P=0.190).The half a year,1-year and 2-year survival rates in observation group were significantly higher than those in control group (90.4%vs.71.8%,78.3% vs.57.7%,60.2%vs.41.0%,all P<0.05).The gradeⅠ-Ⅱ adverse reactions of gastrointestinal tract in observation group was significantly higher than control group(P<0.05).After treatment, serum VEGF level in observation group was lower and serum TNF-α,IL-6 levels were higher than those in control group (P<0.05).The serum levels of CEA, CA19-9 and CA125 in observation group were lower than those in control group ( P <0.05 ) .Conclusion Capecitabine could improve immunologic function and inhibit tumor angiogenesis, which has an exact effect and increase survival rate of advanced gastric cancer patients with minor adverse reactions.Its mechanism may be regulating serum VEGF, TNF-α, IL-6 and tumor biomarkers of CEA, CA19-9 and CA125.

Objective To summarize the clinical outcomes of reconstruction of malunited ankle fractures.Methods From January 2006 to October 2009,23 malunited ankle fractures were treated in our department.All deformities were evaluated individually based on pre-operatively X-ray and CT scan.Varying degrees of fibular shortening or rotational deformity were found in all patients,with 4 cases of varus or valgus deformity,and 5 of a widen syndesmosis.Then different reconstructive techniques were chosen according to the type of malunion:a lengthening fibular osteotomy was performed in patients with fibular shortening or rotational deformity;an opening or closing wedge osteotomy was chosen correspondingly in patients with varus or valgus deformity;functional fusion of syndesmosis was performed in cases of widen syndesmosis.The postoperative follow-up included standard radiography to evaluate bone union;relative complications were also recorded and functional outcome were assessed with American Orthopedic Foot Ankle Society (AOFAS)ankle-hindfoot scores.Results Twenty-one patients were followed up with an average period of 36 months (12-58 months).There were no complications of infection,implant failure,nonunion or malunion.Solid union with a favorable alignment was obtained at an average of 12 weeks (10-14 weeks).The mean pre-operative AOFAS ankle-hindfoot score was 28 (15-39).While the score increased to 82 (70-94) one year after operations.But 2 patients underwent ankle arthrodesis correspondingly 18 months and 24 months post-operatively due to severely post-traumatic arthritis.Conclusion An early realignment reconstruction of the length and rotation of fibula and the congruity of ankle mortise may improve the ankle function and slow down the development of post-traumatic arthritis for patients who suffered from malunited ankle fractures.

Besides hematopoietic stem cells, bone marrow also contains another type of stem cells called mesenchymal stem cells (MSCs). With different induced conditions, MSCs have the ability to differentiate into a variety of nonhematopoietic tissue cells, including osteoblasts, chondroblast, adipocytes, myoblasts, astrocytes, and so on. MSCs can be readily obtained from bone marrow by their adhesion to plastic and expansion in culture. Also they can be genetically engineered by transduced target genes. MSCs may be the farget cells for both cell therapy and gene therapy for diseases derived from many different nonhematopoietic tissues.

Objective　To compare the irradiation-protective and inter-synergestic effects of E838,WR-2721, Rubia cordifolia, cystamin e hydrochloride and ethinyl estradiol on radiation and combined radiation-burn injury. Methods　Above-mentioned drugs were given to the mice i ntraperitoneally, or intragastrcally, then, the mortality and the average surviv al d for 30 d were observed before and after the administration of the drug s. Results　①When drugs were before injury , the survival rate and the average survival d of the radiation and combined radiation-burn injured mice were increased obviously with the best effect in E838 and WR-2721. ②When drugs were given after injury, E838 and R. cordifolia also kept the effect. ③Combined appling WR-2721（pre) and E838（post）displayed a significant syner gistic reaction. Conclusion　E838 and WR-2721 are more e ffective than the others in the prevention of radiation.

Objective To further determine their possible synergistic effect on accelerating wound healing, adenovirus vector containing recombinant human hPDGF-A and hBD2 genes was constructed and the expression of exogenous genes in transformed mesenchymal stem cells derived from rat bone marrow was observed. Methods By putting IRES in the middle of hPDGF-A and hBD2, these two genes were expected to be expressed individually. The shuttle vector was named as pAdTrack-hPDGF-A-IRES2-hBD2, which homologously recombinated with Adeasy-1 in BJ5183 cells and formed the mammalian expression vector pAdeasy-hPDGF-A-IRES2-hBD2. Furthermore, the recombinant vector was packaged in 293 cells into infectious recombinant adenovirus, which were used to infect BMSCs. The expression of hPDGF-A and hBD2 in BMSCs was detected by RT-PCR. Results We successfully constructed recombinant adenovirus vector that simultaneously expressed hPDGF-A and hBD2. The expressions of hPDGF-A and hBD2 were confirmed by RT-PCR on transformed BMSCs. Conclusion The established BMSCs that overexpressed hPDGF-A and hBD2 provide a new strategy of combining cell therapy and gene therapy to promote wound healing, especially the chronic one.

Objective To explore and understand limitations and needs of support for conducting clinical research among clinicians in China.Methods The in-service clinician in our hospital were enrolled in as survey participants,survey questionnaires were designed and filled up by target audience in the questionnaire star platform.Results Main problems identified as restrictions for conducting clinical studies including lack of data platform,have ideas but not protocols,lack of research funding and project management.On the other hand,identified needs for support including research-related technical support,project management facilitation,training,external communication and exchange,as well as quality risk management.Conclusions Hospital should establish Clinical Research Unit to help clinicians to improve research quality by training,providing technical support and administrative service of clinical research.

TSCI have dyskinesia and sensory disturbance that can cause various life-threaten complications. The patients with traumatic spinal cord injury (TSCI), seriously affecting the quality of life of patients. Based on the epidemiology of TSCI and domestic and foreign literatures as well as expert investigations, this expert consensus reviews the definition, injury classification, rehabilitation assessment, rehabilitation strategies and rehabilitation measures of TSCI so as to provide early standardized rehabilitation treatment methods for TSCI.

With the spread of novel coronavirus pneumonia (NCP) in December 2019, the management and rehabilitation of elderly patients with hip fractures and protection of medical staff face new challenges, and need to be adjusted appropriately under this very circumstances. Hip fractures in the elderly account for more than half of osteoporotic fractures. Expert group formulate this consensus so as to make better decision against this epidemic and protect patients' families and medical staff. This consensus elaborates not only epidemic condition of NCP, but also general principles of medical admission, treatment and protection for both medical staff and patients, in order to provide some reference and promote the standardization of clinical diagnosis and treatment of elderly patients with hip fractures under the condition of NCP.