Objective To summarize and evaluate the technique and clinical outcome of limited tarsal sinus incision plus locking plate internal fixation for minimally invasive treatment of intra-articular calcaneal fractures. Methods Between February 2010 and February 2011,16 cases of intra-articular calcaneal fractures were treated in a minimally invasive manner in our department. All cases were evaluated carefully with routine X-rays and CT scans preoperatively to define the type of fracture and the involvement of articular surface.Open reduction and locking plate internal fixation with percutaneous screws were performed via a limited tarsal sinus approach 3 to 6 days after injury (average,4 days).Regular X-ray follow-ups were conducted to measure the Bohler's and Gissane angles.Overall functional evaluation was carried out according to Visual Analogue Scale (VAS),the Hind-foot Score by American Orthopaedic Foot and Ankle Society (AOFAS) and Short Form 36 Health Survey Questionnaire (SF-36).Complications were recorded as well.Results The 13 cases were followed up for a mean duration of 18 months (from 12 to 24 months).There were no wound infection,skin and flap necrosis or implant failure.Bone union was achieved at an average of 10 weeks (from 8 to 12 weeks) post-operatively.The average Bohler's angle was improved significantly from 13.4° ± 3.4° (from 8° to 19°) pre-operatively to 26.5° ± 4.5° ( from 21° to 38°) post-operatively ( t =9.781,P ＜ 0.001 ).The average Gissane angle was improved significantly from 88.1° ± 7.6° (from 77° to 100°)pre-operatively to 116.2°±7.5° (from 100°to 124°) post-operatively (t =12.934,P ＜0.001).On average,the VAS score was 1.5 ± 1.7,the AOFAS score was 84.2 ± 5.9 and the SF-36 score was 79.5 ± 8.1 at the final follow-up.The follow-ups revealed no post-traumatic arthritis. Conclusion Open reduction and locking plate fixation with percutaneous screws via a limited tarsal sinus incision is a safe and reliable treatment for intra-articular calcaneal fractures,because it has the advantages of direct reduction of the articular surface,solid fixation,and limited soft tissue complications.

Objective To evaluate the clinical outcomes of limited open reduction via sinus tarsi approach and traditional open reduction internal fixation of the treatment for Sanders type Ⅱ calcaneal fracture.Methods Between February 2010 and February 2011,30 patients were enrolled into our study and were divided into minimal invasive and traditional groups randomly.Each group consisted of 15 patients.When soft tissue swelling subsided,the patients of mininal invasive group were performed a limited ORIF via a sinus tarsi incision,while those traditional groups were performed ORIF via a classical lateral extensile L-shape approach.X-rays were taken in the regular follow-up,B(o)hler and Gissane angle were measured.The final curative effect was comprehensively assessed according to visual analogue scale (VAS),the ankle and hind-foot score of American Orthopaedic Foot and Ankle Society (AOFAS) and SF-36 at the last follow-up,with the complications recorded.Results The average time of the follow-up was 16.9 nonths and 19.9months respectively in two groups.Superficial skin necrosis occurred in 2 cases in traditional group.X-ray demonstrated bone union 3 months after the operation in both groups.And no implant failure occurred.The B(o)hler angle of minimal invasive group was 13.1°±3.8° and the traditional group was 14.9°±4.3°,the Gissane angle of minimal invasive group was 28.1°±7.8° and the traditional group was 26.2°±8.2°.The average AOFAS ankle and hindfoot score of minimal invasive group at final follow-up was 91.2±15.9,and the average VAS score was 1.7±1.3,while the traditional group was 82.4±14.7 and 1.9±2.1 respectively.But SF-36 score in minimal invasive group (79.5±12.1) was higher than that in traditional group (70.2±12.4).Four patients in minimal invasive group and 15 in traditional group suffered from varying degrees of subtalar joint stiffness.Conclusion No significant difference was found between the two groups in the short-term efficacy of the treatment for Sanders type Ⅱ calcaneal fracture.However,minimal invasive technique has the advantages of lower soft tissue complication rate and lower suhtalar joint stiffness rate.

Objective To observe the changes and clinical significance of plasma heart fatty acid-binding protein(H-FABP)in children after open heart surgery. Methods Forty patients with congenital heart disease(CHD) who had undergone cardiac operation with cardiopulmonary bypass(CPB) were selected in this study,and were randomly divided into two groups (each 20 cases): cold crystalloid cardioplegia perfusion group (Ⅰ group) and cold blood cardioplegia perfusion group(Ⅱ group). Blood samples were taken to check the plasma H-FABP concentration before CPB and different time after CPB. Plasma H-FABP concentration was estimated by enzyme-linked immunosorbent assay (ELISA). Results The difference of plasma concentration of H-FABP before operation was not obvious between Ⅰ group and Ⅱ group. The plas-ma concentration of H-FABP intraoperation and different time after operation was higher than that before anesthesia induction obviously in two groups, and Ⅰ group rose more significantly [(50.13±3.98) μg/L vs (39.27±4.22) μg/L, P<0.01]. Conclusions H-FABP concentration after operation is higher than that before operation significantly. H-FABP can be used to judge myocardial damage earlier as a sensitive index, because plasma concentration of H-FABP increases significantly after open heart surgery, and its peak emerges early. Compared with cold crystalloid cardioplegia,the myocardial protection of cold blood cardioplegia is better.

Objective To explore the regulation mechanism for miR - 125a - 5P in epidermal growth factor receptor(EGFR)signaling pathway in medulloblastoma. Methods The potential targets of miR - 125a - 5P in the EGFR signaling pathway were predicted by TargetScan and Sanger software,there were 3 groups:control group,non -sense group and miR - 125a - 5P group. Their relationship,between miR - 125a - 5P and cyclin - dependent kinase in-hibitor 2B( CDKN2B),E2F transcription factor 3( E2F3),mitogen - activated protein kinase 14( MAPK14)and growth factor receptor - bound protein 10(GRB10),were tested by luciferase experiments. After miR - 125a - 5P oligo-nucleotide was transfected to D341 cells,miR - 125a - 5P level was detected by reverse transcription polymerase chain reaction. Then the thiazolyl blue tetrazolium bromide assay was used to draw the cell growth curves,and Transwell assay was used to detect cell migration ability. The expression levels of GRB10,EGFR,phosphatidylinositol 3 - kinase(PI3K) and Ras were tested by Western blot method. Results The results of luciferase experimental results showed that GRB10 was the only target gene of miR - 125a - 5P. After miR - 125a - 5P being transfected,the D341 cell prolifera-tion obviously declined markedly. Compared with control group[(38. 16 ± 7. 47)% ]and the non - sense group [(36. 79 ± 8. 94)% ],cell migration rate in the miR - 125a - 5P group was lowest[(13. 59 ± 4. 41)% ],and there was a significant difference among 3 groups(χ2 = 11. 495,P < 0. 05);in the miR - 125a - 5P group,the expression level of EGFR increased 1. 67 times,GRB10,PI3K and Ras levels were reduced to 23% ,61% and 42% . Conclusion miR - 125a - 5P can inhibit tumor growth by silenced GRB10 expression targeting EGFR downstream signaling pathways in medulloblastoma.

Objective To compare the effect of autologous bone marrow stem cells transplantation on liver function between first and second transplantation in decompensated liver cirrhosis patients.MethodsA total of 45 decompensated liver cirrhosis patients were enrolled, and 23patients in first transplantation group were transplanted with autologous bone marrow stem cells through femoral artery when condition was stable after medical treatment.In second transplantation group, 22 patients were accepted second transplantation in 4-12 month after the first transplantation.All the patients undergone routine blood test, congulation test and liver function examination at the fourth week and eighth week after transplantation.ResultsEight weeks after transplantation, the liver function was improved obviously in both first and second autologous bone marrow stem cells transplantation.The level of albumin in patients of second transplantation group increased from (37.26± 5.90) g/L before transplantation to (42.49 ± 4.80) g/L (P＜0.01), alanine aminotransferase (ALT) decreased from (57.05±45.51) U/L to (44.86±29.19) U/L (P＜0.05),aspartate aminotransferase (AST) decreased from (39.14-±-15.07) U/L to (53.73 ± 24.98) U/L(P＞0.05).Congulation parameters were also improved, prothrombin time (PT) decreased from (16.15±3.01) s to (14.63±2.32) s (P＜0.01), fibrinofen (Fib) increased from (2.44±0.61) g/L to (3.00±0.81) g/L (P＜0.01).Compared with first transplantation group, the albumin level was higher in second autologous bone marrow stem cells transplantation group, which increased from (38.00±6.33) g/L to (42.49±4.80) g/L (P＜0.05), AST and ALT also improved obviously, and there was significant difference between two groups.Meanwhile, Child-Pugh scores decreased from (7.22±0.67) to (6.67±[0.71) (P＜0.05).But there was no significant difference in bilirubin, FIB and PT.ConclusionThe second transplantation of autologous bone marrow stem cells could further improve liver function and maintain symptoms remission of liver cirrhosis.

Objective To detect the consistency of EGFR mutations in pleural effusion in terminal non-small cell lung cancer(NSCLC)patients by amplification refractory mutation system- polymeric chain reaction (ARMS-PCR).Methods Pleural effusion from 44 cases with advanced NSCLC were collected.DNA was extract-ed from a part of pleural effusion,and EGFR gene18,19,20,and 2 l exons mutations were detected by ARMS-PCR amplification. The left part of pleural effusion was used for the pathological microscopic examination of the embedding and to evaluate the feasibility of pleural effusion direct detection.Part of the case results were compared with tissue or pleural effusion at the same time. Results The mutation rate of EGFR detection in pleural effusion was 54.5%,including 19-del(50.0%)and 21-L858R(50.0%);75.0% of pleural effusion sediment was morpho-logically diagnosed with adenocarcinoma and EGFR mutation rate was 27.3% in pleural effusion with no tumor cell. The consistent rate was 72.7% in 22 cases of pleural effusion and tissue and that was 50.0% in 16 cases of pleural effusion and plasma.The comparison between pleural effusion and organizations and plasma test results was statisti-cally significant(P < 0.05).(P < 0.05).Conclusions EGFR gene mutation rate in pleural effusion is lower than that in tumor tissue specimens in terminal NSCLC patients and tumor tissue is still the best test specimens.

Objective To explore the expression of HCCR, pERK and pELK1 in gastric cancer tissue and para-carci-noma tissue, and to explove its correlations. Methods In 60 human gastric cancers and their corresponding paraneo-plastic tissuses,the expression of HCCR, pERK and pELK1 were detected by immunohistochemistry. Results The ex-pression of HCCR was 75.0%(45/60), pERK, and pELK1 were 73.3%(44/60) and 71.7%(43/60), respectively, and the expression of proteins in gastric tumor were higher than that in paraneoplastic tissues (P<0.05). Conclusion The HCCR, pERK and pELK1 are higher expressed in tumor tissues, availably as a auxiliary index for clinical immunohis-tochemistry in gastric cancer.

In this review, recent progress in the extraction and purification, and the chemical composition analysis of triterpenoids from Ganoderma lucidum was summarized. Triterpenoids are an important class of active components in G. lucidum. Because of its low content, complex procedures of extraction and purification, the preparation of high purity triterpenoids from G. lucidum is currently limited at the laboratory scale. This review discussed the industrial preparation of triterpenoids, aiming to promote the industrial development of G. lucidum, and to provide scientific basis for its study, production, and application in health food and medicine.
Chromatography, High Pressure Liquid ; methods ; Molecular Structure ; Reishi ; chemistry ; Triterpenes ; chemistry ; isolation & purification

Objective:To investigate the clinical manifestations, auxiliary examination results, prognosis and treatment of children with typical hemolytic uremic syndrome (D + HUS). Methods:The clinical data of 36 patients diagnosed as D + HUS in the Department of Pediatrics of Nanjing Jinling Hospital from January 2001 to January 2019 were collected, and the laboratory results including blood routine, liver and kidney function, coagulation function, humoral immunity and urine were compared before and after treatment. Results:The white blood cell count[ (9.28±6.77)×10 9/L vs.(11.20±5.93) ×10 9/ L ], C-reactive protein [7.15(3.34, 29.33) mg/L vs.31.83(25.03, 39.75) mg/L], reticulocyte count [(112.49±76.25)×10 9/L vs. (206.49±147.99)×10 9/L], erythrocyte sedimentation[15.02(11.79, 22.83) mm/1 h vs.28.06(24.13, 40.52) mm/1 h] , aspartate aminotransferase[50.04(41.92, 60.11) U/L vs.62.61(54.58, 83.52) U/L], alanine aminotransferase [16.72(11.80, 24.74) U/L vs.24.54(20.30, 34.36) U/L], uric acid [(532.84±309.06) μmol/L vs.(606.64±327.23) μmol/L], serum creatinine[160.07(124.87, 221.18) μmol/L vs.200.56(160.62, 283.01)μmol/L ], blood urea nitrogen [20.74(15.77, 28.40) mmol/L vs.33.67(25.91, 45.84) mmol/L], lactate dehydrogenase [488.21(337.59, 692.82) U/L vs.1 520.68(734.24, 2 272.10) U/L ], prothrombin time [(12.14±5.89) s vs. (17.91±6.12) s ], activated partial thrombin time [(25.05±6.26) s vs.(32.38±5.49) s], fibrinogen [ (3.79±2.17) g/L vs.(5.17±3.88) g/L], D-dimer [0.92(0.30, 1.13) mg/L vs. 1.27(1.01, 1.90) mg/L ], 24-hour urinary proteinuria [ (84.05±44.19) mg/(kg·24 h) vs.(112.18±78.26) mg/(kg·24 h) ], urinary sediment [175.73(79.72, 258.66)×10 7/L vs. 160.38(118.68, 361.83)×10 7/L], N-acetyl-β-D-glucosaminidase [25.10(18.84, 33.02) U/(g·cr) vs. 41.57(29.49, 58.61) U/(g·cr)], urinary retinol binding protein [0.35(0.18, 1.33) mg/L vs 1.05(0.66, 1.68) mg/L.] in patients after treatment were significantly lower than those before treatment, and the differences were all statistically significant(all P<0.05); patients had higher levels of red blood cell count [ (4.51±1.73)×10 9/L vs.(2.43±1.40) ×10 9/L], platelet[(126.82±78.35)×10 9/L vs. (85.21±69.38)×10 9/L], hemoglobin[(118.46±18.27) g/L vs. (62.36±16.11) g/L], and complement C 3levels [(0.74±0.39) g/L vs.(0.58±0.27) g/L ] after treatment, and the differences were all all statistically significant(all P<0.05). Children with D + HUS showed multiple system injuries.Among 36 cases, 17 cases (47.22%) had fever, 31 cases (86.11%) had abdominal pain and diarrhea, 29 cases (80.56%) had nausea and vomiting, 8 cases (22.22%) had headache and dizziness, 36 cases (100.00%) had proteinuria and hematuria, 34 cases (94.44%) had renal insufficiency, and 21 cases (58.33%) had yellow staining of skin and sclera.The auxiliary examination for abnormal results mainly included renal pathology (100.00%) (mesangial proliferation endothelial cell proliferation and swelling, and shedding of renal tubular brush borders), bone marrow pathology (100.00%) (active bone marrow hyperplasia), and renal B-ultrasound (86.67 %) (kidney injury-like sound image). Conclusions:D + HUS in children shows multiple system damage.Digestive system abnormalities are the main causative factor of D + HUS in children, and the disease is dangerous.Therefore, early diagnosis and active treatment can improve the prognosis.

BACKGROUND:Circular RNAs(circRNAs)play important roles in a variety of diseases or tumors,and recent findings have revealed that circRNAs are abnormally expressed in knee osteoarthritis and are involved in disease progression through microRNA/mRNA regulation. OBJECTIVE:To investigate the effect of circRNA WD repeat containing protein 1(circ-BRWD1)/miR-488-3p/DNA methyltransferase 3A(DNMT3A)on the proliferation and apoptosis of chondrocytes in knee osteoarthritis. METHODS:Real-time fluorescence quantitative PCR was performed to detect the expression of circ-BRWD1,miR-488-3p,DNMT3A in knee osteoarthritis chondrocytes.Cells were divided into si-NC group,si-circ-BRWD1 group,vector group,circ-BRWD1 group,si-circ-BRWD1+anti-miR-NC group,si-circ-BRWD1+anti-miR-488-3p group,miR-NC group,miR-488-3p group,anti-miR-NC group,anti-miR-488-3p group,miR-488-3p+vector group,miR 488-3p+DNMT3A group.Real-time fluorescence quantitative PCR was used to detect circ-BRWD1,miR-488-3p,DNMT3A expression,MTT and flow cytometry assay were used to detect cell proliferation and apoptosis.Western blot assay was used to detect DNMT3A and proliferation/apoptosis-related protein expression.Dual luciferase reporter assay was used to Dual luciferase reporter assay to detect the targeting relationship of circ-BRWD1 with miR-488-3p and miR-488-3p with DNMT3A. RESULTS AND CONCLUSION:circ-BRWD1 and DNMT3A were highly expressed and miR-488-3p was lowly expressed in knee osteoarthritis chondrocytes compared with normal chondrocytes.Knockdown of circ-BRWD1 or overexpression of miR-488-3p inhibited proliferation and induced apoptosis in knee osteoarthritis chondrocytes.circ-BRWD1 targeted negative regulation of miR-488-3p and inhibition of miR-488-3p reversed the effect of circ-BRWD1 knockdown on chondrocyte proliferation and apoptosis in knee osteoarthritis.miR-488-3p targeted negative regulation of DNMT3A and upregulation of DNMT3A reversed the effect of miR-488-3p overexpression on chondrocyte proliferation and apoptosis in knee osteoarthritis.circ-BRWD1 could regulate the expression of DNMT3A by regulating miR-488-3p.To conclude,knockdown of circ-BRWD1 inhibits chondrocyte proliferation and induces apoptosis in knee osteoarthritis,and the mechanism of action may be related to the regulation of miR-488-3p/DNMT3A axis.