BACKGROUND:Ankle fracture complicated with deltoid ligament injury is clinically common,and one stage repair of deltoid ligament with internal fracture fixation has gradually become a main therapeutic method,which can significantly reduce the long-term complications of ankle joint.In recent years,new progress has been made in anatomical structure characteristics and dynamic biomechanical research of deltoid ligament,thus greatly improving repairing techniques for injury in the deep layer of deltoid ligament,but there are still some controversies.OBJECTIVE:To explore the clinical efficacy of suture anchor and medial malleolus repair in the treatment of ankle joint fractures with the deep layer of deltoid ligament.METHODS:A total of 56 patients with ankle joint fractures and complete fracture of the deep and superficial layer of deltoid ligament treated in Affiliated Haikou Hospital,Xiangya School of Medicine,Central South University from January 2017 to January 2022 were selected,and they were divided into two groups according to different treatment methods in repairing the deep layer of deltoid ligament with suture anchor:suture anchor repair group(n=32)and medial malleolus repair group(n=24).The medial clear space of ankle joint and American Orthopedic Foot and Ankle Society Score of patients in the two groups were evaluated before and after operative treatment.RESULTS AND CONCLUSION:(1)All the 56 patients finished the surgery smoothly and were followed up for more than 12 months after operation.Their ankle fracture healed,and the time for fracture healing was 8-12 weeks,with a mean of 10.5 weeks.(2)The medial clear space of ankle joint in the two groups 12 months after operation was remarkably narrower than that before operation,and the difference was statistically significant(P＜0.001).The medial clear space of ankle joint in the two groups maintained a normal range 12 months after operation,and there was no statistically significant difference between the two groups(P＞0.05).(3)The AOFAS scale of patients in the two groups 6 and 12 months after operation was obviously bigger than that before operation(P＜0.001),but there was no statistically significant difference in the American Orthopedic Foot and Ankle Society Score of patients between the two groups at corresponding time points(P＞0.05).(4)It is concluded that both suture anchor and medial malleolus repair in the treatment of injury in the deep layer of deltoid ligament can recover the medial clear space of ankle joint,effectively keep the stability of ankle,and thus achieve good clinical efficacy.

BACKGROUND:Ankle fracture complicated with deltoid ligament injury is clinically common,and one stage repair of deltoid ligament with internal fracture fixation has gradually become a main therapeutic method,which can significantly reduce the long-term complications of ankle joint.In recent years,new progress has been made in anatomical structure characteristics and dynamic biomechanical research of deltoid ligament,thus greatly improving repairing techniques for injury in the deep layer of deltoid ligament,but there are still some controversies.OBJECTIVE:To explore the clinical efficacy of suture anchor and medial malleolus repair in the treatment of ankle joint fractures with the deep layer of deltoid ligament.METHODS:A total of 56 patients with ankle joint fractures and complete fracture of the deep and superficial layer of deltoid ligament treated in Affiliated Haikou Hospital,Xiangya School of Medicine,Central South University from January 2017 to January 2022 were selected,and they were divided into two groups according to different treatment methods in repairing the deep layer of deltoid ligament with suture anchor:suture anchor repair group(n=32)and medial malleolus repair group(n=24).The medial clear space of ankle joint and American Orthopedic Foot and Ankle Society Score of patients in the two groups were evaluated before and after operative treatment.RESULTS AND CONCLUSION:(1)All the 56 patients finished the surgery smoothly and were followed up for more than 12 months after operation.Their ankle fracture healed,and the time for fracture healing was 8-12 weeks,with a mean of 10.5 weeks.(2)The medial clear space of ankle joint in the two groups 12 months after operation was remarkably narrower than that before operation,and the difference was statistically significant(P＜0.001).The medial clear space of ankle joint in the two groups maintained a normal range 12 months after operation,and there was no statistically significant difference between the two groups(P＞0.05).(3)The AOFAS scale of patients in the two groups 6 and 12 months after operation was obviously bigger than that before operation(P＜0.001),but there was no statistically significant difference in the American Orthopedic Foot and Ankle Society Score of patients between the two groups at corresponding time points(P＞0.05).(4)It is concluded that both suture anchor and medial malleolus repair in the treatment of injury in the deep layer of deltoid ligament can recover the medial clear space of ankle joint,effectively keep the stability of ankle,and thus achieve good clinical efficacy.

Objective:To investigate the evaluation efficacy and predictive prognostic value of alpha-fetoprotein (AFP) response in tyrosine kinase inhibitors (TKIs) in combination with PD-1 inhibitors (α-PD-1) for intermediate-to-advanced hepatocellular carcinoma (HCC).Methods:The retrospective cohort study was conducted. The clinicopathological data of 205 patients with intermediate-to-advanced HCC who were admitted to 9 medical centers, including Mengchao Hepatobiliary Hospital of Fujian Medical University et al, from March 2020 to July 2022 were collected. There were 178 males and 27 females, aged (52±12)years. Based on AFP response at 6-8 weeks after treatment, patients were divided into the AFP response group (AFP level decreased by ≥50% compared to baseline) and the AFP no response group (AFP level decreased by <50% compared to baseline). Observation indicators: (1) AFP response evaluation of anti-tumor efficacy; (2) comparison of patient prognosis; (3) analysis of factors affecting patient prognosis. Measurement data with normal distrubution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range) and M( Q1, Q3). Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test. The Kaplan-Meier method was used to draw survival curve and calculate survival rate, and the Log-Rank test was used for survival analysis. The COX proportional risk model was used for univariate analysis and the COX stepwise regression model was used for multivariate analysis. Results:(1) AFP response evaluation of anti-tumor efficacy. Before treatment, all 205 patients were positive of AFP, with a baseline AFP level of 1 560(219,3 400)μg/L. All 205 patients were treated with TKIs in combination with α-PD-1, and the AFP level was 776(66,2 000)μg/L after 6 to 8 weeks of treatment. Of the 205 patients, 88 cases were classified as AFP response and 117 cases were classified as AFP no response. According to the response evaluation criteria in solid tumors version 1.1, the objective response rate (ORR) and disease control rate (DCR) were 42.05%(37/88) and 94.32%(83/88) in patients of the AFP response group and 16.24% (19/117) and 64.10% (75/117) in patients of the AFP no response group, showing significant differences between them ( χ2=16.846, 25.950, P<0.05). According to the modified response evaluation criteria in solid tumors, the ORR and DCR were 69.32% (61/88) and 94.32% (83/88) in patients of the AFP response group and 33.33% (39/117) and 64.10% (75/117) in patients of the AFP no response group, showing significant differences between them ( χ2=26.030, 25.950, P<0.05). (2) Comparison of patient prognosis. All 205 patients were followed up for 12.4(range, 2.4-34.0)months after treatment. The median progression free survival time and total survival time were 5.5 months and 17.8 months, respectively. The 1-year, 2-year progression free survival rates were 20.8% and 7.2%, and the 1-year, 2-year overall survival rates were 68.7% and 31.5%, respectively. The median progression free survival time, 1-year and 2-year progression free survival rates were 9.7 months, 39.6% and 14.2% in patients of the AFP response group and 3.7 months, 7.8% and 2.0% in patients of the AFP no response group, showing a significant difference in progression free survival between them ( χ2=43.154, P<0.05). The median overall survival time, 1-year and 2-year overall survival rates were not reached, 85.2% and 56.3% in patients of the AFP response group and 14.6 months, 56.3% and 14.5% in patients of the AFP no response group, showing a significant difference in overall survival between them ( χ2=33.899, P<0.05). (3) Analysis of factors affecting patient prognosis. Results of multivariate analysis showed that invasion of large blood vessels, extrahepatic metastasis, combined hepatic artery intervention therapy, and AFP response were independent factors influencing progression free survival in patients with intermediate-to-advanced HCC who were treated with TKIs in combination with α-PD-1 ( hazard ratio=1.474, 1.584, 0.631, 0.367, 95% confidence interval as 1.069-2.033, 1.159-2.167, 0.446-0.893, 0.261-0.516, P<0.05), and Eastern Cooperative Oncology Group score, invasion of large blood vessels, extrahepatic metastasis, and AFP response were independent factors influencing overall survival in patients with intermediate-to-advanced HCC who were treated with TKIs in combination with α-PD-1 ( hazard ratio= 1.347, 1.914, 1.673, 0.312, 95% confidence interval as 1.041-1.742, 1.293-2.833, 1.141-2.454, 0.197-0.492, P<0.05). Conclusions:AFP response at 6-8 weeks after treatment can effectively evaluate anti-tumor efficacy of TKIs in combination with α-PD-1 for intermediate-to-advanced HCC. AFP response is the independent factor influencing progression free survival and overall survival in patients with intermediate-to-advanced HCC who were treated with TKIs in combination with α-PD-1.

Objective To study the effect of postoperative adjuvant transarterial chemoembolization (TACE) on prognosis of patients after radical resection of primary hepatocellular carcinoma.Methods A retrospective analysis was conducted on 311 patients with primary hepatocellular carcinoma treated from 2002 to 2008 in Quanzhou First Hospital affiliated to the Fujian Medical University.Utilizing the COX regression model and the Kaplan-Meier analysis,the effects of adjuvant TACE on prognosis of both the high risk group (n =76) and the low risk group (n =91) with tumor ≤5 cm,as well as both the high risk group (n =65) and the low risk group (n =78) with tumor ＞ 5 cm were determined.The low risk group was defined as patients with a single tumor and without vascular invasion,while the high risk group was defined as patients with multiple tumors or with vascular invasion.Results The postoperative overall survival rate of the high risk group who underwent postoperative adjuvant TACE with tumor ＞ 5 cm was higher than that of the high risk group who did not undergo postoperative adjuvant TACE (P ＜ 0.05).However,whether or not postoperative adjuvant TACE was given had no effect on prognosis in the other subgroups of patients (P ＞ 0.05).Conclusion Postoperative adjuvant TACE was beneficial to the high risk group of patients with tumor ＞ 5 cm after radical resection of primary hepatocellular carcinoma.

Objective To analyze the clinical effects of internal radiation of iodine-125 seed implantation in the treatment of advanced pancreatic carcinoma.Methods 22 patients with unresectable and advanced pancreatic carcinoma were treated by the internal and interstitial radiation using iodine-125 seed implantation.Results Survival of 20 months was observed in 5 patients,10 ～ 20 months in 9 patients,2 ～10 months in 8,patients with an average of (13.47 ± 8.12) months.Among the 22 patients,complete response was obtained in 5 patients,partial response in 8 patients,no response in 7 paticnts,and the other showing PD.The response rate( CR + PR) was 59％.Conclusions Intra - operative internal radiation by iodine - 125 seed implantation does show some therapeutic effects for advanced pancreatic carcinoma.

Objective To study the significance of CD24 protein expression in esophageal squamous cell carcinoma and its relationship with clinical pathological parameters and clinical prognosis.Methods The expression of CD24 protein was studied in 90 esophageal squamous cell carcinoma samples by EnVision immunohistochemical analysis and to study relationship of CD24 with clinical pathological parameters and prognosis.Results The expression of CD24 in esophageal squamous cell carcinoma was significantly higher than that in adjacent normal tissue (x 2 =0.832,P ＜ 0.05).The expression of CD24 was not related with the age of patien,sexuality and the histologic grade (x2 =0.741,0.361,0.930,8.858,all P ＞ 0.05),but with clinical stage of the cance (x2 =10.804,P =0.005),lymph node metastasis (x2 =12.349,P =0.000) and depth of tumor invasion (x2 =13.94,P =0.007).Significant difference in survival between the different CD24 expression group,the OR (95 ％ CI) values were 2.105 (61.022-69.273),2.313 (55.108-64.176),1.286 (32.388-37.429),the survival of patients with strong expression of CD24 was inferior to that of weak expression of CD24,depth of tumor invasion and lymph node metastasis were independent prognostic factors of esophageal squamous cell carcinoma.Conclusion CD24 may be related to the malignant process of esophageal squamous cell carcinoma.Overexpression of CD24 indicates poor prognosis in esophageal squamous cell carcinoma patients.CD24 may become a new independent prognostic factor for esophageal squamous cell carcinoma.

Object To study the active constituents of Sanguis Draxonis made form Dracaena cochinchinensis (Lour ) S C Chen in China * Methods Various column chromatographies with Sephadex L 20 gel, MCI gel and silica gel were employed for the isolation and purification The structures of compounds were elucidated by spectral analysis Results Twelve compounds were isolated from the commercial product available on the market By means of spectral data, they were identified as 26 O ? D glucopyranosyl furostan 5,25 (27) diene 1?,3?,22?,26 tetrahydroxy 1 O ? L arabinopyranoside (Ⅰ); 3, 4 dihydroxy allylbenzene 4 O ? D glucopyranoside (Ⅱ); 7 hydroxy 3 (p hydroxyphenyl) chroman (Ⅲ); 7, 4′ dihydroxy 3′ methoxyflavan (Ⅳ); 3, 4 dihydroxyallylbenzene (Ⅴ); resveratrol (Ⅵ); 7, 4′ dihydroxy flavanone (Ⅶ); di (p hydroxyphenyl) methane (Ⅷ); acanthoside B (Ⅸ),p hydroxybenzoic acid (Ⅹ); hydroquinone (Ⅺ) and protocatechualdehyde ( ⅩⅡ ) Conclusion Compound Ⅰ and Ⅱ are new natural glycosides, and Ⅴ and Ⅵ are isolated from D cochinchinensis for the first time