Objective To explore the efficacy of arthroscopic reduction combined with percutaneous screw fixation in the treatment of Sanders types Ⅱ and Ⅲ calcaneal fractures.Methods Forty-eight patients with Sanders types Ⅱ and Ⅲcalcaneal fractures were divided into the arthroscopic reduction combined with percutaneous screw fixation(arthroscopy)group(n=23)and the tarsal sinus approach open reduction combined with screw internal fixation(tarsal sinus approach)group(n=25)according to different surgical methods and plans.The operative time,incision length,postoperative complications and secondary removal of internal fixation were compared between the two groups.Changes in B?hler's angle and Gissane's angle were evaluated and compared between the two groups at 3 months,6 months after operation and at the last follow-up.Additionally,the American Orthopaedic Foot&Ankle Society(AOFAS)ankle-hindfoot score and the visual analog scale(VAS)for pain were used to assess outcomes at the last follow-up.Results Compared with the tarsal sinus approach group,the incision length was reduced,the operation time was prolonged and the incidence of complications was decreased in the arthroscopic group(P＜0.05).At 3 months,6 months after the operation and the last follow-up,there were no significant differences in the B?hler Angle,Gissanes Angle,AOFAS and VAS scores between the arthroscopic group and the tarsal sinus approach group(P＞0.05).Conclusion Both groups of regimens can enable patients to achieve good postoperative therapeutic efficacy.However,under arthroscopic assistance,surgical incisions inherently possess minimally invasive advantages,while the incidence of postoperative complications is lower compared to the sinus tarsi approach.

Aim To investigate the clinical characteristics and related factors of post-implantation syndrome(PIS)following the prophylactic application of non-steroidal anti-inflammatory drugs(NSAID)after thoracic endovascular aortic repair(TEVAR).Methods A total of 510 adult patients who had received prophylactic NSAID after TEVAR at General Hospital of Northern Theater Command from September 2013 to April 2024 were consecutively included in the study.The patients were divided into two groups based on the occurrence of PIS postoperatively:the PIS group(34 pa-tients,6.67％)and the non-PIS group(476 patients,93.33％).General information,past medical history and surgical features were compared between the two groups.Univariate and multivariate Logistic regression analysis were used to i-dentify predictors of PIS.The ROC curve was used to assess the overall diagnostic performance of the risk factors.Results The baseline data and clinical characteristics of PIS group and non-PIS group were compared.The rate of gen-der as male,chest and back pain on adimission,limb ischaemia on admission,systolic blood pressure on admission,use of angiotensin converting enzyme inhibitor(ACEI)/angiotensin receptor blocker(ARB)drugs during hospitalization,preop-erative white blood cell(WBC)count and surgical approach involving an incision in PIS group were higher than those in non-PIS group,and the age,preoperative estimated glomerular filtration rate(eGFR)level and use of statin drugs during hospitalization were lower than those in non-PIS group,all differences were statistically significant.Postoperative C-reac-tive protein level,incidence of clinical adverse events during postoperative hospitalization,and time of postoperative hospi-talization were increased in PIS group compared with those in non-PIS group.There was no significant difference in the incidence of aortic adverse events between the two groups(P＜0.05).Univariate and multivariate Logistic regression a-nalysis identified patients' age＜60 years(OR=4.671,95％CI:1.348～16.188,P=0.015),increased preoperative WBC count(OR=3.582,95％CI:1.469～8.735,P=0.005),and surgical approach involving an incision(OR=8.339,95％CI:1.849～37.610,P=0.006)as independent predictors for PIS.The results of the ROC curve analysis showed that the area under the curve of patients' age＜60 years,increased preoperative WBC count,femoral arteriotomy ac-cess,and the three combined diagnoses in predicting the occurrence of PIS after TEVAR were 0.653(95％CI:0.573～0.733),0.686(95％CI:0.600～0.771),0.699(95％CI:0.627～0.770),0.826(95％CI:0.765～0.887).Conclusion Despite the prophylactic use of NSAID,some patients develop PIS after TEVAR.Patients' age＜60 years,elevated preoperative WBC count,and femoral artery incision approach are independent risk factors for PIS after preventive medication.Additionally,the incidence of PIS increased with the number of independent risk factors present.

Objective To explore the efficacy of arthroscopic reduction combined with percutaneous screw fixation in the treatment of Sanders types Ⅱ and Ⅲ calcaneal fractures.Methods Forty-eight patients with Sanders types Ⅱ and Ⅲcalcaneal fractures were divided into the arthroscopic reduction combined with percutaneous screw fixation(arthroscopy)group(n=23)and the tarsal sinus approach open reduction combined with screw internal fixation(tarsal sinus approach)group(n=25)according to different surgical methods and plans.The operative time,incision length,postoperative complications and secondary removal of internal fixation were compared between the two groups.Changes in B?hler's angle and Gissane's angle were evaluated and compared between the two groups at 3 months,6 months after operation and at the last follow-up.Additionally,the American Orthopaedic Foot&Ankle Society(AOFAS)ankle-hindfoot score and the visual analog scale(VAS)for pain were used to assess outcomes at the last follow-up.Results Compared with the tarsal sinus approach group,the incision length was reduced,the operation time was prolonged and the incidence of complications was decreased in the arthroscopic group(P＜0.05).At 3 months,6 months after the operation and the last follow-up,there were no significant differences in the B?hler Angle,Gissanes Angle,AOFAS and VAS scores between the arthroscopic group and the tarsal sinus approach group(P＞0.05).Conclusion Both groups of regimens can enable patients to achieve good postoperative therapeutic efficacy.However,under arthroscopic assistance,surgical incisions inherently possess minimally invasive advantages,while the incidence of postoperative complications is lower compared to the sinus tarsi approach.

Aim To investigate the clinical characteristics and related factors of post-implantation syndrome(PIS)following the prophylactic application of non-steroidal anti-inflammatory drugs(NSAID)after thoracic endovascular aortic repair(TEVAR).Methods A total of 510 adult patients who had received prophylactic NSAID after TEVAR at General Hospital of Northern Theater Command from September 2013 to April 2024 were consecutively included in the study.The patients were divided into two groups based on the occurrence of PIS postoperatively:the PIS group(34 pa-tients,6.67％)and the non-PIS group(476 patients,93.33％).General information,past medical history and surgical features were compared between the two groups.Univariate and multivariate Logistic regression analysis were used to i-dentify predictors of PIS.The ROC curve was used to assess the overall diagnostic performance of the risk factors.Results The baseline data and clinical characteristics of PIS group and non-PIS group were compared.The rate of gen-der as male,chest and back pain on adimission,limb ischaemia on admission,systolic blood pressure on admission,use of angiotensin converting enzyme inhibitor(ACEI)/angiotensin receptor blocker(ARB)drugs during hospitalization,preop-erative white blood cell(WBC)count and surgical approach involving an incision in PIS group were higher than those in non-PIS group,and the age,preoperative estimated glomerular filtration rate(eGFR)level and use of statin drugs during hospitalization were lower than those in non-PIS group,all differences were statistically significant.Postoperative C-reac-tive protein level,incidence of clinical adverse events during postoperative hospitalization,and time of postoperative hospi-talization were increased in PIS group compared with those in non-PIS group.There was no significant difference in the incidence of aortic adverse events between the two groups(P＜0.05).Univariate and multivariate Logistic regression a-nalysis identified patients' age＜60 years(OR=4.671,95％CI:1.348～16.188,P=0.015),increased preoperative WBC count(OR=3.582,95％CI:1.469～8.735,P=0.005),and surgical approach involving an incision(OR=8.339,95％CI:1.849～37.610,P=0.006)as independent predictors for PIS.The results of the ROC curve analysis showed that the area under the curve of patients' age＜60 years,increased preoperative WBC count,femoral arteriotomy ac-cess,and the three combined diagnoses in predicting the occurrence of PIS after TEVAR were 0.653(95％CI:0.573～0.733),0.686(95％CI:0.600～0.771),0.699(95％CI:0.627～0.770),0.826(95％CI:0.765～0.887).Conclusion Despite the prophylactic use of NSAID,some patients develop PIS after TEVAR.Patients' age＜60 years,elevated preoperative WBC count,and femoral artery incision approach are independent risk factors for PIS after preventive medication.Additionally,the incidence of PIS increased with the number of independent risk factors present.

A 43-year-old female patient was admitted with recurrent thrombosis for more than 2 years and thrombocytopenia for more than 1 year. Both arterial and venous thromboses developed especially at rare sites even during anticoagulation therapy such as cerebral venous sinus thrombosis. Antinuclear antibody, anti-ENA antibody and antiphospholipid antibody were all negative. Platelet count elevated to normal after high dose glucocorticoid and intravenous immunoglobulin (IVIG). Immune thrombocytopenia was suspected. When 4 grade thrombocytopenia recurred, intravenous heparin, rituximab 600 mg, IVIG and eltrombopag were administrated. After 3 weeks, thrombocytopenia did not improve, and new thrombosis developed instead. Screening of thrombophilia related genes revealed PROS1 gene heterozygous mutation and MTHFR TT genotype. Low amount of serum IgG κ monoclonal protein was detected. Heparin-induced thrombocytopenia was differentiated and excluded. Finally, serum negative antiphospholipid syndrome was considered the most likely diagnosis. Dexamethasone 20 mg/day × 4 days combined with sirolimus 2 mg/day was prescribed. The patient was discharged with low molecular weight heparin. At one month, her headache was greatly relieved. The platelet count raised to 20-30×10 9/L, and no new thrombosis or bleeding was reported.

Objectives:To cross-sectionally analyze the clinical characteristics of primary antiphospholipid syndrome (PAPS) patients with thrombocytopenia, risk factors associated with thrombocytopenia, and risk of symptom recurrence in these patients.Methods:The inpatients with PAPS were retrospectively analyzed in Peking Union Medical College Hospital from 2009 to 2019. Using the collected clinical and laboratory data, the clinical characteristics and risk of symptom recurrence in the PAPS patients with thrombocytopenia were compared with those in the PAPS patients with normal platelet counts. Univariate and multivariate logistic regression analyses were performed to screen the risk factors for thrombocytopenia.Results:In this study, 127 patients with PAPS were enrolled, of which 36 (28.3% ) had thrombocytopenia, with a median age of 38 years, and 63.9% were female. In the thrombocytopenia group, the average platelet count was (58.9±27.0) ×10 9/L, and the prevalence of thrombosis and morbid pregnancy was not significantly different from that in the normal platelet group. However, the thrombocytopenia group had higher incidence rate of autoimmune hemolytic anemia (19.4% vs 3.3% ) , livedo reticularis (16.7% vs 3.3% ) , chronic kidney disease (25% vs 8.8% ) and antiphospholipid antibodies triple positiveness (61.1% vs 37.4% ) , lower complement levels (C3 of 0.87 g/L vs 1.07 g/L, C4 of 0.12 g/L vs 0.18 g/L, P<0.05) , and higher adjusted Global APS Score (median score of 13 vs 9, P=0.037) than the normal platelet group. In multivariate logistic regression analysis, hypocomplementemia ( OR value 5.032, 95% CI 3.118-22.095) is an independent risk factor for thrombocytopenia. Conclusions:In patients with PAPS, thrombocytopenia is mostly mild to moderate. Hypocomplementemia may be the independent risk factor for thrombocytopenia in PAPS patients. The PAPS patients with thrombocytopenia may have a higher risk of symptom recurrence.

Objective:To study the orthopedic treatment strategy for hemophilia complicated with musculoskeletal disorders as well as the peri-operative consumption of clotting factor.Methods:Total 338 orthopedic surgeries were performed for 261 patients, average age of 30.6 y (6-65 y) , with hemophilia between January 1996 and December 2019 at our institute. Two hundred and twenty-six patients presented with bleeds within the joints. Sixty-one patients presented with intramuscular bleeds, 45 presented with hemophilic pseudotumors, and six presented with miscellaneous complaints. Strategy of clotting factor replacement therapy was designed as per differences in the level of the operation procedure. Information regarding clinical manifestation, operative strategy, clotting factor consumption, and re-operation for complications was retrospectively recorded. The costs for multiple joint procedure and single joint procedure were studied.Results:We found that 270 of the 338 surgical procedures were major surgical procedures (79.9%) . There were 203 procedures of joint arthroplasty (60%) . Fourteen patients underwent reoperations for local recurrence (4.2%) . The average factor Ⅷ consumption before the surgery was 44.4 ± 8.1 IU/kg. The average FⅧ consumption within postoperative 2 weeks was 40 962 IU (647±177 IU/kg) . Seven type A hemophilic patients developed F Ⅷ inhibitor following the surgical procedure, with an average level of 13.7±11.2 BU/mL. Sixty-eight patients underwent multiple joint procedures under one anesthesia session (26%) . There was no significant difference in the factor consumption between the multiple joint procedure and single joint procedure.Conclusions:Surgical treatment was found to be effective for hemophilic arthropathy and lesion of the musculoskeletal apparatus, with the clotting factor replacement therapy. Multiple joint procedures under one anesthesia were more cost effective for patients with hemophilia, with less factor consumption than staged single joint procedure.

Objective To observe the serum levels of endothelial microparticles (EMP) and tissue factor-bearing microparticles (TF+MP) in patients with acute leukemia before and after daunorubicin-based chemotherapy. Methods From July 2012 to February 2013, 15 patients with newly diagnosed acute leukemia in Peking Union Medical College Hospital received DA (daunorubicin + cytarabine) regimen or VDCLP (vincristine + daunorubicin + cyclophosphamide + L-asparaginase + prednisone) regimen chemotherapy. There were 8 males and 7 females, and the median age of patients was 44 years old. Eleven patients were acute myeloid leukemia (M01 case, M11 case, M29 cases), and 4 were acute lymphocytic leukemia. The peripheral blood samples were taken before induction chemotherapy and after 3 days of daunorubicin. Levels of EMP and TF+MP were assessed using flow cytometry. Results The serum EMP and TF+MP levels were significantly higher after 3-day daunorubicin infusions than those before induction chemotherapy (28.94/μl vs. 10.74/μl, P= 0.001; 64.24/μl vs. 43.80/μl, P= 0.02). Conclusion Daunorubicin-based chemotherapy may cause increased numbers of EMP and TF+MP in patients with acute leukemia.

A 17-year-old young man with a history of swollen leg and intermittent jaundice was presented to Peking Union Medical College Hospital with acute fever and mental disturbance.He developed deep venous thrombosis,acute myocardial infarction and plantar skin necrosis during the past four years,and was presented with an acute episode of fever,thrombocytopenia,acute kidney injury,acute myocardial infarction,mental disturbance,and obstructive jaundice.Laboratory tests showed schistocytes on peripheral blood smear.High titer of antiphospholipid antibodies was detected.Strikingly,the activity of a disintegrin and metalloprotease with a thrombospondin type 1 motif,member 13 (ADAMTS13)was significantly decreased without the production of inhibitors.Images indicated stenosis of the common bile duct,common hepatic duct,and cystic duct,which caused dilation of bile ducts and the gall bladder.Corticosteroids and anticoagulation therapy were effective at first,but the disease relapsedonce the corticosteroids tapered down.Plasma exchange was administrated for 17 times,which was effective temporarily during this episode.Methylprednisolone pulse therapy,intravenous immunoglobulin,rituximab,anticoagulation therapy,and bile drainage,were all tried but still could not control the disease.The patient's family agreed to withdraw treatment after he developed septic shock.

BACKGROUND:Drug eluting stents and endothelium stents for clinical treatment of vascular stenosis can lead to delayed endothelialization and restenosis. A rapamycin eluting stent combined with CD34 antibody can play a synergistic role to offset delayed endothelialization and intimal hyperplasia due to antiproliferative drugs, but it is stil in the pilot phase. OBJECTIVE:To observe the ability of rapamycin eluting stent combined with CD34 antibody to capture endothelial progenitor cels, and to observe the differentiation characteristics of the captured cels. METHODS:Scanning electron microscope and indirect immunofluorescence were used to observe the morphology and differentiation characteristics of captured endothelial progenitor cels. Under a fluorescence microscope, we observed the captured endothelial progenitor cels and the degree of endothelialization after implantation of the rapamycin eluting stent combined with CD34 antibody into rabbit ear vein. RESULTS AND CONCLUSION:Under the scanning electron microscope, fusiform-like cels with a diameter of 6-8 μm were captured by the composite stent, and 24 hours later, the cels became ful-shaped. The captured cels had the appearance characteristics of endothelial progenitor cels. Results from indirect immunofluorescence observation showed that there were a lot of red fluorescent spots on the coating which represented adherent cels positive for vascular endothelial growth factor receptor-2; the composite stent was largely covered with vascular endothelial cels at 24 hours after stent implantation, and fuly covered at 48 hours, but there was no abnormal cel cluster. These findings indicate that the rapamycin eluting stent combined with CD34 antibody can be specific to rapidly capture endothelial progenitor cels in the peripheral blood, and the stent can be completely covered with vascular endothelial cels at 48 hours after stent implantation, thereby achieving rapid endothelialization and promoting the repair of endothelial cels.