OBJECTIVE: To explore treatment strategy for complex Schatzker Ⅳ tibial plateau fracture. METHODS: Forty-one patients with complex Schatzker type Ⅳ tibial plateau fractures were treated from January 2016 to January 2021, including 28 males and 13 females, aged from 19 to 65 years old with an average of (35.3±19.8) years old. Individualized treatment plan was developed according to preoperative imaging characteristics, medial surgical approach was mainly combined with other auxiliary incisions. Posteromedial inverted L approach was used in 18 patients, posteromedial approach and anterolateral extended approach in 19 patients, and posteromedial approach with anterolateral and lateral condylar osteotomy in 4 patients. Articular surface and facture healing were observed, range of knee joint motion was measured at 12 months after opertaion, and function of knee joint was evaluated by Lysholm scoring system. RESULTS: Forty-one patients were followed up for 12 to 26 months with an average of (13.3±6.8) months. Twenty-nine patients and 10 patients were obtained complete fracture healing at 6 and 12 months after operation respectively, and fracture healing time was 4 to 13 months with an average of (5.0±3.7) months. Two patients occurred posterior medial internal fixation failure and varus deformity of knee joint, and the fracture healed and varus deformity was corrected after the second operation. Range of knee joint motion was (118±29) °, and Lysholm score was(83.0±16.0) points. CONCLUSION Individualized treatment should be reasonably selected for complex Schatzker Ⅳ tibial plateau fractures, the characteristics of lateral plateau fractures are an important reference for selecting surgical approaches, the effective fixation of posteromedial bone blocks should be pay full attention, and the overall treatment results are satisfied.
Male ; Female ; Humans ; Young Adult ; Adult ; Middle Aged ; Aged ; Adolescent ; Tibial Plateau Fractures ; Bone Plates ; Tibial Fractures/surgery* ; Treatment Outcome ; Knee Joint/surgery* ; Fracture Fixation, Internal/methods* ; Retrospective Studies

The differences in the spatial distribution of regional Chinese material medicine resources between regions are determined by differences in natural conditions and social resources among different regions. Spatiotemporal evolution of the distribution of Chinese material medicine resources is a manifestation of the development process of Chinese medicine industry in time and space. The spatiotemporal evolution of the distribution of regional Chinese material medicine resources can reveal the regularity of spatial distribution of Chinese material medicine resources. County as the basic unit of the national material medicine resources census, the difference of resource endowment is of great significance to the rational development of Chinese material medicine resources policy and the coordinated development of regional resources and environment. Based on the results of the pilot project of Jilin province, this study selected 51 counties that had completed the census of Chinese material medicine resources. According to the species of Chinese material medicine resources, we explored the diversity of Chinese material medicine resources in Jilin province by using statistical data analysis (ESDA), trend surface analysis and spatial variability function to analyze the spatial differences of Chinese material medicine resources. Chinese material medicine resources are distributed in the eastern and southeastern part of Jilin province, mostly in the Changbai Mountains. The species of Chinese material medicine resources tend to be low-value spatial aggregation; the overall cold spots are located in Changchun and Jilin city, near the administrative center, mostly urban built-up area. The rich areas of Chinese material medicine resources are rich in hot spots, mainly in broad-leaved forest. The low-abundance of Chinese material medicine resources is dominated by cultivated vegetation.

Geo-herbals are preferred by long-term clinical application of Chinese medicine, they are produced in a specific area and affected by the specific production and processing methods. Geo-herbals have a high reputation, compared with other regions produced by the same kind of herbs with good quality, efficacy and stable quality characteristics. Geo-herbal is a unique concept that has been formed by the history of Chinese civilization for thousands of years and the history of Chinese medicine. According to the definition of geo-herbal, it can be seen that there are some differences in the quality and efficacy of the same kind of medicinal herbs in different regions, and there is some similarity in the specific area. In this study, the spatial distribution characteristics of artemisinin in Artemisia annua were analyzed by spatial statistical analysis. ①The spatial autocorrelation of artemisinin content was analyzed by "I coefficient". The results showed that the content of artemisinin in each province was significant and positive spatial autocorrelation. The content of artemisinin in each province was not randomly distributed, but with a clear spatial aggregation characteristics. ②The spatial variability of artemisinin content was analyzed by "G statistic". The results showed that the area with high content of artemisinin was distributed in the southwest region, and the content of artemisinin was concentrated in the space, which tends to accumulate at high value. The content of artemisinin in Tianjin and Liaoning province is low, and it tends to accumulate at low value, while the content of artemisinin in other provinces is the transition zone of high and low value. ③Based on the index of artemisinin in each province, the spatial correlation of artemisinin content in each region was analyzed by "moran scatter plot". The results showed that the content of artemisinin in nine provinces such as Guangxi and Chongqing belonged to high value gathering area. ④Based on the artemisinin content and ecological environment factor of sampling point, the "geophysical detector" was used to analyze the continuous quantitative data and discontinuous qualitative data. The results showed that the sunshine, temperature and precipitation were the main factors affecting the content of artemisinin.

Objective To investigate the nursing professional environmental conditions in Grade A hospitals,so as to provide evidence for countermeasures.Methods Totals of 1 078 clinic nurses were investigated with Gallup Q12 questionnaire.Results Totals of 1 045 nurses were adopted into the study.Among 1 045 clinic nurses,59.71％ nurses showed they "pleasant work",29.95％ nurses showed they "feel good",10.33％ nurses showed they "feel bad or not pleasant".Nurses with different age,department,positions had significantly different recognition degree on professional environmental (x2 =25.229,31.170,16.250,respectively;P ＜ 0.01).Conclusions Nursing professional environmental conditions in Grade A hospitals is good,while some nurses have low satisfaction degree on it.So manager should pay attention to the implementation of incentive measures,and self growth of nurses in order to improve nursing professional environmental conditions.

OBJECTIVEHBsAg loss and seroconversion in patients with chronic hepatitis B leads to long-lasting good clinical outcomes. The aim of this paper was to investigate to improve the rate of HBsAg loss and seroconversion in chronic hepatitis B patients by prolonged treatment of PEG-IFNa-2a. 217 cases of HBeAg-positive or negative patients were collected from inpatient and outpatient in Beijing Ditan Hospital from May 2005 to October 2009 and subcutaneous injection of 135 ug or 180 ug PEGASYS were given once a week according to body weights. The drug doses were adjusted according to the neutrophilic granulocyte and platelet counts during treatment course. Quantitative HBV DNA test was conducted using a commercially available real-time fluorescence quantitative PCR kit. The serum HBsAg/anti-HBs and HBeAg/anti-HBe were quantitatively detected by Abbott i 2000 chemiluminescent kit before and during treatment every three months. Patients with HBsAg steadily decreased and reached serum HBsAg level below 200 IU/ml after 48 weeks of treatment would receive prolonged treatment. Patients with more than 12 weeks of treatment entered into analysis. Main efficacy of prolonged treatment was evaluated by the incidences of HBsAg loss and seroconversion.

RESULTSThe treatment courses of the 217 patients ranged from 12.0 to 197.6 weeks with an average of 53.1+/-33.4 weeks, 118 cases took more than 48 weeks and another 89 cases less than 48 weeks. 13.4% (29/217) of patients achieved HBsAg loss or HBsAg seroconversion with treatment courses from 17.6 to 197.6 weeks (average 75.4+/-42.8 weeks). Among these 29 patients 24 (82.8%) received more than 48 weeks of treatment, but the treatment courses of HBV DNA reached undetectable level were 20.8+/-8.9 weeks. In this study, 9.5% (14/148) of HBeAg-positive patients achieved HBsAg loss or seroconversion, all of them treated more than 48 weeks, from 48 to 194 weeks, average 81.32+/-39.36 weeks. 21.7% (15/69) of HBeAg-negative patients achieved HBsAg loss or seroconversion, significantly higher than that of HBeAg-positive patients (9.5%) (x2 = 6.129, P = 0.013). The average treatment course for HBeAg-negative patients with HBsAg loss was 70.2+/-48.0 weeks, shorter than that of HBeAg-positive patients with HBsAg loss (81.3+/-39.4 weeks), but no significant difference (t = -0.522, P = 0.602) found between.

CONCLUSIONHigher rate of HBsAg loss and seroconversion could be obtained by individual extended treatment courses in patients with rapid HBV DNA and HBsAg response to PEG-IFNa-2a treatment and the HBeAg-negative patients could got higher rate of HBsAg loss than HBeAg-positive patients.

Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Female ; Hepatitis B Surface Antigens ; blood ; immunology ; Hepatitis B virus ; Hepatitis B, Chronic ; blood ; drug therapy ; immunology ; Humans ; Infant ; Interferon-alpha ; administration & dosage ; therapeutic use ; Male ; Middle Aged ; Polyethylene Glycols ; administration & dosage ; therapeutic use ; Recombinant Proteins ; administration & dosage ; therapeutic use ; Treatment Outcome ; Young Adult

Objective To investigate the antitumor therapeutic effect of combined therapy of magnetic induction heating by nano-magnetic particles, herpes simplex virus thymidine kinase gene(HSV-tk suicide gene) and internal radiation in mice bearing MCF-7 breast carcinoma. Methods The transfection reagents, plasmids heat shock protein-HSV-tk (pHSP-HSV-tk), ferroso-ferric oxide nano-magnetic fluid flow and 188Re-ganciclovir-bovine serum albumin-nanopaticles (GCV-BSA-NP) were prepared. The heating experiments in vivo were carried out using ferroso-ferric oxide nano-magnetic fluid flow. Sixty mice tumor models bearing MCF-7 breast carcinoma were established and randomly divided into six groups. Group A was the control group, B was gene transfection therapy group, C was hyperthermia group, D was gene transfection therapy combined with radionuclide brachytherapy group, E was gene therapy combined with hyperthermia group, and F was gene therapy, hyperthermia combined with radionuclide brachytherapy group. The tumor growth, tumor mass and histopathological changes were evaluated. The expression of HSV-tk in the groups of B, D, E and F was detected by RT-PCR. Poisson distribution and one-way analysis of variance (ANOVA) were used for statistical analysis by SPSS 10.0 software. Results In the animal heating experiments, the temperature of tumor increased up to 39.6 ℃, 43.2 ℃, and 48.1 ℃ quickly with different injected doses (2, 4 and 6 mg respectively) of nano-magnetic particles and maintained for 40 min. The temperature of tumor tissue reduced to 36.8 ℃, 37.5 ℃ and 37.8 ℃ in 10 min when alternating magnetic field (AMF) stopped. The tumor mass in Groups C ((452.50 ±30.29) mg), D ((240.98 ±35.32)mg), E((231.87 ±27.41) mg) and F ((141.55 ±23.78) mg) were much lower than that in Group A ((719.12±22.65) mg) (F=800.07, P＜0. 01), with the most significant treatment effect in Group F.The tumor mass in Group B((684.05 ±24.02) mg) was higher than that in Group D (t =32. 805, P ＜0. 05). Semi-quantitative RT-PCR analysis showed that the expression of HSV-tk in Groups B and D (0.33 ±0. 13 and 0. 46 ±0.12) was significantly different from that in Groups E and F (0.66 ±0.13 and 0.74 ±0. 11)(F = 21. 573, P ＜ 0.05). Conclusion Combined use of hyperthermia, gene therapy and radionuclide brachytherapy could effectively depress the growth of MCF-7 breast carcinoma, thus possessing treatment potential for this tumor.

Objective To investigate the relation of serum HBsAg, HBeAg contents and HBV-DNA load changes in HBeAg-positive chronic hepatitis B during IFN-α treatment. Methods After enrolled, the patients were treated with 3MU-5MU IFN subcutaneous injection every two days, and their serum was collected before treatment and every 3 months during the treatment course. The serum HBV-DNA load was determined by real-time fluorescence quantitative PCR method kit ( lower detection limit 500 copies/ml, Piji company, Shenzhen city, China,) according to production instruction, and HBeAg and HBsAg contents were detected by ARCHITECH I 2000.chemiluminescent kit. The relation of serum HBV-DNA, HBeAg and HBsAg content was analyzed by SPSS statistic software. Results There were 228 patients enrolled into this group, male 162 cases, female 66 cases, aged 14-60 years, average 30. 94 years old. After 1FN treatment the HBV-DNA, HBeAg and HBsAg levels were all gradually decreased. But there was no relation of HBsAg content to HBV DNA and HBeAg content before and during treatment course( P ＞0.05 ). However the serum HBeAg content was related to HBV-DNA content significantly (P ＜ 0.05 ) and their changes was correspondence. Conclusion Before and during treatment of interferon, HBeAg and HBV-DNA content changes are closely related, while there is no significant correlation between HBsAg and HBeAg and HBV-DNA content. During interferon therapy, HBsAg, HBeAg, HBV-DNA contents should be detected together.

To investigate the biological characteristics of the variant translocation der ins (17;15) in a patient with acute promyelocytic leukemia (APL), the conventional G-banding technique, interphase fluorescence in situ hybridization (int-FISH), RT-PCR, gene scanning, gene sequence and flow cytometry were performed. The results indicated that the variant translocation der ins (17, 15) observed by G banding technique was a rare type, the int-FISH assay by using dual-color pml/raralpha fusion probes confirmed the cytogenetic findings. The detection results of other molecular methods demonstrated the existence of the whole pml/raralpha fusion gene, while this case had insertion variant translocation. This patient got complete remission by using combined chemotherapy, and survives with continuous complete remission during following up for 1 year. In conclusion, the variant translocation der ins (17; 15) is rare type in APL, its incidence is lower, several signal types in detection of int-FISH were observed and the combination chemotherapy for this patient showed more obvious efficacy.
Chromosome Banding ; Chromosomes, Human, Pair 15 ; Chromosomes, Human, Pair 17 ; Humans ; In Situ Hybridization, Fluorescence ; methods ; Interphase ; genetics ; Leukemia, Promyelocytic, Acute ; genetics ; Male ; Translocation, Genetic ; Young Adult

To investigate the cytogenetic and clinical characteristics of inv(3q) (q21q26) and t(3;3) (q21; q26) aberrations as well as prognosis, cases were collected and chromosome specimens of bone marrow cells were prepared by 24-hour culture, while G-banding technique was used to perform karyotyping. The results showed that the simple inv(3q) and t(3; 3) aberrations were rare, they commonly combined with other chromosome aberrations such as -7/7q- and t (9; 22). The involved diseases included myelodysplastic syndromes, acute myeloid leukemia and chronic myelogenous leukemia in blast crisis. Out of 24 patients, 2 patients diagnosed with M(5) subtype did not achieve complete remission after multiple chemotherapy; 2 patients received allogenic stem cell transplantation relapsed. It is concluded that 3q21q26 aberration commonly combined with chromosome aberration 7/7q-, for these patients the efficacy of chemical therapy is poor, the efficacy of bone marrow transplant is too poor, these patients with inv(3q) and t(3; 3) aberrations have poor prognosis and short overall survival.
Adult ; Aged ; Chromosome Inversion ; Chromosomes, Human, Pair 3 ; genetics ; Chromosomes, Human, Pair 7 ; genetics ; Female ; Humans ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; genetics ; Leukemia, Myeloid, Acute ; genetics ; Male ; Middle Aged ; Myelodysplastic Syndromes ; genetics ; Prognosis ; Translocation, Genetic ; Young Adult

OBJECTIVESTo evaluate the efficacy and safety of imatinib mesylate (imatinib) for patients with Philadelphia chromosome-positive (Ph+ ) chronic myeloid leukemia (CML) in accelerated and blastic phase.

METHODSSeventy-five Ph+ CML patients in accelerated phase and 49 in blastic phase were treated with 400 mg or 600 mg of imatinib once daily.

RESULTSFor patients in accelerated phase, the cumulative hematological response (HR) rate was 93.3%, including complete HR (CHR) rate 85.3%, and returning to chronic phase (RCP) rate 8% in a median follow-up of 23.0 (1.0 -64.0 ) months. Cumulative major cytogenetic response (MCyR) rate was 33.0%, and complete cytogenetic response (CCyR) rate 28.0%. For patients with CCyR, the major molecular response (MMoR) rate was 47.6%. The estimated 4-year progression-free survival (PFS) rate and overall survival (OS) rate were 48.2% and 52.2% in patients with HR, respectively. Severe leukocytopenia, anemia and thrombocytopenia occurred in 37.3%, 34.6% and 45.3% of all patients, respectively. For patients in blastic phase, the cumulative HR rate was 63.3%, including CHR rate 44.9%, and RCP rate 18.4% in a median follow-up of 4.5 (0.3 -63.0) months. Cumulative MCyR rate and CCyR rate were both 12.2%. For patients with CCyR, the MMoR rate was 33.3%. For patients with HR, the estimated 1-year/2-year PFS and OS rates were 32.8%/15.8% and 46.0%/ 21.0% respectively. Severe leukocytopenia, anemia and thrombocytopenia occurred in 75.5%, 71.4% and 73.5% of all patients, respectively.

CONCLUSIONSThe efficiency of imatinib was decreasing, and severer hematological toxicities increasing with the disease progressing in patients with Ph+ CML. Imatinib improves progression-free survival significantly in most patients in accelerated phase, particularly in those with continuous CCyR or MMoR. The response duration in majority of blastic phase patients is short, and the relapse rate is high.

Adult ; Aged ; Antineoplastic Agents ; therapeutic use ; Benzamides ; Blast Crisis ; drug therapy ; Female ; Follow-Up Studies ; Humans ; Imatinib Mesylate ; Leukemia, Myeloid, Accelerated Phase ; drug therapy ; Male ; Middle Aged ; Piperazines ; therapeutic use ; Prognosis ; Pyrimidines ; therapeutic use ; Treatment Outcome