BACKGROUND:Ilizarov bone transport is very effective in the treatment of open large tibial bone defects,but there are still complications,among which the difficulty of junction healing is one of the difficult points in treatment. OBJECTIVE:To investigate the effect of Ilizarov bone transport combined with antibiotic bone cement on junction healing after operation of open large tibial bone defect. METHODS:Totally 51 patients with open large tibial bone defect(bone defect>4 cm)admitted to Binzhou Medical University Hospital from August 2010 to January 2022 were selected,of which 28 received Ilizarov bone transport alone(control group)and 23 received Ilizarov bone transport combined with antibiotic bone cement treatment(trial group).External fixation time,bone healing time,bone healing index,visual analog scale score during bone removal,bone defect limb function,junction healing and complications at the final follow-up were statistically compared between the two groups. RESULTS AND CONCLUSION:(1)All the 51 patients were followed up for a mean of(22.53±5.77)months.External fixation time,bone healing time,bone healing index,postoperative infection rate,and non-healing rate of junction were less in the trial group than those in the control group(P<0.05).There was no significant difference between the two groups in visual analog scale scores at 6 months after the second surgery and in the functional excellence and good rate of limb with bone defect at the final follow-up(P>0.05).(2)These findings indicate that compared with the Ilizarov bone transport alone,Ilizarov bone transport combined with antibiotic bone cement treatment can promote the healing of open tibial fracture junction and increase the rate of bone healing.

As a novel neuromodulation technology,the application of deep brain stimulation(DBS)in treatment-resistant psychiatric disorders has received widespread attention in recent years.Based on the current research frontiers,this review puts forward several unique and insightful issues of DBS in psychiatric disorders,including therapeutic targets,stimulation modes,closed-loop modulation,and long-term efficacy in order to provide suggestions and perspectives for future research directions.

Objective:To investigate the clinical value of Octreotide plus Ulinastatin in the treatment of severe acute pancreatitis(SAP)in elderly patients.Methods:From May 2016 to February 2019, 124 elderly SAP patients admitted to the gastroenterology department of our hospital were enrolled and divided into the combination therapy group and the control group, with 62 patients in each group.The combination therapy group was treated with Octreotide and Ulinastatin, while the control group was treated with Octreotide alone.Serum leukocyte count, C-reactive protein(CRP), interleukin(IL)-6, tumor necrosis factor(TNF)-α and amylase levels were monitored before and 1, 3, 5, 7 and 14 days after treatment by automated biochemical analysis and enzyme-linked immunosorbent assays.The pain grade scale, APACHE-Ⅱ score and efficacy evaluation were analyzed for the two groups 7 days after treatment.The time to oral refeeding and length of hospitalization were compared between the two groups, and related complications during the treatment were recorded.Complications and the recurrence of pancreatitis within 1 year were followed up in both groups.Results:There was no statistically significant difference in serum white blood cell count, CRP, amylase, IL-6 and TNF-α levels between the two groups before treatment(all P>0.05). Serum white blood cell count, CRP and TNF-α levels had significant differences( t=3.735, 2.851 and -2.147, P=0.036, 0.029 and 0.043)and serum amylase and IL-6 levels had no significant difference( P>0.05)between the two groups 3 days after treatment.All the above parameters had significant differences between the two groups 7 days after treatment( t=3.624, 2.918, -2.166, 2.684 and -2.593, P=0.023, 0.011, <0.001, 0.015 and <0.001). Serum amylase, IL-6 and TNF-α levels had significant differences( t=-3.515, 4.627 and -3.189, all P<0.001)and serum white blood cell count and CRP had no significant difference(all P>0.05)between the two groups 14 days after treatment.There were significant differences in visual analogue scale(VAS)and APACHE-Ⅱ score between the two groups 7 days after treatment( t=-2.346 and -3.245, P=0.021 and 0.002). On the 7th day after treatment, the effectiveness rate was 79.0%(49/62)in the combination therapy group and 61.3%(38/62)in the control group, with a significant difference between the two groups( χ2=4.661, P=0.031). Compared with the control group, time to oral refeeding and hospitalization length were shorter in the combination therapy group than in the control group(6.72±1.87 d vs.7.65±1.69 d, 11.23±2.98 d vs.13.85±3.42 d, t=-2.868 and -4.565, both P<0.05). There were significant differences in the incidences of infectious pancreatic necrosis, gastrointestinal adverse reactions and organ failure between the combination therapy group and the control group(11.3% or 7/62 vs.25.8% or 16/62, 43.5% or 27/62 vs.21.0% or 13/62, 1.6% or 1/62 vs.11.3% or 7/62, χ2=4.324, 7.233 and 4.810, P=0.038, 0.007 and 0.028). There were significant differences in mean length of time without complications and recurrence between the combined group and the control group(10.25±3.26 months vs.8.72±3.73 months, 10.69±2.51 months vs.9.62±2.92 months, Log Rank χ2=7.463 and 4.589, P=0.006 and 0.032). Conclusions:Octreotide combined with Ulinastatin can effectively alleviate local symptoms, slow clinical progression, reduce the risk of complications, decrease the recurrence rate and promote early recovery in elderly SAP patients.

AIM: To investigate the ability of quercetin to reverse acquire adriamycin (ADR) resistance and explored its probably mechanism. METHODS: The CCK-8 assay was used to detect the cytotoxicity of quercetin in MCF-7/ADR cells and the reversal effect of ADR. The colony formation assay and Hoechst 332582 staining were used to detect the cell proliferation, cell apoptosis and the accumulation of rhodamine 123 (Rh123) respectively. The RNA expression levels of GAS5 and ABCB1 were detected by qRT-PCR. The protein expression levels of GSK-3β, β-catenin, c-MYC, cyclin D1, and ABCB1 were detected by Western blot. RESULTS: Quercetin (10, 20, 40 μmol/L) significantly enhanced the sensitivity of MCF-7/ADR to ADR, inhibitd cell proliferation, and increased the intracellular accumulation of Rh123. Treatment with quercetin in MCF-7/ADR cells, the expression levels of GAS5 and GSK-3β were increased, whereas the expression levels of β-catenin, c-myc, cyclin D1 and ABCB1 were decreased. Further research revealed that reduction of GAS5 by RNA interference (si-GAS5) induced inhibitory effects on the expressions of GAS5 and GSK-3β, and enhanced the expressions of β-catenin, c-myc, cyclin D1, and ABCB1. Furthermore, treatment by quercetin combined with si-GAS5 in MCF-7/ADR cells, the expressions of these proteins were effectively reversed in comparison to quercetin combined with siRNA negative control (sncRNA). CONCLUSION: Quercetin increases the expression of GAS5by GSK-3β/β-catenin signaling pathway, which inhibits the expression of ABCB1, ultimately reversing ADR resistance in the MCF-7/ADR cells.

Objective To investigate the effect of periosteum deficiency on the treatment of segmental bone defect of lower extremity by Ilizarov bone transport Technique.Methods From April 2009 to April 2016,data of 54 cases with lower limb segmental bone defect who were treated by Ilizarov bone transport technique were retrospectively analyzed.According to intraoperative observation of the distribution of periosteum at the osteotomy site,all cases were divided into two groups.There were 10 cases in absent periosteum group,including 6 males and 4 females,aged from 23 to 57 years old (mean,38.20±9.90 years old).There were 3 cases locating at femur,and 7 cases at tibia.4 cases had non-infective bone defect,while the other 6 had infective bone defect.Segmental bone defect ranged from 4.0 to 14.0 cm (mean,6.85±2.87 cm).There were 44 cases in normal periosteum group,including 32 males and 12 females,aged from 22 to 65 years old (mean,38.90±10.10 years old).There were 9 cases locating at femur and 35 cases at tibia.12 cases had non-infective bone defect,while 32 cases had infective bone defect.Segmental bone defect ranged from 4.0 to 9.0 cm (mean,6.09±1.54 cm).Visual analogue scale (VAS) was used to estimate the pain during bone transport.The distraction index,bone healing index,external fixator index was collected to evaluate the distraction osteogenesis and mineralization.The Paley method was utilized to appraisal the function of proximal joints in bone transport.Results All the 54 cases were followed up for 24-48 months,with an average of 28.50±5.70 months.All skin and soft tissue defects were satisfied healed.All limbs were restored to their original lengths,and bone healing was eventually achieved.There were no statistically significant differences in the distraction index,bone healing index,external fixator index,VAS between absent periosteum group (12.29± 1.04 d/cm,39.00±3.96 d/cm,51.25±3.69 d/cm,3.30± 1.77 score) and normal periosteum group (11.67±0.96 d/cm,38.07±4.22 d/cm,49.74±4.25 d/cm,3.36± 1.66 score)(P ＞ 0.05).Paley adjacent joint function evaluation showed no statistically difference between absent periosteum group [good rate 100％(10/10)] and normal periosteum group [good rate 97.7％ (43/44)] (P=0.901).The overall incidence of complications was 20.0％ (2/10) in the absence of periosteum group,with 1 case of mild infection and 1 cases of tissue contracture incarcerated at the docking site.The overall incidence of complications was 27.3％ (12/44) in the normal of periosteum group,with 2 cases of mild infection,3 cases of poor limb strength alignment,6 cases of tissue contracture incarcerated at the docking site and 1 case of severe foot drop deformity.There was no statistically significant difference in the overall incidence of complications between the two groups (P=0.636).Conclusion The absence of periosteum at the epiphyseal osteotomy site hasno significant effect on Ilizarov bone transport technique in the treatment of segmental bone defects of lower limbs in bone regeneration and healing,mineralization and bone remodeling,and does not increase the incidence of complications.

Objective: To investigate the clinical efficacy of minimally invasive plate oseoynthesis (MIPO) assisted by a self-designed lower limb axial tractor in the treatment of complex tibial plateau fractures. Methods: The data were retrospectively analyzed of the 31 patients who had undergone surgical treatment for complex tibial plateau fractures from June 2015 to April 2018 at Department of Orthopeadics, Hospital Affiliated to Binzhou Medical College. MIPO was conducted with the assistance of the axial tractor in 17 of them. They were 12 men and 5 women with an age of 50.8±14.7 years, with 8 cases of Schatzker type Ⅴ and 9 ones of Schatzker type Ⅵ. MIPO was conducted without the assistance of the axial tractor but with the assistance of manipulation reduction in the other 14 patients. They were 9 men and 5 women with an age of 48.9±9.5 years, with 6 cases of Schatzker type Ⅴ and 8 ones of Schatzker type Ⅵ. The 2 groups were compared in terms of operation time, intraoperative bleeding, and Rasmussen scores for knee function and medial angle of the proximal tibia at the last follow-up. Results: The 2 groups were comparable due to insignificant differences in the preoperative general data between them (P>0.05). The tractor and manipulation groups were followed up for a mean of 9.8 months and 10.9 months respectively. Bone healing was achieved in all patients. For the tractor and manipulation groups, respectively, the operation time was127.8±40.8 min and 174.1±66.8 min, and the intraoperative bleeding 115.6±41.7 mL and 184.3±91.4 mL, showing significant differences between them (P<0.05). In the tractor group at the last follow-up, the knee flexion was 126.1°±9.3°, the medial angle of the proximal tibial 87.8°±1.4°, the posterior inclination angle 8.7°±3.8° and the Rasmussen score 26.5±2.9 points; in the manipulation group at the final follow-up, the knee flexion was 124.7°±8.9°, the medial angle of the proximal tibial 86.9°±2.1°, the posterior inclination angle 9.8°±4.1° and the Rasmussen score 25.6±3.2 points. There were no significant differences between the 2 groups in the above items (P>0.05). Loss of force line was observed in none of the patients at the last follow-up. Conclusion Compared with conventional manipulation reduction, use of our self-designed lower limb axial tractor can shorten operation time, reduce bleeding and facilitate reduction of fracture fragments in the treatment of tibial plateau fractures of Schatzker types Ⅴ and Ⅵ.

Objective To analyze the effect of extralateral approach interbody fusion in the treatment of degenerative lumbar diseases. Methods A total of 50 patients with lumbar degenerative diseases admitted to our hospital were selected, and were treated with extralateral approach interbody fusion, and the therapeutic effect was observed and analyzed. Results All patients successfully completed the operation. The average amount of bleeding during operation was (145. 5 ± 4. 7) m L, the average operation time was (56. 3 ± 2. 2) min, and the average hospitalization time was (7. 2 ± 1. 5) days. Four patients suffered from hip flexion weakness after operation, and the symptoms recovered completely after two months. Six patients suffered from sensory numbness in front of thighs after operation, and the symptoms disappeared or relieved after 6 to 8 weeks. No complications such as abdominal organs and blood vessels injury, cerebrospinal fluid leakage, mislocation of intervertebral space, paralytic intestinal obstruction and permanent injury of genitofemoral nerve occurred. All patients were followed up for 24 months. The results showed that at the last follow-up, the Visual Analogue Scale (VAS) scores of low back pain and lower limb pain were significantly lower, and the lumbar spine scores of Japanese Orthopaedic Association (JOA) were significantly higher than before operation (P ＜ 0. 05). Conclusion Extralateral approach interbody fusion can achieve satisfactory results in the treatment of lumbar degenerative diseases, with fewer complications and higher fusion rate.

Objective To analyze the effect of extralateral approach interbody fusion in the treatment of degenerative lumbar diseases. Methods A total of 50 patients with lumbar degenerative diseases admitted to our hospital were selected, and were treated with extralateral approach interbody fusion, and the therapeutic effect was observed and analyzed. Results All patients successfully completed the operation. The average amount of bleeding during operation was (145. 5 ± 4. 7) m L, the average operation time was (56. 3 ± 2. 2) min, and the average hospitalization time was (7. 2 ± 1. 5) days. Four patients suffered from hip flexion weakness after operation, and the symptoms recovered completely after two months. Six patients suffered from sensory numbness in front of thighs after operation, and the symptoms disappeared or relieved after 6 to 8 weeks. No complications such as abdominal organs and blood vessels injury, cerebrospinal fluid leakage, mislocation of intervertebral space, paralytic intestinal obstruction and permanent injury of genitofemoral nerve occurred. All patients were followed up for 24 months. The results showed that at the last follow-up, the Visual Analogue Scale (VAS) scores of low back pain and lower limb pain were significantly lower, and the lumbar spine scores of Japanese Orthopaedic Association (JOA) were significantly higher than before operation (P ＜ 0. 05). Conclusion Extralateral approach interbody fusion can achieve satisfactory results in the treatment of lumbar degenerative diseases, with fewer complications and higher fusion rate.

Objective To investigate the value of X-ray guided desmopressin (DDAVP) stimulated bilateral inferior petrosal sinus sampling (IPSS) in diagnosing the recurrence of ACTH dependent Cushing disease or ineffectiveness after surgery or radiotherapy. Methods Retrospective analyses of patients with recurrent ACTH dependent Cushing disease (31 cases) or ineffective (3 cases) treatment after surgery or radiotherapy from January 2013 to October 2014 in our hospital was conducted. Bilateral inferior petrosal sinus angiography showed the same side of the cavernous sinus to prove successful intubation. The cases with discontinuous of the inferior petrosal sinus and cavernous sinus were excluded by this study. Finally, there were 34 cases of the patients in this study. Diagnosis was based on the ratio of ACTH level in IPS to peripheral vein after desmopressin test.The gradient≥2 at baseline or gradient≥3 after desmopressin test suggested the sources were in the pituitary. Diagnosis was confirmed by gold standard to investigate the value of X-ray guided desmopressin (DDAVP) stimulated bilateral IPSS. Results The IPS gradient≥2 at baseline or gradient≥3 after desmopressin test suggested the sources were in the pituitary in 30 patients. A total of 22 (22/30) patients underwent surgery with a final diagnosis of ACTH adenoma. The symptoms were obviously relieved in 8 (8/30) cases after sellar area gamma knife treatment and lesions were confirmed in the pituitary. IPS gradient<2 at baseline or gradient<3 after desmopressin test was found in 4 cases. One case (1/4) was found to have for ACTH adenoma after pituitary surgery. The other 3 cases (3/4) were confirmed to have lung carcinoid and clinical symptom alleviated after surgery. The sensitivity of desmopressin stimulated IPSS was 96.8%, the specificity was 100%, and the accuracy was 97.1%. Conclusion Desmopressin stimulated IPSS is an effective diagnostic procedure in diagnosing ACTH dependent Cushing disease recurrence or ineffectiveness after surgery or radiotherapy.

Objective To explore the role and clinical significance of GSTM 3 ( glutathione S-trans-ferase mu 3) expression in prostate cancer (PCa). Methods We had used the two-dimensional fluores-cence difference gel electrophoresis ( 2D-DIGE) and mass spectral analysis to further verify the microarray data of mRNA expression profiling discovered .GSTM3 mRNA level was detected by Rael-time Quantitative PCR ( RT-QPCR) in 28 pairs of prostate cancer tissue and benign tissue .The relationship of GSTM 3 level with the serum PSA level and the clinical feature of PCa were analyzed . Results In 2D-DIGE study, we found that the expression of GSTM 3 protein in adjacent tissues was significantly higher than that in PCa tis-sues (P<0.05).RT-QPCR results showed that GSTM3 in adjacent tissues (8.12±0.51) was significantly higher than that in PCa tissues (7.18±0.54) (P<0.05).There was no significant difference of GSTM3 ex-pression in different serum PSA packets ( P>0.05) and prostate cancer clinical pathological parameters ( P>0.05). Conclusions GSTM3 expression is down-regulated in PCa tissues, and we may identify PCa by detecting the GSTM 3 expression .