Objective:To study the clinical efficacy of our modified double reverse traction technique in the treatment of tibial plateau fractures.Methods:A retrospective study was conducted of the 66 patients with tibial plateau fracture who had been treated by our modified double reverse traction technique at Articular Department, Zhongshan Hospital of Traditional Chinese Medicine from March 2019 to December 2021. There were 37 males and 29 females, with an age of (44±14) years. The double reverse traction technique was used in all patients for reduction of the tibial plateau fracture, and their collapsed articular surfaces were restored by our self-designed universal high affinity prying technique, or by fibular graft support, or by the hooping technique to restore the transverse diameter of the tibial plateau which had been widened. The outcomes of fracture reduction at 2 days postoperation were recorded and evaluated by Rasmussen imaging assessment. Complications were also recorded. The visual analog scale (VAS) pain scores and Hospital for Special Surgery (HSS) scores were compared between preoperation, 3 and 6 months postoperation and the rates of fracture healing between 3 and 6 months postoperation.Results:This group of 66 patients was followed up for 12.0(8.0, 16.5) months. The Rasmussen imaging assessment at 2 days postoperation: 60 excellent, 4 good, and 2 fair cases, yielding an excellent to good rate of 97.0% (64/66). At 3 and 6 months postoperation, the VAS scores [1 (0, 1) and 0 (0, 1)] and HSS scores [84 (78, 88) and 91 (85, 95)] were significantly improved compared with those before operation [4 (3, 5) and 36 (29, 39)], and the values at 6 months postoperation were significantly improved compared with those at 3 months postoperation ( P<0.05). The rate of clinical fracture healing at 6 months postoperation (100%, 66/66) was significantly higher than that at 3 months postoperation (77.3%, 51/66) ( P<0.05). Perioperatively, no adverse events were observed like incision infection, deep vein thrombosis of lower limbs, or failure or exposure of internal fixation, except for delayed incision healing in only one patient. Conclusion:In the minimally invasive surgery for tibial plateau fractures, our modified double reverse traction technique can result in excellent fracture reduction by imaging assessment, fine functional recovery of the knee joint and relief of pain.

Hepatic fibrosis (HF) is a self-healing pathological process after all kinds of chronic liver injuries and can cause diseases such as liver cirrhosis and liver cancer. The Wnt signaling pathway is highly conserved in species evolution and widely exists in invertebrates and vertebrates, and many studies have confirmed that the Wnt signaling pathway is closely associated with the development and progression of HF. This article reviews the mechanisms of the classical and non-classical Wnt signaling pathways in regulating hepatic stellate cells, hepatic macrophages, and hepatic progenitor cells, so as to provide new ideas for subsequent studies on the mechanism of the Wnt signaling pathway in regulating HF and further exploration of therapeutic targets that can reverse HF.

Objective:To investigate the effects of Resolvin D1 (RvD1) on the inflammatory response and the expression of Nod-like receptor protein 3(NLRP3) inflammasomes in mice with acute lung injury.Methods:The 30 male BALB/c mice weighing 25-30 g were divided into 3 groups(each group with 10 mice). Mice in the normal control group were given normal saline by tail vein injection.Mice in the lipopolysaccharide (LPS) group were given the same volume of LPS (10 mg/kg) via tail vein injection.Mice in the RvD1 group were injected with RvD1 (5 μg/kg) through the tail vein 30 minutes prior to LPS administration.Mice were humanely sacrificed after 6 hours.Histopatholo-gical changes of lung tissue, the levels of pro-inflammatory cytokines interleukin(IL)-18 and IL-1β, and the expression of NLRP3 inflammasomes in lung tissue were measured.Results:After LPS administration, the lung of mice showed pathological damage.The levels of pro-inflammatory factors IL-18 and IL-1β as well as the expression of NLRP3, apoptosis-associated speck-like protein containing a card(ASC)and Caspase-1 in the LPS group were significantly higher than those in the normal control group (all P<0.05). After pretreatment with RvD1, the pathological damage of lung tissue was alleviated.The levels of pro-inflammatory factors IL-18 and IL-1β as well as the expression of NLRP3, ASC and Caspase-1 in the RvD1 group were significantly lower than those in the LPS group (all P<0.05). Conclusions:RvD1 can attenuate the pulmonary inflammation in acute lung injury and inhibit the release of pro-inflammatory factors, which is possibly related to the suppression of NLRP3.

Objective:To compare the clinical outcomes between modified percutaneous kyphoplasty (PKP) and conventional PKP in the treatment of Kümmell disease.Methods:A retrospective cohort study was conducted of the 57 patients with single level kummell disease who had undergone PKP between January 2015 and December 2017 at Department of Spinal Surgery, Jiangmen Hospital Affiliated to Sun Yat-sen Uni-versity.Of them, 36 received modified PKP and 21 conventional PKP.In the modified PKP group, there were 24 males and 12 females with an age of 73.9 years±9.4 years and a course of disease of 2.2 months±1.5 months; the disease was located at a thorocic vertebra in 20 cases and at a lumbar vertebra in 16.In the conventional PKP group, there were 15 males and 6 females with an age of 72.6 years±11.9 years and a course of disease of 1.8 months±1.1 months; the disease was located at a thorocic vertebra in 10 cases and at a lumbar vertebra in 11.The 2 groups were compared in terms of operation time, bone cement volume, cement leakage, visual analogue scale (VAS), Oswestry disability index (ODI), anterior and middle heights and cobb angle of injured vertebra at postoperative 3 days, 1 and 3 months, and final follow-up.Results:There were no significant differences in the general clinical data between the 2 groups, showing compatibility between groups ( P>0.05).All the operations were accomplished uneventfully with no such serious complications as spinal cord nerve injury, wound infection, pulmonary embolism, bone cement poisoning reaction or death. There was no significant difference between the 2 groups in operation time or bone cement volume ( P>0.05).The rate of cement leakage in the modified PKP group [33.3%(9/27)] was significantly lower than that [52.4%(11/21)] in the conventional PKP group ( P<0.05).There were no significant differences be-tween the 2 groups in VAS, ODI, anterior or middle height of injured vertebra or cobb angle at postoperative 3 days or one month ( P>0.05), but the postoperative values were improved compared to the preoperative ones.At postoperative 3 months and final follow-up, the modified PKP group was significantly better in all the indexes than the conventional PKP group ( P<0.05). Conclusion:Compared with conventional PKP, the modified PKP may lead to better outcomes for Kümmell disease.

Objective To investigate the risk factors of extubation failure following surgical repair of congenital heart defects (CHD) in infants.Methods Infantile patients who underwent surgical repair of CHD under cardiopulmonary bypass (CPB) in the First Affiliated Hospital of Sun Yat-Sen University from January 2015 to October 2016 were included.According to results of extubation,the patients were divided into the extubation failure group and extubation success group.Clinical and laboratory data were collected and analyzed,including age,gender,body mass,the types of congenital heart disease,extracorporeal circulation time and the use of vasoactive drug,et al.Results Sixty cases were enrolled in this study.Among them 12 cases (7 males,5 females with the boy to girl ratio of 1.4 ∶ 1.0,and average age was 0.56 years old) were in the extubation failure group,in which 3 cases (25.0％)aged ＜3 months,5 cases(41.6％) aged 3-6 months.Eight cases(66.7％) weighed ≤5 kg and 4 cases(33.3％)weighed ＞ 5-10 kg.Forty-eight cases (27 males,21 females;the boy to girl ratio was 1.2 ∶ 1.0 and average age was 1.15 years old) were in the extubation success group.The distribution of age and body weight were significantly lower in the extubation failure group than those in the extubation success group [0.42 (0.37) years old vs.1.00 (1.08)years old,Z=-3.22,P＜0.01;5.00 (1.25) kgvs.8.40 (3.95) kg,Z=-3.57,P＜0.01].The durations of CPB and mechanical ventilation until the initial extubation were significantly longer in the extubation failure group than those in the extubation group [114.0 (110.O) minutes vs.80.0 (45.0) minutes,Z =1.59,P ＜ 0.05;142.5 (229.5)hours vs.14.0 (48.9) hours,Z =2.00,P ＜ 0.05].The incidences of airway spasm and pulmonary infection had no difference between the 2 groups (x2 =4.00,5.54,all P ＞ 0.05).Multiple Logistic regression showed thatthe duration of CPB was an independent risk factor of extubation failure [odds ratio (OR) =0.967,95％ CI:0.956-0.997,P =0.024].Conclusions The risk factors of extubation failure include young age,low body weight,and prolonged CPB and mechanical ventilation.CPB time is an independent risk factor of extubation failure following cardiac surgery in infants.

Objective To evaluate the efficacy of the combined therapy of ReDuNing injection and acyclo-vir on children with infectious mononueleosis(IM). Methods From October 2012 to July 2015 in the emergency ward of Children′s Hospital of Nanjing Medical University ,167 cases diagnosised with infectious mononucleosis were enrolled in this study. Ninety-five cases received acyclovir treatment were recruited in the conventional treat-ment group,72 cases received the combined thrapy of ReDuNing injection and acyclovir of children were recruited in the observation group. The clinical symptoms ,clinical manifestation and blood routine ,liver and kidney func-tion,myocardial enzymes,temperature recovery time,reduce lymph node,liver function recovery time and hospi-talization time of patients were recorded and compared between the two groups. Results No significant differences were observed in the clinical course and general fever,pharyngitis,lymphadenopathy,hepatosplenomegaly,rash and eyelid edema in children of the observation group (ReDuNing + Acyclovir) and routine treatment group (Acyclovir). No significant differences were found in blood routine ,blood biochemical indexes of liver ,kidney function and myocardial enzymes in patients of the two groups before and after treatment. The white blood cells , ALT and LDH were significantly reduced in patients of the two groups after treatment(P<0.05). However,LDH was still high in patients of the two groups before discharge ,with the level of(355.63 ± 116.89)U/L and(347.79 ± 106.74)U/L,respectively. The pyretolysis time(2.97 ± 2.56)d,lymph node reduced time(9.08 ± 1.54)d,liver function recovery time(8.67 ± 2.35)d,white blood cell recovery time(6.76 ± 2.96)d,hospitalization time (11.10 ± 3)d in the observation group were significantly shortened than those in the conventional treatment group ((4.38 ± 2.70)d,(10.48 ± 3.62)d,(11.50 ± 3.71)d,(9.15 ± 3.24)d,12.32 ± 3.62)d,respectively)(P<0.05, respectively). Conclusions The fever,lymphadenopathy,leukocytosis,liver damage and LDH were relieved and reduced at different degrees in patients of both the observation group and the routine treatment group after treat-ments. Reduning combined with acyclovir treatments lead to better clinical efficacy in children ,with shortening the duration of fever,Lymph node reduction time,and white blood cell recovery time. In particularly,the combined therapy can shorten the recovery time of patients with liver function damage ,which is a safe clinical application and can be used as one of the effective treatment measures for children with infectious mononucleosis.

Objective To analyze the preoperative related factors of early weaning of infants with congenital heart disease after operation. Methods From January ,2014 to January ,2017 in Pediatric Cardiology CICU , infants with congenital heart disease were selected as research objects. The clinical data were retrospectively collect ed and the relationship between preoperative influencing factors and postoperative early weaning were analyzed. Early weaning meant mechanical ventilation time was shorter than 24 h and late weaning meant longer than 24 h. Results Single factor analysis showed that early weaning success rate was related to preoperative cardiac function grade 1,NNIS grade 0~1,ASA grade 1,no lung infection and no or mild pulmonary hypertension(average P<0.05). Non conditional logistic regression analysis showed that preoperative heart function grade 1 was an indepen-dent influencing factor,with OR value(95%CI)of 3.9(1.9~7.7). Conclusions In infants with congenital heart disease,preoperative heart function grade 1,NNIS grade 0 ~ 1 ,ASA grade 1,no lung infection and no or mild pulmonary hypertension benefit early withdrawing of ventilator and preoperative cardiac function grade 1 is an inde-pendent factor for early weaning.

Background and objective Treatment options for patients with squamous cell carcinoma of the lung (SCC) are limited in chemotherapy. However, not all patients could benefit form standard platinum regimen. Considering the dismal prognosis of patients with advanced SCC, a greater focus on selecting sensitive chemotherapy regimens remains of up-most importance to improve outcomes in this disease. In this study, we used matrix-assisted laser desorption/ionization time-of-flight mass spectrometry to detect pre-chemotherapy serum peptides in advanced lung squamous cell carcinoma patients accepting paclitaxel combined with platinum chemotherapy and to analyze the correlation between serum peptides and che-motherapy efcacy. Methods Patients with advanced lung squamous cell carcinoma received paclitaxel combining with plati-num chemotherapy and evaluated the efcacy every two cycles. Evaluation of complete response (CR) or partial response (PR) patients defined as sensitive group, progressive disease (PD) patients defined as resistant group. Serum samples were collected from patients with lung squamous cell carcinoma. Eighty-one patients were randomly divided into training group (sensitive group Ⅰ and resistant group Ⅰ) and validation group (sensitive group Ⅱ and resistant group Ⅱ) according to the ratio of 3:1. Se-rum samples were pretreated and Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS) was used to detect serum peptide fingerprints. ClinProTools software was used to analyze the differences between the sensitive group Ⅰ and the resistant group Ⅰ. Three kinds of biological algorithms (SNN, GA, QC) built in CPT software were used to establish the curative effect prediction model respectively and the optimal algorithm was selected. The validation group was used for blind verification. Results Thirty sensitive patients and 31 resistant patients were enrolled in the training group. Ten sensitive patients and 10 resistant patients were included in the validation group. The training group had 96 differentially expressed peptides in the sensitive and resistant patients, with 16 statistically significant peptides (P<0.001). The predictive model was established by 5 polypeptides (1,897.75 Da, 2,023.93 Da, 3,683.36 Da, 4,269.56 Da, 5,341.29 Da). The recognition rate of this model was 89.18% and the cross validation rate was 95.11%. The accuracy of the model was 85%, the sensitivity was 90.0% and the specificity was 80.0%. The median PFS in the sensitive group was better than patients in the resistant group (7.2 months 95%CI: 4.4-14.5 vs 1.8 months 95%CI: 0.7-3.5). The results showed that the differential peptides 4,232.04 Da and 4,269.56 Da were correlated with PFS in patients with lung squamous cell carcinoma (P<0.001). Conclusion MALDI-TOF-MS was used to detect the difference of serum peptides between sensitive and resistant groups. The preliminary curative effect prediction model was used to predict the efcacy of paclitaxel combined with platinum regimen. However, this model need further investigations to verify the accuracy and the sensitivity.