Objective To investigate the relationship between the expression of serum microRNA-326(miR-326)and microRNA-623(miR-623)in non-small cell lung cancer(NSCLC)patients and their clinical pathological characteristics and prognosis.Methods A total of 114 NSCLC patients diagnosed in our hospital from March 2019 to June 2020 were collected as study subjects as case group,123 healthy individuals who underwent physical examination were as the control group.According to the 3-year prognosis,patients were separated into a survival group of 71 cases and a death group of 43 cases.Patient related clinical data were collected,real-time fluorescence quantitative PCR method was applied to detect the expression levels of miR-326 and miR-623 in various serum samples;Kaplan-Meier method was applied to analyze the relationship between the expression levels of serum miR-326 and miR-623 in NSCLC patients and their 3-year prognosis;Cox proportional risk regression model was applied to analyze the influencing factors of 3-year prognosis in NSCLC patients.Results The expression levels of serum miR-326 in the case group and control group were 0.64±0.15 and 1.02±0.23,respectively,and the expression levels of miR-623 were 0.56±0.10 and 0.98±0.15,respectively.The difference between the two groups was statistically significant(P＜0.05).The proportions of patients with low expression of miR-326 and miR-623 in low differentiation,TNM stage Ⅲ+Ⅳ,and lymph node metastasis were higher than those in high differentiation,TNM stage Ⅰ and Ⅱ,and no lymph node metastasis(P＜0.05).The 3-year survival rates of patients with low expression of miR-326(20/55,36.36％)and miR-623(27/61,44.26％)in the serum of NSCLC patients were lower than those of patients with high expression of miR-326(51/59,86.44％)and miR-623(44/53,83.02％)(Log Rank x2=32.060,22.812,P＜0.05).Serum miR-326[(0.55±0.09)vs.(0.69±0.11)]and miR-623 levels[(0.48±0.08)vs.(0.61±0.10)]of patients in the death group were significantly lower than those in the survival group(P＜0.05).The area under the curve(AUC)for poor prognosis of serum miR-326 and miR-623 alone and in combination in patients diagnosed with NSCLC were 0.828(95％CI:0.754 to 0.901),0.763(95％CI:0.671 to 0.855),and 0.903(95％CI:0.849 to 0.958),respectively.The proportions of patients with TNM stage Ⅲ+Ⅳ,lymph node metastasis,low expression of miR-326 and low expression of miR-623in the death group were higher than those in the survival group(P＜0.05).MiR-326 and miR-623 were protective factors affecting 3-year mortality in NSCLC patients,while TNM staging and lymph node metastasis were independent risk factors affecting 3-year mortality in NSCLC patients(P＜0.05).Conclusion The low expression of miR-326 and miR-623 may be involved in the occurrence and development of lung cancer,which is closely related to the clinical pathological characteristics and poor prognosis of patients.

Objective:To investigate the effect of arthroscopically-assisted open reduction and internal fixation of intra-articular distal radius fracture.Methods:A retrospective cohort study was made on clinical data of 44 patients with distal radial intraarticular fracture admitted to Jing′an District Central Hospital, Fudan University between June 2017 and August 2020. There were 13 males and 31 females, at age of 35-85years [(62.5±12.9)years]. According to AO/OTA fracture classification system, there were 7 patients with type B and 37 with type C. Open reduction and internal fixation with volar plate was used in all patients, among which 22 were operated on using arthroscopy assistance (arthroscopy group) and 22 were operated on with traditional intraoperative fluoroscopy (fluoroscopy group). The operation time in both groups and triangular fibrocartilage complex (TFCC) injury and fracture displacement in arthroscopy group were recorded. Patient-rated wrist evaluation (PRWE) score, disabilities of the arm, shoulder and hand (DASH) questionnaire and range of wrist motion were compared between the two groups at 12 months after operation. The incidence of complications was observed.Results:All patients were followed up for 12-15 months [(13.3±1.1)months]. The operation time in arthroscopy group was (104.0±40.5)minutes, longer than (71.3±32.1)minutes in fluoroscopy group ( P<0.05). In arthroscopy group, 14 patients (64%) with TFCC injury were diagnosed intraoperatively, with the fracture displacement gap and step for 0.8 (0.3, 0.8)mm and 1.0 (0.3, 1.5)mm under arthroscopic vision, which were reduced to 0.3 (0.0, 0.5)mm and 0.5 (0.0, 0.5)mm after arthroscopically-assisted reduction (all P<0.05). The PRWE score in arthroscopy group was (9.8±4.9)points at 12 months after operation, lower than (13.4±5.8)points in fluoroscopy group ( P<0.05). The DASH questionnaire in arthroscopy group was (9.0±5.0)points at 12 months after operation, lower than (13.0±6.1)points in fluoroscopy group ( P<0.05). The dorsal extension and posterior rotation of the wrist in arthroscopy group were (73.8±8.9)° and (82.5±8.0)°, higher than (65.8±14.2)° and (76.3±10.4)° in fluoroscopy group (all P<0.05). There were no postoperative complications such as loosened or broken screws, vascular nerve damage, incision infection or traumatic arthritis in both groups. Conclusion:Arthroscopic-assisted open reduction and internal fixation of intra-articular distal radius fracture can increase the accuracy of joint surface reduction, improve postoperative wrist function and confirm the diagnosis of TFCC injury during operation.

Objective The three-dimensional (3D) solid model of medulla oblongata-upper cervical spinal cord based on specimen pathological section data was established, and the stress and strain levels of medulla oblongata-upper cervical spinal cord under dentate process compression were obtained by finite element analysis, so as to provide references for clinical research. Methods Mimics was used to process the slice data, so as to establish the point cloud model. SolidWorks was used to locate, edit and optimize the point cloud model, so as to establish the 3D solid model. HyperMesh was used to establish the finite element model and ANSYS was used for finite element analysis. Results The medulla oblongata-upper cervical spinal cord model with clear boundary between gray matter and white matter and white matter fiber bundle was established. The stress and strain levels and stress-strain curves of white matter and gray matter under different compression degrees were obtained. Conclusions Combined with pathological sections of specimens and reverse engineering, the 3D medulla oblongata-upper cervical spinal cord model with clear morphology and structure of gray/white matter can be established. When the medulla oblongata-upper cervical spinal cord is compressed, the stress level of gray matter is lower than that of white matter, and about 20% of compression is the critical state of white matter. When the disease develops beyond the critical state, the biomechanical properties of white matter may fail, resulting in gray matter damage.

Objective:To investigate the dose-response relationship between serum polycyclic aromatic hydrocarbon adducts and serum complement C3 and C4 levels among children from a city in East China.Methods:In September 2016, two boarding schools in the air pollution exposure area and the control area (beyond the upwind of 30 km in the air pollution exposure area) in a city in East China were selected as the research site, and the eligible school-age children were recruited as the research objects. A total of 273 children were included, including 163 in the exposure group and 110 in the control group. The annual air pollutant data (PM 2.5, PM 10 and NO 2) of the two regions during the study period were collected. The exposure level of tobacco was evaluated by cotinine in urine. The levels of serum complement C3 and C4 were determined by automatic biochemical analyzer. The serum anti-7, 8, -dihydrodiol-9, 10-epoxide benzo[a]pyrene (BPDE)-albumin adduct levels were detected by ELISA. Linear regression model was used to explore the dose-response relationship between BPDE-albumin adducts and serum complement C3 and C4. Results:The age of 273 subjects was (13.67±0.37) years old, including 165 boys (60.4%). The average annual exposure levels of PM 2.5, PM 10 and NO 2 and the level of serum BPDE-albumin adducts in the exposure group were higher than those in the control group ( P<0.05). The results of linear regression model analysis showed that after adjusting age, sex, BMI z-score and urinary cotinine level, when the serum BPDE-albumin adduct level increased by 10%, the serum complement C4 level decreased by 1.2% ( P=0.017). After adjusting age, BMI z-score and urinary cotinine level, for every 10% increase in serum BPDE-albumin adduct level in boys, the serum complement C4 level decreased by 1.68% ( P=0.024). After adjusting age, sex and BMI z-score, the levels of serum complement C3 and C4 decreased by 1.31% and 3.57% respectively for every 10% increase in serum BPDE-albumin adducts among children in the urinary cotinine detection group ( P<0.05). Conclusion:There is a significant dose-response relationship between serum BPDE-albumin adducts and the complement C4 among children.

Objective:To investigate the dose-response relationship between serum polycyclic aromatic hydrocarbon adducts and serum complement C3 and C4 levels among children from a city in East China.Methods:In September 2016, two boarding schools in the air pollution exposure area and the control area (beyond the upwind of 30 km in the air pollution exposure area) in a city in East China were selected as the research site, and the eligible school-age children were recruited as the research objects. A total of 273 children were included, including 163 in the exposure group and 110 in the control group. The annual air pollutant data (PM 2.5, PM 10 and NO 2) of the two regions during the study period were collected. The exposure level of tobacco was evaluated by cotinine in urine. The levels of serum complement C3 and C4 were determined by automatic biochemical analyzer. The serum anti-7, 8, -dihydrodiol-9, 10-epoxide benzo[a]pyrene (BPDE)-albumin adduct levels were detected by ELISA. Linear regression model was used to explore the dose-response relationship between BPDE-albumin adducts and serum complement C3 and C4. Results:The age of 273 subjects was (13.67±0.37) years old, including 165 boys (60.4%). The average annual exposure levels of PM 2.5, PM 10 and NO 2 and the level of serum BPDE-albumin adducts in the exposure group were higher than those in the control group ( P<0.05). The results of linear regression model analysis showed that after adjusting age, sex, BMI z-score and urinary cotinine level, when the serum BPDE-albumin adduct level increased by 10%, the serum complement C4 level decreased by 1.2% ( P=0.017). After adjusting age, BMI z-score and urinary cotinine level, for every 10% increase in serum BPDE-albumin adduct level in boys, the serum complement C4 level decreased by 1.68% ( P=0.024). After adjusting age, sex and BMI z-score, the levels of serum complement C3 and C4 decreased by 1.31% and 3.57% respectively for every 10% increase in serum BPDE-albumin adducts among children in the urinary cotinine detection group ( P<0.05). Conclusion:There is a significant dose-response relationship between serum BPDE-albumin adducts and the complement C4 among children.

Objective: The consistency of 24-hour oropharyngeal Dx-pH monitoring and proton pump inhibitor(PPI) test in the diagnosis of laryngopharyngeal reflux disease (LPRD) was investigated. Methods: Sixty patients with laryngopharyngeal reflux (LPR) related symptoms who had never received PPI treatment were assessed by reflux symptom index (RSI) and reflux finding score (RFS) between October 2017 and October 2018, including 28 males and 38 females, aged from 16 to 72 years, with a medium age of 38 years. Prior to treatment, all patients were evaluated with 24 hours oropharyngeal Dx-pH monitoring(Restech). After empiric therapy with PPI twice-daily for 8 weeks, the efficacy was evaluated according to posttreatment RSI score.The data was analysed with Kruskal-Wallis test, Student Newman Keuls test and consistency check. Results: (1)Among all 60 patients,13 patients (21.7%) had pathologic Ryan score and all resulted responsive to PPI;27 patients (45.0%) with a negative Ryan score were unresponsive to PPI; 20 patients (33.3%) despite a negative Ryan score resulted responsive to PPI therapy. Considering responsiveness to PPI therapy as the gold standard for the diagnosis of LPRD, the sensitivity, specificity, positive predictive value and negative predictive value of Ryan score were 39.4%, 100%, 100% and 57.4% respectively. The Kappa value was 0.369 (P<0.01). (2)Among 34 patients (56.7%) with positive Dx-pH results (24-hour oropharyngeal acid reflux events≥ 3 times), 29 patients were positive and 5 patients were negative in PPI test. Among 26 patients with negative Dx-pH results (24-hour oropharyngeal acid reflux events<3 times), 4 patients were positive and 22 patients were negative in PPI test. Considering responsiveness to PPI therapy as the gold standard for the diagnosis of LPRD, the sensitivity, specificity, positive predictive value and negative predictive value of 24-hour oropharyngeal acid reflux events were 87.9%, 81.5%, 85.3% and 84.6% respectively. The Kappa value was 0.696(P<0.01). Conclusions There is a positive correlation between 24-hour oropharyngeal Dx-pH monitoring positive results (24-hour oropharyngeal acid reflux events≥3 times) and PPI test in the diagnosis of LPRD. The 24-hour oropharyngeal Dx-pH monitoring can be a promising tool for the diagnosis of suspected LPRD patients, and more sensitive and accurate Dx-pH diagnostic index will be required in the clinic.

Wrist is one of the most frequently used joints in life and work. Wrist injury will seriously affect the ability of self-care, study, work, exercise and fitness. The wrist is small in size but complex in composition, so the bone and ligament structures are relatively fine. Traditional open surgery increases the risk of damage to these structures or their blood supply, and thus the recovery effect is limited. With the development of small arthroscopy-related instruments and techniques, minimally invasive surgery techniques such as ligament injury repair, reduction and fixation of intra-articular fractures, fixation of nonunion bone grafts, and reduction and fixation of complex fractures have emerged, which made the treatment of wrist and ligament injury minimally invasive. The application of the 3D printing guide technology and navigation technology modifies the traditional surgical techniques, as making the treatment of wrist bone and ligament injuries more minimally invasive and precise to reduce the degree and risk of iatrogenic injury and improve the curative effect. Wrist arthroscopy has become an indispensable tool in the surgical diagnosis and treatment of wrist and ligament injuries, and is an essential skill for hand surgeons. The authors introduce the progress of minimally invasive and precise surgical techniques of fracture fixation and ligament repair for wrist bone and ligament injuries, which provides a reference for clinical work.

The prevention and treatment of scars has always been an important task in the field of wound repair.Humans have started treatment for scars long time ago and have created a series of treatments.At the same time,with the development of science and technology,the diagnosis and treatment of scars have made great progress.Through the basic research for new therapeutic targets and innovative of treatment methods,treatment for scar turns more diversified and integrated.As a result,clinicians will suffer many challenges while having more options for scars treatment.Combined with traditional treatment,developing new treatments,and the comprehensive therapy of multiple treatment methods is the mainstream trend of scar treatment.

Objective To investigate the relationship between clinical features and lymph node metastasis in lung adenocarcinoma patients with T1 stage. Methods We retrospectively analyzed the clinical data of 253 T1-stage lung adenocarcinoma patients (92 males and 161 females at an average age of 59.45±9.36 years), who received lobectomy and systemic lymph node dissection in the Second Affiliated Hospital of Harbin Medical University from October 2013 to February 2016. Results Lymph node metastasis was negative in 182 patients (71.9%) and positive in 71 (28.1%). Poor differentiation (OR=6.988, P=0.001), moderate differentiation (OR=3.589, P=0.008), micropapillary type (OR=24.000, P<0.001), solid type (OR=5.080, P=0.048), pleural invasion (OR=2.347, P=0.024), age≤53.5 years (OR=2.594, P=0.020) were independent risk factors for lymph node metastasis. In addition, in the tumor with diameter≥1.55 cm (OR=0.615, P=0.183), although the cut-off value of 1.55 cm had no significant difference, it still suggested that tumor diameter was an important risk factor of lymph node metastasis. Conclusion In lung adenocarcinoma with T1 stage, the large tumor diameter, the low degree of differentiation, the high ratio of consolidation, and the micropapillary or solid pathological subtypes are more prone to have lymph node metastasis.

Objectives To investigate the clinical significance of dual energy spectral CT (DESCT) in quantitatively differentiating peripheral lung cancers from pulmonary inflammatory masses.Methods Sixty patients with 35 lung cancers and 25 inflammatory masses underwent DESCT to get arterial phase (AP) images and venous phase (VP) images.Iodine concentrations in the central and peripheral zone of the masses were measured and normalized to the aorta as normalised iodine concentration (NIC).The difference of NIC between central and peripheral zone of the masses (dNIC) was calculated.The spectral attenuation curve was obtained automatically and the slope of curve (λHU) was also calculated in the two groups.The quantitative parameters was presented as M (Q1,Q3),and Wilcoxon signed rank test was used to compare above two independent samples.Receiver operating characteristic (ROC) curves were generated to calculate the sensitivity and specificity.Results NICs in the central zone of peripheral lung cancers were significantly lower than that of inflammatory masses:mean NICs were 0.03 (0,0.05) versus 0.12 (0.07,0.20) in AP,and 0.14 (0.12,0.19) versus 0.30 (0.21,0.57) in VP (Z=-4.14,-3.70,respectively,P＜0.01).While the dNIC values of lung cancers were significantly higher than that of inflammatory masses:dNIC values were 0.08 (0.05,0.11) versus 0.04 (-0.02,0.08) in AP,and 0.23 (0.17,0.34)versus 0.07 (-0.04,0.08) in VP(Z=-2.56,-4.00,respectively,P＜0.05).Mean λHU values of lung cancers were also lower than inflammatory masses:1.03 (0.67,1.67)versus 2.75 (1.61,3.19) in AP,and 1.58 (1.30,2.17) versus 3.25 (2.37,4.54) in VP (Z=-3.90,-4.42 respectively,P＜0.01).According to ROC curves,cutoff value of λHU =2.11 in VP had the highest sensitivity (89％) and specificity (91％) in differentiating peripheral lung cancers from inflammatory masses.Conclusions Contrast-enhanced dual energy spectral CT imaging with some quantitative parameters such as normalised iodine concentration,dNIC,and the slope of spectral attenuation curves may be a promising new method for differentiating peripheral lung cancers from inflammatory masses.