Objective:To investigate the feasibility and clinical efficacy of using the mirror technique, which involves overlapping the distance between the center of rotation of the femoral head and the posteromedial edge of the greater trochanter, combined with the injured side and the posterior edge of the contralateral femoral medial and lateral condyles, to correct rotational displacement of the femur during closed reduction and intramedullary nail fixation for multi-level comminuted femoral shaft fractures.Methods:This study included 52 adult patients with unilateral comminuted femoral shaft fractures treated with closed reduction and antegrade interlocking intramedullary nail fixation at the Trauma Center of Liuzhou Workers' Hospital from January 2020 to December 2022. The cohort consisted of 37 males and 15 females, with an average age of 44.4±3.5 years (range 19-68 years). During the operation, C-arm fluoroscopy was used to confirm the standard lateral position of the knee joint, identified by overlapping the posterior edges of the medial and lateral femoral condyles. With this position maintained, X-ray fluoroscopy was performed on the hip joint in the anteroposterior view to identify the rotation center of the femoral head (point O) and the intersection point of the arc projection between the posteromedial edge of the greater trochanter and the upper edge of the femoral neck (point Y). The distance from point O to point Y (OY) was measured and recorded. The rotational deformity of the femoral shaft fracture was corrected by internally or externally rotating the main screw sight frame to match the OY distance between the injured and healthy sides. Postoperative CT was used to measure bilateral femoral neck anteversion (FNA), and the difference in FNA between the two sides was compared to verify the accuracy of rotation control. Clinical efficacy was evaluated based on fracture healing rate, lower extremity functional scale (LEFS) score, Harris score, Lysholm knee score, hip and knee joint range of motion, and complications.Results:The postoperative FNA was 14.45°±3.23° on the healthy side and 14.21°±3.28° on the injured side. The mean FNA difference between the two sides was 0.79°±0.58° (range 0°-2.5°). In 3 cases, the difference exceeded 2°, with a maximum difference of 2.5°. In 10 cases, the difference ranged from 1° to 2°, and in 39 cases, the difference was ≤1°, including 2 cases with no difference. There was no significant difference in postoperative FNA between the two sides ( t=1.063, P=0.168). At the last follow-up, there were no significant differences in LEFS score, Harris score, or Lysholm score between the injured and healthy sides ( P>0.05). The range of motion (ROM) of the hip joint at the last follow-up was 117.0°±2.2° in flexion, 24.3°±3.2° in extension, 33.4°±3.1° in abduction, 20.8°±2.7° in adduction, 19.4°±3.5° in internal rotation, and 38.2°±1.5° in external rotation. The ROM of the healthy side was 122.0°±2.4° in flexion, 25.4°±2.8° in extension, 35.6°±2.0° in abduction, 23.4°±1.6° in adduction, 21.0°±2.2° in internal rotation, and 38.4°±1.8° in external rotation, with no significant differences ( P>0.05). The knee flexion ROM was 135.0°±2.8° on the injured side and 138.4°±1.2° on the healthy side, with no significant difference ( P>0.05). The fracture healing time was 10.6±2.3 months (range 6-13 months). One patient developed fat embolism syndrome on the third postoperative day and recovered after 2 weeks of hormone therapy and respiratory support. No other complications, such as vascular or nerve injury, infection, deep vein thrombosis, or joint dysfunction, were observed in the remaining 51 patients. Conclusion:The method of using the vertical projection distance between the center of rotation of the femoral head and the posteromedial edge of the greater trochanter, combined with the overlap of the injured side and the posterior edge of the medial and lateral femoral condyles, is a new quantitative approach. This technique accurately determines and corrects the rotational displacement of femoral fractures, offering an effective and quick intraoperative correction method.

Objective:To evaluate the preventive effect of indwelling pancreatic duct guide wire through nasobiliary drainage catheter for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) in cholelithiasis patients with small-caliber pancreatic duct.Methods:The clinical data of 127 patients with gall bladder and common bile duct stones undergoing ERCP and elective laparoscopic cholecystectomy in the Cholelithiasis Center of Shanghai East Hospital Affiliated to Tongji University from January 2019 to June 2023 were analyzed retrospectively, including 55 males and 72 females, aged (56.95±10.86) years old. According to the preventive methods of PEP, patients were divided into the guide wire group (indwelling pancreatic duct guide wire through nasobiliary drainage catheter), stenting group (nasobiliary catheter with 5Fr 5 cm single pigtail pancreatic duct stent) and conventional group (nasobiliary catheter). The incidence of post-ERCP hyperamylasemia (PEH) and PEP were compared.Results:The incidence of PEH in the guide wire group was lower than that in the conventional group [17.8% (8/45) vs. 43.5% (10/23), P=0.023], and also lower than that in the stenting group [17.8% (8/45) vs. 32.2% (19/59)], despite no statistical significance ( P=0.337). The incidences of PEH were comparable in the stenting group and conventional group [32.2% (19/59) vs. 43.5% (10/23), P=0.096)]. The incidence of PEP in the guide wire group was lower than that in both the stenting group [6.7% (3/45) vs. 23.7% (14/59), P=0.030]. and conventional group [6.7% (3/45) vs. 30.4% (7/23), P=0.025]. The incidences of PEP were comparable in the stenting and conventional group [23.7% (14/59) vs. 30.4% (7/23), P=0.532]. Conclusion:Compared to the preventive pancreatic duct stenting, indwelling pancreatic duct guide wire through nasobiliary drainage catheter can effectively prevent the PEH and PEP in high-risk patients with a small-caliber pancreatic duct.

Objective:To investigate the early clinical effects of orthopedic surgery robot-assisted double Endobutton titanium plate internal fixation in the treatment of fresh acromioclavicular joint dislocation.Methods:Thirty-nine patients with fresh acromioclavicular joint dislocation were included from January 2020 to January 2022. A total of 19 patients were treated with double Endobutton suspension internal fixation assisted by the domestic third-generation orthopaedic surgical robot (TiRobot ? 2.0) Dimensity system. There were Rockwood type III in 11 cases, type IV in 8 cases. Twenty cases were treated with conventional incision double Endobutton internal fixation, with Rockwood type III in 13 cases, type V in 7 cases. The operation duration, blood loss volume, incision length and hospitalization time were compared between the two groups. The following CT parameters of acromioclavicular joint at 2 days and 1 year after operation, distance between distal inferior cortex of clavicle and subacromial cortex, distance between upper and lower endobuttons, horizontal distance between anterior edge of distal clavicle and anterior edge of acromion and diameter of coracoid process and diameter of clavicular tunnel were measured. The visual analogue score (VAS), Constant-Murley shoulder function score and shoulder abduction activity were also evaluated before and at 12 months after operation. Results:The follow-up duration was 10.8±2.4 months in the robot group and 11.5±3.1 months in the routine group. The VAS score of the robot group decreased from 5.3±2.1 to 0.3±0.2 at 12 months after operation ( t=10.46, P=0.014). The Constant-Murley score increased from 55.6±6.4 to 92.0±4.2. The range of shoulder abduction increased from 42.2°±5.4° to 172.6°±6.1° ( t=17.24, P<0.001). The operation duation of the robot group was 74.4±6.6 min, which was longer than that of the conventional group 61.7±7.2 min ( t=5.43, P=0.037). There was no significant difference in VAS score, Constant-Murley score, shoulder abduction activity or CT measurement between the two groups ( P>0.05). During the follow-up, two cases in the robot group had cortical osteolysis on the supraclavicular surface, one case in the conventional group had loss of reduction, one case in the supraclavicular cortical osteolysis, and 4 cases in the cortical defect on the side of the coracoid process tunnel. Conclusion:Orthopedic robot-assisted and conventional incision with double Endobutton titanium plate internal fixation in treating fresh acromioclavicular joint dislocation can achieve satisfied early clinical effects. Accurate establishment of clavicle and coracoid bone tunnel assisted by robot can overcome the defects of bone tunnel deviation in conventional incision operation and can prevent reduction and bone loss. However, robot-assisted and conventional incision Endobutton internal fixation could enlarge bone tunnel.

Objective:To characterize the histopathological subtypes and their clinicopathological parameters of gender and onset age by common, rare and sparse primary esophageal malignant tumors (PEMT).Methods:A total of 272 437 patients with PEMT were enrolled in this study, and all of the patients were received radical surgery. The clinicopathological information of the patients was obtained from the database established by the State Key Laboratory of Esophageal Cancer Prevention & Treatment from September 1973 to December 2020, which included the clinical treatment, pathological diagnosis and follow-up information of esophagus and gastric cardia cancers. All patients were diagnosed and classified by the criteria of esophageal tumor histopathological diagnosis and classification (2019) of the World Health Organization (WHO). The esophageal tumors, which were not included in the WHO classification, were analyzed separately according to the postoperative pathological diagnosis. The χ 2 test was performed by the SPSS 25.0 software on count data, and the test standard α=0.05. Results:A total of 32 histopathological types were identified in the enrolled PEMT patients, of which 10 subtypes were not included in the WHO classification. According to the frequency, PEMT were divided into common (esophageal squamous cell carcinoma, ESCC, accounting for 97.1%), rare (esophageal adenocarcinoma, EAC, accounting for 2.3%) and sparse (mainly esophageal small cell carcinoma, malignant melanoma, etc., accounting for 0.6%). All the common, rare, and sparse types occurred predominantly in male patients, and the gender difference of rare type was most significant (EAC, male∶ female, 2.67∶1), followed with common type (ESCC, male∶ female, 1.78∶1) and sparse type (male∶ female, 1.71∶1). The common type (ESCC) mainly occurred in the middle thoracic segment (65.2%), while the rare type (EAC) mainly occurred in the lower thoracic segment (56.8%). Among the sparse type, malignant melanoma and malignant fibrous histiocytoma were both predominantly located in the lower thoracic segment (51.7%, 66.7%), and the others were mainly in the middle thoracic segment.Conclusion:ESCC is the most common type among the 32 histopathological types of PEMT, followed by EAC as the rare type, and esophageal small cell carcinoma and malignant melanoma as the major sparse type, and all of which are mainly occur in male patients. The common type of ESCC mainly occur in the middle thoracic segment, while the rare type of EAC mainly in the lower thoracic segment. The mainly sparse type of malignant melanoma and malignant fibrous histiocytoma predominately occur in the lower thoracic segment, and the remaining sparse types mainly occur in the middle thoracic segment.

Objective:To analyze the situation of articles published in Journal of Leukemia & Lymphoma and provide reference for the development of the journal and better service to readers and authors. Methods:All articles published in Journal of Leukemia & Lymphoma from January 2019 to December 2021 were searched on the official website of the journal (www.bxblbl.com.cn) and the full-text database of Chinese medical journals (www.yiigle.com), and the statistical analysis of the articles published in the journal was performed using bibliometric methods and Excel software. Website readings and downloads were recorded based on data from the Chinese medical journal network publishing platform (https://app.yiigle.com/cmaapp/). Results:From January 2019 to December 2021, 36 issues of Journal of Leukemia & Lymphoma were published, containing a total of 578 articles, with an average of about 16 articles per issue. There were 222 (38.4%) original articles, 173 (29.9%) brief communications, 11 (1.9%) guidelines and consensus articles, 58 (10.0%) topic reviews, and 94 (16.3%) reviews; the degree of authorship cooperation was 5.10 (2 946/578). The first author's affiliation included 28 provinces, cities and autonomous regions. The top 10 regions were Jiangsu, Henan, Beijing, Fujian, Shanxi, Guangdong, Tianjin, Shanghai, Hebei, and Shandong, with a total of 425 (73.5%) articles. There were 257 (44.5%) funded articles, including 105 (18.2%) articles funded by national funds. The average number of citations per article was 18.6 (10 751/578). The average annual number of reads was 104 630, and the top 20 most-read articles in 2021 were mostly in the category of guidelines and consensus and topical reviews. Conclusions:Journal of Leukemia & Lymphoma has developed well in recent years, and its influence in the field of hematology-oncology has steadily increased. In the future, according to the purpose of the journal, the special columns should be further created, and the academic quality should be improved to better serve the readers and authors.

Objective:To analyze the articles and literature indicators of Cancer Research and Clinic, in order to provide reference for the development of the journal. Methods:All articles published in Cancer Research and Clinic from January 2017 to December 2021 were searched on the official website of the journal (www.zlyjylc.com.cn), and the core literature indicators of Cancer Research and Clinic published in the Citation Report of Chinese Science and Technology Journals (Core Edition) from 2018 to 2022 were searched, and the statistical analysis of the articles and literature indicators was performed using bibliometric method and Excel software. Results:From 2017 to 2021, a total of 60 issues of Cancer Research and Clinic were published, containing a total of 1 065 articles, with an average of 17.8 articles per issue; a total of 4 416 pages of articles were published, with an average of 4.1 pages per article. There were 609 original articles (57.2%), 193 brief communications (18.1%) and 224 reviews (21.0%) in the main sections. The degree of authorship cooperation was 3.84 (4 086/1 065). The first author affiliation of the article was located in 31 regions, of which the top 10 regions in terms of the number of articles published were Shanxi, Jiangsu, Beijing, Shandong, Hubei, Shaanxi, Liaoning, Guangdong, Henan, and Hebei, with a total of 822 articles (77.2%). A total of 487 articles (45.7%) were funded by the foundation, including 134 articles (12.6%) funded by the national foundations. The average number of citations per article was 19.3 (20 557/1 065); the total number of marked keywords was 4 412, with an average of 4.1 per article. The impact factor and total citation frequency in 2018 were the highest (0.680 and 775), and the rate cited, open factor and overall evaluation total score in 2021 were the highest (0.94, 42 and 29.8). Conclusions:Cancer Research and Clinic has adhered to its own purpose and formed its own characteristics, and its academic quality and influence have steadily improved in the field of oncology in China in recent years. It should continue to improve the quality and strive to be a first-class oncology journal in the future.

Objective:By comparing the clinical effect of minimally invasive hollow screw internal fixation Assisted by orthopedic robot (TiRobot) and O-arm navigation in the treatment of pelvic fractures, and practicability and security of both treatments were evaluated.Methods:Retrospective analysis of data of 42 cases of Tile C type pelvic fractures was employed during June 2017 to June 2020. Among them, 32 cases, twenty-four men, eight women, aged 34±6.2 years (range 24-68 years), were treated with percutaneous screw fixation guided by O-arm X wire instrument. According to Tile classification, there were 3 cases of C1.1 type, 8 cases of C1.2 type and 21case of C1.3 type. According to the Denis classification of sacral fractures, 17 cases were in zone I, and 8 cases in zone II. Ten patients, eight males and two females, aged 36±5.2 years (range 19-62 years) were treated by percutaneous screw fixation assisted by orthopedic robot. According to Tile classification, there were 1 case of C1.1 type, 2 cases of C1.2 type and 7 cases of C1.3 type. According to the Denis classification of sacral fractures, there were 5cases in zone I, 2 cases in zone II. For those who got obviously displaced pelvic fractures, Starr frames were used and then internal fixation was used to fix pelvic anterior ring and posterior ring injury respectively. Based on the times of needle adjustments, intraoperative fluoroscopy time, good screw position and incidence of complications two groups were statistically analysed. Matta score was employed to evaluate the quality of fracture reduction, while the Majeed score was employed to evaluate the clinical efficacy. Through the two groups of cases guide needle adjustment times, intraoperative fluoroscopy time, screw position excellent and good rate and the incidence of complications, which were statistically analyzed.Results:All screw positions were confirmed by CT scan after operation. The average time required for each screw placement of the O-arm group was 7.36±2.63 s, of the robot group was 6.80±3.20 s, so difference was not statistically significant ( P<0.05). An average of screw adjustments per one screw was 1.56±0.02 times by O-arm, and by the robot group was 0.34±0.06 times, so differences between the two groups were statistically significant ( P>0.05). The average operating time of O-arm group was 53.86±15.06 min, while the robot group was 52.52±15.14 min, so differences between the two groups were not statistically significant ( P>0.05). Position distribution of screw placement in two groups, all screws in O-arm group of position evaluations were excellent, excellent rate was 100%, all screw position evaluations by robot were excellent, excellent rate was 100%, so difference in screw distribution between the two groups was not statistically significant ( P>0.05). All cases were followed up for 6-12 months. Fracture healing time: 34.6±8.6 weeks for O-arm group, 33.4±9.4 weeks for robot group. Comparison between the two groups was not statistically significant ( P>0.05). Majeed score of O-arm group was 55-87, including Excellence of 17 cases, goodness of 9, fairness of 6. The rate of excellence and goodness was 81.2%, while robot group was 76-95, and that were excellent 7 cases,1 good, and the excellent and good rate was 80%, there was no significant difference between Matta and Majeed score between the two groups ( P>0.05). The incidence of complications between the two groups were no statistically significant ( P>0.05). Conclusion:Orthopedic robot system and O-arm navigation system assisted by percutaneous hollow screw fixation treatment of pelvic anterior and posterior ring injury, which are accurate, safe, minimally invasive, can reduce radiation damage to patients and surgeons. The efficacy were satisfactory. Both treatments are ideal for minimally invasive treatment of pelvic fractures, and the orthopedic robot have advantages of being programmed, standardized, stable and it’s learning curve is shorter.

Objective:To investigate the feasibility and clinical efficacy of percutaneous screw fixation for acetabular anterior column fracture with laser-assisted axial fluoroscopy.Methods:Data of 20 patients (22 sided) with acetabular anterior column fracture treated by percutaneous screw fixation with laser-assisted axial fluoroscopy from January 2017 to December 2018 were retrospectively analyzed. There were 11 males and 9 females with an average of 42.1±3.2 years (range, 24-68 years). There were 7 cases of unilateral acetabular anterior column fracture, 2 cases of bilateral acetabular anterior column fracture (4 sides), 7 cases of anterior column with ipsilateral sacral fracture, and 4 cases of anterior column with sacroiliac joint injury. There were 3 hips of Area I, 6 Area II, 13 Area III of acetabular anterior column fractures according to Nakatani partition. The time from injury to surgery was 5 days (range, 3-11 days). All patients with acetabular anterior column fractures were fixed by percutaneous screw fixation with laser-assisted axial fluoroscopy, and patients with sacral fracture or sacroiliac joint injury were fixed by percutaneous sacroiliac screws with Starr frame-assisted reduction. The time of operation, the number of intraoperative fluoroscopy and the amount of intraoperative bleeding were recorded. Matta scoring criteria were used to assess fracture reduction quality, and hip function was assessed at the last follow-up according to the modified Merle D' Aubigné and Postel scoring system.Results:The average operative time was 22±10 min (range, 20-40 min) with an average times of intraoperative fluoroscopy of 30±8 times (range, 21-45 times), and the amount of intraoperative blood loss was 20±5 ml (range, 10-40 ml). 20 patients were followed up after operation for a period of 14±3.1 months (range, 12-18 months). The quality of postoperative fracture reduction was assessed according to the Matta acetabular fracture reduction criteria: anatomical reduction in 18 hips, satisfactory reduction in 2 hips, unsatisfactory reduction in 2 hips, with an excellent and good rate of 91% (20/22). The fracture healing time was 13±2.2 weeks (range, 11-16 weeks). At the lastest follow-up, hip function was assessed according to the modified Merle D' Aubigné and Postel scoring system: excellent 18, good 3, fair 1, and the satisfactory rate was 95%(21/22). No major neurological, vascular injury, wound infection and ectopic ossification were found during follow-up.Conclusion:Using laser-assisted axial fluoroscopy percutaneous screw to treat acetabular anterior column fracture, the operation is simple. And there is low risk to damage important blood vessels and nerves. This method can shorten the operation time of acetabular anterior column fracture, reduce the amount of blood loss during the operation, and the outcome is satisfactory.

Data of patients with maxillofacial and jugular venous malformations involving isthmus faucium area from January 2012 to July 2016 were collected. Patients were questioned about the medical history before operation, and the airway was adequately evaluated. The patients diagnosed as having non-difficult airways were endotracheally tubed using fast induction of anesthesia. Tracheal intubation was per-formed using fast induction of anesthesia combined with topical anesthesia after visual laryngoscopy in the patients assessed as having difficult airways. Endotracheal intubation was guided with a visual hard endo-scope or a fibrobronchoscope in the patients with difficulty in opening mouth after multiple treatments. Post-operative airway management was as follows: the tracheal tube was removed after extubation, the tracheal tube was retained for 24-48 h, or preventive tracheotomy was performed. Oxygen was inhaled by mask. A total of 157 patients were included in this study, 55 patients diagnosed as having difficult airways, and a-mong the 55 patients, 87％ cases were intubated after visual laryngoscopy and 13％ cases received tracheot-omy. There were 10 patients with difficulty in opening mouth after multiple treatments and 5 cases under-went tracheotomy in the outer hospital. Sixteen patients presented with a transient increase in airway pres-sure during intraoperative injection of anhydrous ethanol. There were 106 cases in whom the tracheal tube was removed immediately after emergence, and among them, 32. 1％ cases needed tongue traction and 2. 8％ cases underwent emergency tracheotomy after extubation. Thirty-eight patients needed to retain the tracheal tube for 24-48 h after operation, and among them, 37％ cases needed tongue traction and 3％ ca-ses required emergency tracheotomy after extubation. Thirteen cases underwent preventive tracheotomy. The preoperative visit and assessment are especially important, appropriate airway management strategies should be developed, vital signs should be closely observed during operation, and the timing of extubation should be grasped for this type of patients, and the SpO2 and airway pressure should be mainly observed during op-eration especially for the patients who underwent anhydrous ethanol injection.

Objective Human milk of mothers with positive hepatitis B surface antigen (HBsAg) contains hepatitis B virus (HBV). However, breastfeeding does not increase the risk of mother-to-infant transmission of HBV. Previous investigations demonstrated that breast milk has a property of binding with HBsAg. This study aimed to identify the component in human milk that can bind to HBsAg. Methods This study was performed in Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, from June 2015 to February 2017. Human milk samples from two postpartum women with negative HBV markers and two control samples of cow milk and goat milk were analyzed by Far-Western blot, in which highly purified recombinant yeast HBsAg was used to bind with whey proteins. Based on the results of mass-spectrum analysis, competition inhibition test was used to confirm the functioning component. Results Far-Western blot showed remarkable protein bands at the relative molecular weight of about 80 000 in both lanes of human milk, but none in the lane of cow or goat milk. Mass-spectrum analysis of the protein band indicated there were proteins sharing 28.4%-93.4% homology in amino acid sequences with five proteins with the highest homology to lactoferrin (93.4%). Further Far-Western blot with purified recombinant lactoferrin showed that lactoferrin could bind to the recombinant HBsAg. Competition inhibition test suggested that the purified recombinant lactoferrin inhibited the binding of HBsAg to its antibody in a dose-dependent manner. Conclusions This study confirms the capability of lactoferrin in human milk to combine with HBsAg, suggesting that lactoferrin can bind to HBV. Further study on whether lactoferrin can inhibit the infectivity of HBV would be valuable to clarify the reason for not increasing the risk of mother-to-infant transmission of HBV by breastfeeding.