Objective:To evaluate the effect of ultrasound and CT three-dimensional reconstruction in open reduction and internal fixation of fractured ribs.Methods:A retrospective case-control study was conducted to analyze the clinical data of 112 patients with chest trauma and rib fractures admitted to Yan′an People′s Hospital from January 2021 to September 2023. According to the different preoperative positioning methods used, the reconstruction group was divided into a reconstruction group ( n=61) and a combined group ( n=51). The reconstruction group positioned the surgical incision position based on conventional CT three-dimensional reconstruction, while the combined group positioned the rib fracture end based on CT three-dimensional reconstruction combined with ultrasound. Record clinical data of two groups of patients and compare their preoperative positioning accuracy, average incision length, exposure time of fracture ends, fracture healing time, incision infection rate, surgical related indicators, visual analogue pain score (VAS) at one month after surgery, and surgical incision healing levels. Measurement data with normal distribution were expressed as mean±standard deviation ( ± s), and t-test was used for inter group comparison; Comparison of count data between groups using chi-square test; The comparison of grade data were conducted using Mann-Whitney U test. Results:The preoperative localization accuracy, postoperative VAS at one month, and surgical incision healing grade A of the combined group patients were 94.4%, (2.26±0.48) points, 96.1%, respectively, the reconstruction group were 84.1%, (4.52±1.34) points, 72.1%, the combined group was better than the reconstructed group, the difference between the two groups was statistically significant ( P<0.05); The average incision length, fracture exposure time, fracture healing time, surgical time, and thoracic tube retention time of the combined group were (7.32±2.44) cm, (18.06±4.78) min, (48.16±4.58) d, (55.46±7.48) min, and (3.57±1.28) min, respectively. The reconstruction group were (10.16±2.86) cm, (29.45±5.65) min, (55.36±4.45) d, (64.36±7.52) min, and (7.49±1.52) min, respectively, the difference between the two groups was statistically significant ( P<0.05). Conclusion:Application of ultrasound combined with CT three-dimensional reconstruction in open reduction and internal fixation of fractured ribs can increase the preoperative positioning accuracy, which can guide the surgical incision, thus alleviating postoperative pain, facilitating postoperative healing, minimizing surgical trauma, and improving the patient′s prognosis.

Background: Peste des petits ruminants (PPR), caused by the PPR virus (PPRV), is an acute and fatal contagious disease that mainly infects goats, sheep, and other artiodactyls.Peripheral blood mononuclear cells (PBMCs) are considered the primary innate immune cells. Objectives: PBMCs derived from goats were infected with PPRV and analyzed to detect the relationship between PPRV replication and apoptosis or the inflammatory response. Methods: Quantitative real-time polymerase chain reaction was used to identify PPRV replication and cytokines expression. Flow cytometry was conducted to detect apoptosis and the differentiation of CD4+ and CD8+T cells after PPRV infection. Results: PPRV stimulated the differentiation of CD4+ and CD8+ T cells. In addition, PPRV induced apoptosis in goat PBMCs. Furthermore, apoptosis and the inflammatory response induced by PPRV could be suppressed by Z-VAD-FMK and Z-YVAD-FMK, respectively.Moreover, the virus titer of PPRV was attenuated by inhibiting caspase-1-dependent apoptosis and inflammation. Conclusions This study showed that apoptosis and the inflammatory response play an essential role in PPR viral replication in vitro, providing a new mechanism related to the cell host response.

Objective:To evaluate the efficacy and safety of sodium hyaluronate gel in preventing adhesion after prophylactic enterostomy.Methods:One hundred and twenty four patients from 6 hospitals were enrolled in this prospective multi-center randomized controlled trial. Patients were randomized into the study group ( n=59) or the control group ( n=65).All patients underwent prophylactic enterostomy. Patients of study group received odium hyaluronate gel for adhesion-prevention,while those in control group did not receive any adhesion-prevention treatment. The incidence of moderate to severe adhesion around the incision in the stoma area were evalutated during stoma reduction surgery. Results:The incidence of moderate to severe adhesion around the incision in the stoma area was 6.3% in the study group, the difference was statistically significant ( P<0.05) compared to that of the control group (32.6%). Conclusion:Sodium hyaluronate gel can safely and effectively reduce the incidence of moderate and severe adhesions after abdominal surgery.

Objective:To explore the effects of the γ-aminobutyric acid(GABA) neurons and melanin-concentrating hormone (MCH) neurons of the nucleus accumbens (NAc)-lateral hypothalamic area (LHA) neural pathway on the rewarding feeding(palatable food sweat condensed milk) in the obesity rats.Methods:Total 142 male Wistar rats of SPF grade were divided into normal diet (ND) group ( n=68) and high-fat diet induced obesity (DIO) group ( n=74) according to the principle of body mass matching. The rats in the two groups were given normal diet and high-fat diet for 8 weeks. Eight weeks later, 6 DIO rats were randomly selected to observe the nerve projection from GABA neurons in NAc to MCH neurons in LHA by fluorogold retrograde tracing combined fluorescence immunohistochemistry. And the expressions of c-Fos and MCH in LHA after ingestion of sweet condensed milk(rewarding feeding) were observed by fluorescence immunohistochemistry (6 rats in each group). GABA receptor agonist Musimol or GABA receptor antagonist Bicuculine was microinjected into the nucleus of LHA to observe the effect of GABA on rewarding food intake in ND and DIO rats ( n=8 in each group), and the changes of rewarding food intake after blocking MCH signal ( n=8 in each group). SPSS 17.0 was used for statistical analysis, two-way ANOVA and post hoc Bonferroni test were used for comparison among multiple groups, and t-test was used for comparison between two groups. Results:After 8 weeks of high-fat diet modeling, the intake of delicious food in DIO rats was significantly higher than that in ND rats((12.52±2.29) mL, (7.45±1.23) mL, t=4.778, P<0.01) after satiety.The results of fluorogold retrograde tracing combined with fluorescence immunohistochemistry showed that GABA neurons in NAc projected nerve fibers to neurons in LHA, and GABA A receptors in some neurons in LHA coexisted with MCH.The results of NAc-LHA pathway on delicious food intake showed that the interaction between rat group and drug intervention was significant( F=9.869, P<0.01). Simple effect analysis showed that the intake of delicious food after microinjection of Musimol into LHA nucleus of ND rats was significantly lower than that of microinjection normal saline ((4.25±1.38) mL, (7.29±1.49) mL, P<0.01), while the intake of delicious food after injection of Bicuculine was significantly higher than that of microinjection normal saline((10.72±2.11) mL, (7.29±1.49) mL, P<0.05). The intake of delicious food after microinjection of Musimol into LHA nucleus in DIO group was significantly lower than that of microinjection normal saline((3.51±1.77)mL, (13.68±2.95) mL, P<0.01), but there was no significant difference between microinjection Bicuculine and microinjection normal saline ((14.83±3.44) mL, (13.68±2.95) mL, P>0.05). The results of blocking MCH signal on delicious food intake showed that the interaction effect between SNAP-94847 and Bicuculine intervention was not significant ( F=1.468, P>0.05). The main effect of SNAP-94847 intervention was significant ( F=15.880, P<0.01)and the main effect of Bicuculine intervention was significant ( F=6.930, P<0.05). After intracerebroventricular injection of MCH receptor blocker SNAP-94847, the delicious food intake of ND rats was significantly less than that of injection normal saline((4.78±1.72) mL, (7.63±2.77) mL, P<0.05), and it was not affected by pre injection of Bicuculine in LHA ((6.24±2.18) mL, (4.78±1.72) mL, P>0.05). In the DIO rats, the interaction effect between SNAP-94847 and Bicuculine intervention was not significant( F=0.006, P>0.05). The main effect of SNAP-94847 intervention was significant ( F=18.46, P<0.01) and the main effect of Bicuculine intervention was not significant ( F=2.059, P>0.05). After intracerebroventricular injection of MCH receptor blocker SNAP-94847, the delicious food intake of DIO rats was significantly lower than that of injection normal saline((6.89±2.11) mL, (12.19±4.36) mL, P<0.05), and it was not affected by pre injection of Bicuculine in LHA ((8.72±2.26) mL, (6.89±2.11) mL, P>0.05). Conclusion:GABAergic signal in NAc can regulate the expression of MCH in neurons of LHA. In the DIO rats, the sensitivity of MCH neurons in LHA to satiety signal decreases and the hedonic feeding increases.

Resistance to breast cancer (BCa) chemotherapy severely hampers the patient's prognosis. MicroRNAs provide a potential therapeutic prospect for BCa. In this study, the reversal function of microRNA34a (miR34a) on doxorubicin (Dox) resistance of BCa and the possible mechanism was investigated. We found that the relative level of miR34a was significantly decreased in Dox-resistant breast cancer cell MCF-7 (MCF-7/A) compared with Dox-sensitive MCF-7 cells. Transfection with miR34a significantly suppressed the invasion, migration, adhesion of MCF-7/A cells without inhibiting their growth obviously. The combination of miR34a and Dox could significantly inhibit the proliferation, migration, invasion and induce the apoptosis of MCF-7/A cells. The synergistic effect of this combination on resistant MCF-7/A cells has no obvious relation with the expressions of classical drug-resistant proteins P-GP, MRP and GST-

Objective:To evaluate the effects of weight-bearing area compression injury of the femoral head on the prognosis of elderly acetabular fractures after open reduction and internal fixation.Methods:A retrospective analysis of 36 elderly patients with acetabular fractures treated with open reduction and internal fixation during January 2014 to January 2018 were conducted. All patients with compression injury of the weight-bearing area of the femoral head, including 22 males and 14 females with 73.2±6.5 years old (range 60-87 years old), were included. The compression injury of weight-bearing area of the femoral head was not treated. According to the Letournel-Judet classification of acetabular fractures, there were 14 cases with both-column, 12 cases with anterior column and posterior hemitransverse, 4 cases with T type, 4 cases with transverse, and 2 cases with posterior column+ posterior wall. A total of 14 cases were accompanied by acetabular joint surface compression, while 29 cases were accompanied by joint dislocation. The Merle d'Aubigné score was used to evaluate the hip function during follow-up. The Matta classification method was used to evaluate the results of acetabular fracture reduction. The Kellgren-Lawrence classification standard and Ficat-Alert staging method were used to evaluate the traumatic arthritis of the hip and femoral head necrosis, respectively. During the follow-up, the femoral head necrosis with stage III, IV, or traumatic arthritis III, IV, or with indications for joint replacement was defined as surgery failure. CT scans of the pelvis were performed before and at 2-5 days after operation. The compression size of the femoral head on the coronal and axial planes of the CT scan was calculated for the compression volume. The compression severity was divided into small (<1 cm 3), medium (1-2 cm 3) and large (>2 cm 3) according to the volume. Binary Logistic regression analysis was used to analyze whether the postoperative measurement of the femoral head compression volume was associated with the risk of surgical failure. Results:All patients were followed up for 34.7±8.9 months (range 25-54 months). There were 7 cases with large compression of femoral head, 14 cases with medium, and 15 cases with small pre-operatively. However, there were 12 cases, 10 cases and 14 cases with large, medium and small at 2-5 days after operation, respectively. Six cases were excellent reduction, 22 cases were good, and 8 cases were poor. Thus, the excellent and good rate was 78% (28/36). At the last follow-up, Merle d'Aubigné score was excellent in 2 cases, good in 8 cases, fair in 5 cases, and poor in 21 cases. The excellent and good rate was 28% (10/36). There were 20 cases with surgery failure with 56% (20/36) failure rate. There were no statistically significant differences in the patient's age, body mass index, operation duration, blood volume, fracture type, fracture reduction, combined acetabular joint surface compression, and combined joint dislocation between the two groups. However, there was a statistically significant difference in the frequency distribution of compression volume in the weight-bearing area of the femoral head after surgery (χ 2=22.047, P<0.001). In patients with large, medium, and small-volume compression of the femoral head weight-bearing area, the surgery failure rates were 92%, 80%, and 7%, respectively. The large and medium-volume compression of the femoral head weight-bearing area were independent risk factors for surgical failure. Conclusion:Open reduction and internal fixation can be used to treat elderly patients with acetabular fractures combined with femoral head compression injury. Despite satisfactory reduction for acetabular fractures, the larger volume of femoral head compression affects the clinical outcomes with extremely high rate of surgical failure within 2 years.

Objective:To compare the predictive values between 4 risk assessment scales for deep venous thrombosis (DVT) in patients with pelvic or acetabular fracture.Methods:The clinical data of 235 patients with pelvic or acetabular fracture were retrospectively analyzed who had been admitted to Xi'an Honghui Hospital from July 2014 to July 2018. They were 168 males and 67 females, aged from 18 to 90 years (average, 43.5 years). They were divided into a DVT group and a DVT-free group according to the results of vein ultrasongraphy. The RAPT, Caprini, Wells, and Autar scales were used respectively to assess the risk of DVT in the patients. The 2 groups were compared in terms of the scores of the 4 scales. After the receiver operating characteristic curve (ROC) was drawn and the area under the ROC curve (AUC) was calculated, the predictive values of the 4 scales were evaluated for lower limb DVT in the patients with pelvic or acetabular fracture.Results:Of the 235 patients, 104 (44.3%) had DVT. There was no statistically significant difference in the preoperative general data between the 2 groups, showing comparability ( P>0.05). The DVT group scored significantly higher in RAPT, Wells and Autar scales than the DVT-free group( P<0.05). The AUCs for the RAPT, Caprini, Wells, and Autar scales were respectively 0.84±0.02, 0.65±0.05, 0.81±0.02 and 0.72±0.03, showing significant differences ( F=1.254, P=0.031). The AUCs for RAPT and Wells scales were significantly higher than those for Caprini and Autar scales, and the AUS for Autar scale was significant higher than that for Caprini ( P<0.05). The sensibilities for RAPT, Caprini, Wells and Autar scales were respectively 94.0%, 65.0%, 90.6% and 84.0% while the specificities for them 62.1%, 51.8%, 67.2% and 32.5%. Conclusion:Although all the 4 scales have a certain predictive value for the DVT risk in patients with pelvic or acetabular fracture, RAPT and Wells scales are more valuable.

Objective To explore the clinical curative effect of using different blocking methods to renal artery in laparoscopic nephron sparing surgery.Methods A total of 118 cases admitted in the Affiliated Heji Hospital of Changzhi Medical College who reserved the nephron routine after laparoscopic surgery of renal tumor surgery were selected.According to different methods of renal artery block,the patients were divided into the whole block group (61 cases) and selective blocking group (57 cases).The clinical curative effects of the two groups were compared.Results The differences of age,sex,suffering from kidney area and excising were not statistically significant between the two groups(all P ＞ 0.05).The blocking time,operation time and intraoperative blood loss,drainage at postoperative 1 day in the whole block group were (22.58 ± 4.62) min,(138.75 ± 21.76) min,(108.47 ± 75.39) mL and (137.36 ±18.34) mL,respectively,which in the selective block group were (28.61 ± 4.59) min,(103.26 ± 18.64) min,(132.58 ± 68.43) mL and (163.15 ± 15.87) mL,respectively,the differences were significant between the two groups (t =5.356,-8.247,7.463,10.358,all P ＜ 0.01).The postoperative hospital stay [(8.36 ± 2.19) d vs.(7.78 ±2.35)d] had no statistically significant difference between the two groups(P ＞0.05).There were no statistically significant differences in preoperative creatinine level and glomerular filtration rate between the two groups (all P ＞0.05).After operation,the creatinine and glomerular filtration rate in the whole block group were (106.38 ±32.76) μmol/L,(33.53 ± 6.14) ％ statistically,which in the selective block group were (95.26 ± 25.49) μmol/L,(38.27 ± 5.29)％ statistically,the differences were statistically significant between the two groups (t =-2.154,4.572,all P ＜ 0.05).Conclusion Renal artery block has shorter operation time,larger haemorrhage amount,increased postoperative creatinine,reduced glomerular filtration rate,for a small single kidney surgery,using selective renal artery block as far as possible,it has less intraoperative bleeding,and postoperative effect is better.

Objective: To explore the application of Doppler ultrasound to assess the stability of pelvic ring in treatment of lateral-compression-1 (LC-1) pelvic fractures. Methods: For this prospective study 38 patients with LC-1 pelvic fracture were enrolled who had been admitted to the Department of Orthopedic Trauma, Honghui Hospital from July 2016 to November 2017. They were 22 men and 16 women with an age of 55.2±16.1 years. After the patient's condition was stable, they underwent a Doppler ultrasound examination in the pelvic compression separation test. According to the criteria preset: those with a left-right mobility ≥ 0.3 cm were assigned as an unstable group (16 cases) and those with a mobility<0.3 cm as a stable group (22 cases). The stable group received conservative treatment while the unstable group surgical treatment. The 2 groups were compared in terms of mobility of fracture ends, follow-up time, weight-bearing time, fracture healing time, and the Majeed scores of pelvic function at the last follow-up. Results: The 2 groups were compatible due to their insignificant differences in baseline data(P>0.05). The mobility of fracture ends (left-right distance: 0.45±0.22 cm; anterior-posterior distance: 0.26±0.16 cm; oblique distance: 0.50±0.23 cm) in the unstable group was all significantly greater than in the stable group (left-right distance: 0.11±0.03 cm; anterior-posterior distance: 0.05±0.04 cm; oblique distance: 0.11±0.07 cm) (P<0.05). The weight-bearing time in the stable group (0.9±0.5 months) was significantly shorter than that in the unstable group (1.9±2.0 months) (Z=-2.353, P=0.019). There were no significant differences between the 2 groups in follow-up time (13.9±3.8 months versus 15.1±3.0 months), fracture healing time (4.6±1.3 months versus 4.5±1.2 months) or the Majeed scores (84.8±6.4 versus 80.3±12.2) (all P>0.05). Conclusions Since ultrasonography is helpful in assessment of the stability of LC-1 pelvic fractures, a proper treatment strategy can be decided. Stable ones can be treated conservatively and unstable ones surgically.

Objective To compare the perioperative incidence of deep venous thrombosis (DVT) and level of plasma D-dimer between different ages in patients with lower limb fracture in Northwest China.Methods The data were retrospectively analyzed of the 1,185 patients with lower limb fracture in 5 provinces in Northwest China from July 2014 to March 2017.They were 583 males and 602 femals,with an average of 60.3 years(from 18 to 102 years).Of them,723 were from Shaanxi Province,148 from Gansu Province,137 from Qinghai Province,128 from Ningxia Hui Nationality Autonomous Regions and 49 from Xinjiang Uygur Autonomous Region.They were divided into a young group (≤44 years old) (n =288),a middle-aged group (from 45 to 59 years old) (n =256),a junior elderly group (from 60 to 74 years old) (n =263),and a senior elderly group (≥75 years old) (n =378).The incidences of perioperative deep venous thrombosis (DVT) and levels of plasma D-dimer were compared between the 4 age groups.Results The DVT incidences before and after operation in the young group were significantly lower than in the other 3 groups (P ＜ 0.05);the DVT incidence after operation in the middle-aged group was significantly lower than that in the junior elderly group (P ＜ 0.05).The pre-and post-operative levels of plasma D-dimer increased with the age of the patients;the pre-and post-operative levels of plasma D-dimer in the senior elderly group were significantly higher than in the other 3 groups (P ＜ 0.05).Conclusions The perioperative incidence of DVT was high in the elderly patients with lower limb fracture in Northwest China,peaking in the age range from 60 to 74 years old.The pre-and post-operative levels of plasma D-dimer increased with the age of the patients.