BACKGROUND:Due to the mismatch between the design of the proximal femoral nail antirotation Asian version(PFNA-Ⅱ)and Asian population,extrusion of the proximal femoral intertrochanteric nail may occur in the treatment of femoral intertrochanteric fractures.The influence of the protruding length on the curative effect of the operation needs to be further discussed. OBJECTIVE:To quantitatively measure the protruding length of the proximal trochanter of the femur with intramedullary nail after PFNA-Ⅱ,and to analyze the effect of protruding length on the efficacy of PFNA-Ⅱ in the treatment of femoral intertrochanteric fractures. METHODS:Totally 68 patients with femoral intertrochanteric fractures treated with PFNA-Ⅱ internal fixation in the First Affiliated Hospital of Anhui Medical University were selected.The extramedullary process of the proximal trochanter of the femur was quantitatively measured on the anterior and posterior X-ray films of the hip joint within 6 months after operation.According to the existence of extrusion of the proximal trochanter intramedullary nail,the patients were divided into protruding group and non-protruding group.The data of sex,height,fracture type,length and diameter of the intramedullary nail,the position of screw blade in the femoral neck and protruding length of proximal greater trochanter were collected.The postoperative curative effect was judged by visual analog scale pain score and hip joint Harris score at 6 months after operation.The influence of protruding proximal trochanter of the PFNA-Ⅱ intramedullary nail on the operative effect was observed. RESULTS AND CONCLUSION:(1)There were significant differences in sexual characteristics between the protruding group and the non-protruding group(P=0.001).(2)According to AO/OTA classification,there were no significant differences in fracture type between the protruding group and the non-protruding group(P=0.289).(3)There was no significant difference in the length and diameter of the intramedullary nail between the two groups(P=0.067,P=1.000).(4)There was no significant correlation between the height of all patients and the length of the intramedullary nail(P=0.510),but there was a significant correlation between height and protruding length(P=0.034).There was no significant correlation between screw blade position and protruding length(P=0.968).(5)Six months after operation,there was no significant difference in the hip Harris score(P=0.373),but the visual analog scale pain score was significantly higher in the protruding group than that in the non-protruding group(P=0.000).(6)The results suggest that nail extrusion often occurs in the proximal greater trochanter when PFNA-Ⅱ is used in the treatment of intertrochanteric fractures in Asians.When the nail extended into the proximal soft tissue of the greater trochanter,patients complained of proximal greater trochanteric pain and the visual analog scale score of proximal greater trochanter pain in the patient was significantly higher than that in the non-protruding group.To be more suitable for the Asian population,we suggest that the PFNA-Ⅱ should be improved to further shorten the proximal nail end to obtain better clinical results of femoral intertrochanteric fracture fixation.

BACKGROUND:The use of vancomycin in total knee arthroplasty is a controversial strategy for the prevention of incisional infection.At present,there is little evidence to evaluate the efficacy of this preventive measure in China. OBJECTIVE:To evaluate the efficacy of local vancomycin in the prevention of early postoperative incision infection during total knee arthroplasty. METHODS:120 patients with osteoarthritis of the knee who received unilateral total knee arthroplasty for the first time at Department of Joint Surgery of First Affiliated Hospital of Anhui Medical University from March to June 2022 were included in this study.They were randomly divided into the observation group and the control group,with 60 cases in each group.All patients gave informed consent to the treatment plan.In the observation group,1 g of vancomycin was applied intraoperatively;in the control group,no vancomycin was applied intraoperatively.Erythrocyte sedimentation rate,C-reactive protein,fever rate on seven consecutive days after surgery,degree of knee joint swelling,cumulative drainage volume,and incidence of periprosthetic joint infection were recorded in two groups of patients on days 1,3,and 5 after surgery so as to evaluate the efficacy of topical vancomycin in total knee arthroplasty for the prevention of incision infection in the early postoperative period. RESULTS AND CONCLUSION:(1)The differences in erythrocyte sedimentation rate and C-reactive protein between the two groups on days 1,3,and 5 after surgery were not significant(P>0.05).(2)The difference in fever rate between the two groups for 7 consecutive days after surgery was not significant(P>0.05).(3)There was no significant difference in the degree of postoperative knee swelling and cumulative drainage flow between the two groups(P>0.05).(4)The difference in the incidence of periprosthetic joint infection one year after surgery was not significant between the two groups(P>0.05).(5)The results suggest that the local use of vancomycin in total knee arthroplasty has not shown significant efficacy in preventing incision infection in the early postoperative period.

Objective:To compare the preventive effects of different doses of esketamine on remifentanil-induced hyperalgesia(RIH)in the patients underwent thoracoscopic pnlmonary lobectomy,and to provide the basis for the multimodal analgesia and rapid postoperative recovery.Methods:The prospective,double-blind,parallel-designed randomized controlled trial(RCT)were conducted,and 107 patients who underwent visual-assisted thoracoscopic pulmonary lobectomy were included.The patients were randomly divided into normal control group,low dose of esketamine group,and high dose of esketamine group using random number methods.Except the patients who were eliminated and those who dropped out of the study,there were 31 patients in normal control group,33 patients in low dose of esketamine group,and 33 patients in high dose of esketamine group.The patients in low dose of esketamine group were given the intravenous injection of 0.25 mg·kg-1 esketamine(diluted to 5 mL)during anesthesia induction;the patients in high dose of esketamine group were given the intravenous injection of 0.50 mg·kg-1 esketamine(diluted to 5 mL),and the patients in normal control group were given 5 mL intravenous injection of saline.The mechanical pain thresholds of the non-dominant forearm skin and skin around the surgical incision at different time points,numeric rating scale(NRS)scores,Ramsay sedation scores,perioperative analgesic drug dosages,and the incidences of adverse reactions such as postoperative delirium,nausea,and vomiting of the patients in various groups were recorded.Results:Compared with normal control group,the mechanical pain thresholds around the surgical incision skin of the patients in low and high doses of esketamine groups were increased(P＜0.05);compared with low dose of esketamine group,the extubation time of the patients in high dose of esketamine group was increased(P＜0.05).Two minutes after anesthesia induction administration,compared with normal control group,the mean arterial pressure(MAP)and heart rate(HR)of the patients in low and high doses of esketamine groups were increased(P＜0.05),but there were no significant differences in the MAP and HR of the patients between low dose of esketamine and high dose of esketamine group(P＞0.05);compared with normal control group,the incidences of hallucinations and delirium among the patients in high dose of esketamine group were increased(P＜0.05),while there were no significant differences in the incidences of above adverse reactions in low dose of esketamine group(P＞0.05);compared with low dose of esketamine group,the incidences of hallucinations and delirium among the patients in high dose of esketamine group were increased(P＜0.05).Conclusion:Intravenous administration of esketamine with a dosage of 0.25 mg·kg-1 during anesthesia induction improves the postoperative mechanical pain threshold of the patients undergoing thoracoscopic pulmonary lobectomy,which exhibits effective prevention of RIH without an increase in incidences of adverse reactions during the perioperative period.

Objective:To investigate the long-term efficacy and complications of augmentation uretero-enterocystoplasty (AUEC).Methods:The clinical data of 262 patients with lower urinary tract dysfunction who underwent AUEC at our center from January 2003 to June 2022 were analyzed retrospectively. There were 193 males and 69 females, the median age was 24 (4, 67) years, the median disease duration was 12.0 (0.2, 56.0) years and the preoperative creatinine was 91.5 (68.1, 140.0) μmol/L. 320 ureters had high-grade UUTD, 216 ureters had VUR, 14 of which had low-pressure reflux.The number of low-grade VUR ureter was 22 (10.2%) and the number of high-grade VUR ureter was 194 (89.8%). Video-urodynamics showed that the maximum bladder capacity was 102 (47, 209) ml, the maximum detrusor pressure was 33.0 (15.5, 50.5) cmH 2O, and the bladder compliance was 6.4 (3.0, 12.3) ml/cmH 2O. All patients underwent AUEC. The surgical method is to cut a segment of sigmoid colon, open the sigmoid colon along the mesenteric margin, fold and suture it into " U" or " S" shaped intestinal mesh according to the principle of " detubulization" . At the same time, perform ureteroplasty and replanting, and then anastomosis the intestinal mesh with the opened bladder flap to form an expanded new bladder. Follow-up was performed via outpatient clinic or telephone. The creatinine, maximum bladder capacity, maximum detrusor pressure, bladder compliance, ureteral reflux and upper urinary tract dilatation were compared preoperatively and postoperatively. The postoperative complications were also evaluated. Results:The median follow-up time was 57.4 (4, 151) months after surgery. At 1-3 months after surgery, the maximum bladder capacity and bladder compliance increased to 303.9% and 189.9% of the preoperative level, and the maximum detrusor pressure decreased to 63.6% of the preoperative level. At 6-10 years after surgery, the maximum bladder capacity and bladder compliance increased to 490.2% and 627.9% and the maximum detrusor pressure decreased to 25.8% of the preoperative level. The UUTD of the patients was significantly reduced after surgery. The number of the high grade UUTD decreased to 116 (116/398, 29.2%) at 1-3 months and 51 (51/274, 18.6%) at 4-6 months. At 6-10 years, the number of the high-grade UUTD decreased to 4 (4/76, 5.3%) ( P<0.001), which was significantly lower than that before operation. The VUR was significantly relieved after operation, and 393 ureters had no VUR at 1-3 months, accounting for 97.8% (393/402) of the total ureters. Sustained remission of VUR was observed during follow-up. 73 ureters had no VUR at 6-10 years, accounting for 96.1% (73/76) of total ureters ( P<0.001). Patients' creatinine decreased to 79.0 (65.0-128.2) μmol/L at 1-3 months postoperatively, with a downward trend but no statistical difference, and creatinine levels were not significantly elevated at any postoperative time point compared with preoperative levels ( P>0.05). Postoperative complications included metabolic acidosis in 26 cases (9.9%), vesicoureteral anastomosis stenosis in 15 cases (5.7%), recurrent urinary tract infection in 16 cases (6.1%), and urinary calculi in 20 cases (7.6%), and intestinal obstruction requiring laparotomy in 8 cases (3.1%), all of them could be improved after treatments. Conclusions:AUEC is a safe and effective method for treating high-grade VUR or VUR with impaired anti-reflux mechanism, high-grade UUTD or UUTD with ureteral or vesicoureteral junction obstruction, and all of the complications can be improved after treatment. This technique can increase the bladder capacity and compliance, reconstruct the anti-reflux mechanism, and release upper urinary tract obstruction. It may play an important role in stabilizing and protecting the residual renal function from further deterioration.

Objective:To investigate the long term outcome of artificial urinary sphincter implantation for patients with stress urinary incontinence.Methods:The data of 46 patients who underwent artificial urethral sphincter implantation in China Rehabilitation Research Center from April 2002 to April 2022 were retrospectively analyzed.The patients’ age ranged from 19-80 years old (median 45.6 years). There were 45 males and 1 female. The history of illness was 8 months to 33 years. The patients category were urethral injuries associated urinary incontinence ( n=24), neurogenic urinary incontinence ( n=9) and post-prostatectomy incontinence ( n=13). Preoperative daily pad usage was 3.5±1.0. The impact of incontinence on the quality of life (QOL)measured by the visual analogue scale (VAS)was 7.1±1.2. All 46 patients underwent artificial urethral sphincter implantation, of which 20 patients were treated with anticholinergic drugs (5 cases) or urinary tract related surgery (urethral stenosis incision in 2 cases, sphincterectomy in 3 cases, urethral dilation in 5 cases, urethral calculus lithotripsy in 1 case, and augmentation cystoplasty in 4 cases) before artificial urethral sphincter implantation. Of the 45 male patients, 25 patients had the transperineal approach and 20 had the trans-scrotal approach. The female case had a trans-retropubic approach. Different cuffs size was used based on individual circumference of bulbar urethra (45 male cases: 4.5cm in 16 cases, 4.0cm in 29 cases; one female case: 8.0cm). Long-term surgical efficacy was evaluated. Assessments included postoperative urinary continence (socially continent: one pad per day or less; complete dry: wearing no pads), artificial urinary sphincter status and complications. The influences of patients of different etiologies, surgical approaches and cuff size on surgical results were compared. Results:The mean follow-up time was 7.1 years ranged from 6 months to 19 years. At the latest visit, 32 patients (69.6%) maintained the primary functional artificial urinary sphincter. Three patients (6.5%) had artificial urinary sphincter revisions and maintained continence with the new device. 11 patients (23.9%) removed the artificial urinary sphincter because of post-complications. Thirty-five patients were socially continent, of which 16 patients were totally dry, leading to the overall social continent rate as 76.1%(35/46). There was a significant reduction in pad usage to 1.2±0.6 diapers per day ( P<0.001). The impact of incontinence on the QOL measured by the VAS dropped to 2.6±1.9 ( P<0.001). The complication rate was 32.6%(15/46), including infections ( n=4), erosions ( n=5), mechanical failure ( n=3), dysurie ( n=2) and urethral atrophy ( n=1). There were no significant differences in social continent rate between patients with different etiologies[75.0%(18/24)vs. 66.7%(6/9) vs. 84.6%(11/13)], perioperative complications [37.5%(9/24)vs. 33.3%(3/9) vs. 23.1%(3/13)] and device re-intervention rate[37.5%(9/24) vs. 33.3%(3/9)vs. 15.4%(2/13)]. There were no statistically significant differences in postoperative complete dry rate [32%(8/25)vs. 40%(8/20), P=0.76] and postoperative device failure free rate [60%(15/25)vs. 80%(16/20), P=0.20] between trans-perineal group and trans-scrotal group. There was no statistically significant difference in postoperative social continent rate between 4.5cm cuff and 4.0 cuff[75%(12/16) vs. 65.5%(19/29), P=0.74]. Conclusions:Artificial urethral sphincter implantation is an effective treatment for stress urinary incontinence due to intrinsic sphincter deficiency. There was no difference in the continent rate and complication rate between patients of different etiologies, different surgical approaches and cuff size selection.

Objective　To analyze the association between serum homocysteine (Hcy),white matter hyperintensity (WMH) and cerebral microbleeds (CMBs).Methods　309 patients were divided into CMBs group (n=116) and control group (n=193),lobar CMBs group (n=90) and deep CMBs group (n=26),minor CMBs group (n=78) and major CMBs group (n=38),low-level Hcy group (n=158) and high level Hcy group (n=151) according to the quantity and site of CMBs and the median levels of Hcy.Results　The levels of Hcy,glucose,creatinine,the total score of Fazekas scale,systolic pressure and pulse pressure difference were higher in CMBs group than control group (P<0.05);Male,systolic pressure and the total score of Fazekas scale were independent risk factors of CMBs by Logical regression (P<0.05).The scores of Fazekas scale were higher in lobar CMBs group than deep CMBs group (P<0.05);Serum Hcy,the scores of Fazekas scale were related to quantity of CMBs (P<0.05).Conclusions　The serum Hcy was partcipated in the process of CMBS.The severity of WMH was correlation with lobar CMBs may play a prediction role in CMBs.

Objective To investigate the molecular mechanism of luteolin-regulated epithelial-mesenchymal transition (EMT) in non-small cell lung cancer. Methods Firstly,the potential target of luteolin was studied by molecular docking.The effect of luteolin on EMT markers was analyzed,and then molecular biology experiments were used to verify the results. Results The result of molecular docking showed that luteolin had a good docking effect on the integrin family,of which the lowest binding energy was -15.11 in docking with Integrin αIIbβ3.The result of flow cytometry showed that luteolin could down-regulate the expression of integrin induced by hypoxia. Conclusion Luteolin can regulate integrin expression,which suggested that luteolin can regulate EMT through integrin.This conclusion may provide new methods in prevention of tumor metastasis for traditional Chinese medicine.

Objective To explore the correlation between dual energy imaging indices,microvessel densi-ty(MVD),vascular endothelial growth factor(VEGF)and lung cancer lymph nodes metastasis and its practical sig-nificance by applying dual source CT(DSCT)dual energy imaging.Methods 62 cases of non-small cell lung can-cer(NSCLC)were underwent DSCT dual energy imaging and divided into groups with and without lymph node me-tastasis according to the results of pathology.The expressions of MVD and VEGF were detected as well.All the indi-ces were compared between the two groups. Results(1)The differences between the lung cancer lymph node groups in the iodine concentration,normalized iodine concentration(NIC),spectrum curve of arterial phase,MVD and VEGF were statistically significant(P<0.05).(2)The iodine concentration,NIC and spectrum curve of arte-rial phase were positively correlated with MVD and VEGF.Conclusion Iodine concentration,NIC,and spectrum curve of arterial phase of DSCT dual energy imaging can be regarded as part of the important indices for preopera-tive diagnosis of lymph node metastasis of NSCLC.

Epithelial mesenchymal transition ( EMT) is one of the important biological processes in tumor invasion and metastasis . However , due to the complexity of EMT signaling pathway and its unclear molecular mechanism , the treatment of EMT is still a worldwide problem .But many studies have proved that EMT is not an irreversible process .In recent years , the research of FOX gene family in EMT shows its important role in tumor metastasis . This review focuses on the FOX-mediated EMT process in many kinds of tumor , aiming to have a better understanding of EMT signaling network , and provide a new target for the effective pre-vention of EMT .

BACKGROUND:Distal femur is a predilection site for primary bone tumors, most of which are treated with salvage treatment. There are many reports on the early-stage, mid-term and prognosis of the distal femur tumor-type artificial knee joint prosthesis, but reports on long-term function and prognosis are less.
OBJECTIVE:To study the long-term prognosis and limb function after treatment with rotating-hinge knee prosthesis.
METHODS:Thirty-four patients with distal femoral bone tumors admitted to the Department of Orthopedics, the First Affiliated Hospital of Anhui Medical University between January 2000 and June 2008 were retrospectively analyzed, including 19 males and 15 females. Al patients were subjected to rotating hinge knee prosthesis replacement.
RESULTS AND CONCLUSION:The mean fol ow-up period was 62.4 months (range 11 to 126 months). At the final of fol ow-up, 23 patients were event-free alive and 11 patients were dead. Seven of 23 survival patients suffered from prosthesis related complications, including four cases of prosthesis revision and three cases of amputation. The event-free survival rate of 23 patients undergoing replacement of domestic tumor prosthesis around the knee was 67.6%in 5 years. The mean functional score of affected limb was 19.30 (7 to 27 points):excellent in 6 cases, good in 16, fine in 5 and poor in 2. The excellent-good rate was 75.9%. The clinical outcomes suggested that the satisfactory limb function and survival rate could be achieved with the application of domestic tumor prosthesis replacement for treatment of malignant bone tumors around the knee.