Lipid metabolism has been associated with progression of various cancers. However, the underlying mechanisms of the impact of lipid metabolism-associated genes (LMAGs) on the tumor immune microenvironment have not been well-elucidated. This study aimed to determine the effects of lipid metabolism on the progression and development of hepatocellular carcinoma (HCC). Expression profiles and clinical data of 371 and 231 patients with HCC were obtained from the TCGA and Internal Cancer Genome Consortium (ICGC) databases, respectively. Using Cox regression and LASSO regression analyses, a prognostic risk model was constructed based on the LMAG data. The tumor mutation burden (TMB), immune cell infiltration levels, and immune response checkpoints of the identified risk groups were determined and compared. A total of two clusters were identified based on the LMAG expression, showing significant differences in tumor stage and immune cell infiltration. A prognostic risk model based on four LMAGs was constructed and proven to have a significant prognostic value. The 1-, 3-, and 5-year survival rates in the high-risk group were 62.2%, 20.5%, and 8.1%, respectively, whereas those in the low-risk group were 78.9%, 28.1%, and 13.5%, respectively. The survival differences between the two risk groups were likely associated with TP53 mutation status, TMB score, degree of immunocyte infiltration, and immune checkpoint level. Likewise, the expression level of every LMAG included in the model had the same effect on the overall survival and immune cell infiltration levels. More importantly, the prognostic value of the signature was verified in an independent ICGC cohort. Thus, the expression levels of LMAGs are closely related to the tumor microenvironment in HCC and may serve as promising biological indicators for prognosis and immune therapy in patients with HCC.

目的 对比探讨超声引导下经皮微波消融与手术切除治疗CNLC I期原发性肝癌的疗效.方法 收集2017年1月-2020年12月无锡市人民医院收治的107例行超声引导下经皮微波消融或手术切除治疗CNLC I期肝癌患者的临床资料,其中微波消融(MWA)组56例,手术切除(SR)组51例.比较两组术后检验学指标、术后并发症、短期疗效及短期生存率,探讨两组病人的生存影响因素.两组间的计数资料用卡方检验比较,计量资料采用Mann-Whitney比较.采用Kaplan-Meier和Cox回归分析影响患者术后生存的相关因素.结果 术后SR组患者LDH(P=0.036)、PT(P=0.006)及INR(P=0.007)均高于MWA组,术后疼痛发生率显著高于MWA组(P<0.001).MWA组患者半年、1年、2年的生存率分别为98.2％、89.3％、53.6％,SR组患者半年、1年、2年的生存率分别为100％、92.2％、58.8％,两组患者术后生存率比较,差别无统计学意义(P=0.681).于MWA患者而言,肿瘤多发为主要危险因素;于SR患者而言,肿瘤直径及术前LDH为主要危险因素.结论 超声引导下经皮微波消融或手术切除治疗CNLC I期肝癌的短期疗效无明显差异,但经皮微波消融所带来的并发症更少.

ObjectiveTo assess the efficacy and safety of acute hypervolemic hemodilution (AHHD) targeting stroke volume variability (SVV) in reducing blood loss and transfusion volume in patients who underwent spinal tumor surgery. MethodsForty patients with spinal tumor were randomly categorized into groups A and B. Patients in group A received AHHD with SVV ≤7%, and those in group B received AHHD with SVV ≥13%. Blood gas analysis results, regional cerebral oxygen saturation (rSO2) levels, and hemodynamic indexes at T0, T1, T2, T3, and T4 were recorded. The mini-mental state examination (MMSE) scores on the day before surgery and on days 1, 3, and 5 postoperatively were recorded. ResultsThere was no significant difference in blood loss volume between both the groups (P>0.05). During surgery, total infusion volume and urine volume were higher in group A than in group B, and blood transfusion volume and rate were lower in group A than in group B (P<0.05). Compared with group A, the heart rate and lactate level increased and mean arterial pressure and rSO2 decreased in group B at T3 (P<0.05). The MMSE scores on day 1 postoperatively were lower in group B than in group A, and the incidence of cognitive dysfunction was higher in group B than in group A (P<0.05). ConclusionsTarget-oriented AHHD with SVV ≤7% can decrease the blood transfusion volume and rate during spinal tumor surgery, stabilize hemodynamics, and reduce the incidence of postoperative cognitive dysfunction.

目的:探讨前列地尔联合丹参在防治家兔髋部骨折后下肢深静脉血栓(deep venous thrombosis,DVT)形成中的疗效.方法:将32只新西兰雌性家兔随机平均分为2组:治疗组,前列地尔+丹参组;对照组,低分子肝素组.建立家兔左侧髋部骨折模型,左下肢曲髋屈膝位石膏固定4周.分别给药持续4周,治疗组:前列地尔5μg+丹参10mL/只/天;对照组:低分子肝素钠100IU/kg/天.于术后第3、10、17、24天,2组各取4只做左下肢股静脉多普勒超声及查凝血功能,并取患肢标本做病理,观察2组药物对DVT的作用.结果:两组药物均能明显改善凝血功能指标,减轻血栓形成,差异无统计学意义(P>0.05).结论:前列地尔联合丹参防治DVT疗效显著,与低分子肝素相似,副作用小,值得临床应用.

目的 探讨撬拨加手法复位内固定术及跗骨窦微创入路钢板内固定术两种微创手术方式治疗跟骨骨折的疗效及并发症情况.方法 2015年12月至2019年12月,按照随机数码表法,随机收集跟骨骨折患者共60例,分为撬拨加手法复位内固定组(撬拨组)及跗骨窦微创入路钢板内固定组(跗骨窦组),其中SandersⅡ型患者共30例,使用撬拨加手法复位内固定的患者15例,使用跗骨窦微创入路内固定的患者15例;SandersⅢ型患者共30例,其中使用撬拨加手法复位内固定的患者15例,使用跗骨窦微创入路内固定的患者15例.术后定期随访,观察两种手术入路治疗跟骨骨折后的并发症情况,包括术后愈合情况、 骨折延迟愈合、 骨折不愈合及创伤性关节炎的发生率等.采用Maryland评分评价患者术后后足功能情况.结果 对纳入的60名患者进行随访,随访时间3～6个月,平均(4.15±1.05)个月.在Sanders各分型中,撬拨组与跗骨窦组相比较,其骨折愈合时间差异无统计学意义,P>0.05,根据Maryland足部评分标准标准,Ⅱ型跟骨骨折术后优良率为:撬拨组73.33％,跗骨窦组80％,P>0.05差异无统计学意义;Ⅲ型撬拨组优良率66.67％,跗骨窦组80％,P<0.05,差异有统计学意义.在SandersⅡ型中,撬拨组与切复组并发症情况相比较,在感染率、骨折延迟愈合、不愈合、创伤性关节炎方面差异均无统计学意义.在SandersⅢ型中,撬拨组与切复组并发症情况相比较,在感染及创伤性关节炎方面差异有统计学意义(P<0.05).结论 相比与跗骨窦组,撬拨组治疗跟骨骨折的伤口并发症更低,适合用于SandersⅡ型跟骨骨折.但由于创伤性关节炎的发生率的增加,该手术方式并不适合于Sanders分型更高的骨折,故对于SandersⅢ型骨折,推荐使用跗骨窦入路进行治疗.

目的 研究采用万向锁定加压接骨板治疗AO-C型桡骨远端骨折的疗效.方法 选取2019年1月至2019年8月间上海九院黄浦分院收治的27例AO-C型桡骨远端骨折患者,所有患者行掌侧入路并采用万向锁定加压掌侧接骨板进行固定,术后嘱早期功能锻炼.结果 本组27例患者均获得定期门诊随访,随访时间为4～7个月,平均5.7个月,术后X光片提示均愈合,轴向长度均恢复,并无骨折复位的丢失,根据Dienst腕关节功能评价标准,优15例,良8例,可4例,优良率达85.2％.结论 万向锁定加压接骨板在治疗AO-C型桡骨远端骨折中,由于其更符合三柱理论,所以固定效果更确切,且不容易出现骨折复位的丢失.同时由于螺钉的角度可以小范围的调整,避免了多次拆装内固定所带来的麻烦,减少了手术的时间,有效提高了手术效果.

目的 探讨改良双切口手术治疗肘关节内翻-后内侧旋转不稳定的早期疗效.方法 2016年1月至2019年5月,采用改良双切口治疗10例肘关节内翻-后内侧旋转不稳定患者.其中,男7例,女3例;34～71岁,平均年龄47.2岁;左侧4例,右侧6例;致伤原因:摔伤6例,车祸伤4例.根据O'Driscoll标准对冠状突进行分类,Ⅱ 1型8例,Ⅱ 2型2例.术中、术后均麻醉下行内翻、内旋和轴向应力位透视评价肘关节稳定性,然后取肘关节外侧Kocher入路探查并以锚钉修复断裂的外侧副韧带.术后加强早期功能锻炼.结果 所有患者术后均获得9～14个月随访,平均12.6个月.骨折均获得临床愈合,愈合时间7～l5周,平均为11.2周.平均屈曲135.4°±3.4°,平均伸直2.7°±1.2°,平均旋前85.4°±2.3°,平均旋后86.2°±2.3°.所有患者均未出现肘关节不稳定、肘内翻等情况.Mayo肘关节功能评分标准(MEPS):优8例,良2例.结论 改良双切口治疗肘关节内翻-后内侧旋转不稳定可以达到足够的关节稳定性,早期进行肘关节功能训练可取得满意的效果.

RATIONALE:Ectopic pheochromocytoma is a special type of pheochromocytoma which occurs outside the adrenal gland. The most common symptoms of ectopic pheochromocytoma are palpitations, headaches, profuse sweating, and hypertension. In clinical practice, diagnosis of ectopic pheochromocytoma remains difficult.PATIENT CONCERNS:The patient was a 43-year-old female who was admitted to our hospital with the chief complaint of upper abdominal discomfort for 1 week. Computed tomography demonstrated a neoplasm in the head of pancreas. The patient also had history of hypertension and type-2 diabetes.DIAGNOSIS:According to the postoperative pathological examination, the lesion was mainly composed of chromaffin cells. Immunohistochemical staining revealed that the tumor expressed chromogranin A, NSE, and synaptophysin. Based on these findings, this mass was diagnosed as benign ectopic pheochromocytoma (paraganglioma).INTERVENTIONS:Surgical resection operation was carried out and the patient's blood pressure was monitored continuously. Vasopressor or anti-hypertensive drugs were used according to circumstances.OUTCOMES:The patient recovered well and was discharged from hospital with normal blood pressure.LESSONS:This report reminds us to pay close attention to the likelihood of ectopic pheochromocytoma and other low-incidence diseases. Physicians and imaging clinicians should explore all clinical possibilities to avoid missed diagnosis or misdiagnosis of ectopic pheochromocytoma and take effective treatment measures to maximize patient benefits.

Objective:To construct a computed tomography (CT)-based radiomics model for predicting tumor recurrence of early-stage hepatocellular carcinoma (HCC) after resection, and explore its application value.Methods:The retrospective cohort study was conducted. The clinicopathological data of 243 patients with early-stage HCC who underwent hepatectomy in 2 medical centers between January 2009 and December 2016 were collected, including 165 in the First Affiliated Hospital of Nanjing Medical University and 78 in the Wuxi People′s Hospital. There were 182 males and 61 females, aged from 30 to 86 years, with a median age of 57 years. According to the random numbers showed in the computer, 243 patients were randomly assigned into training dataset consisting of 162 patients and test dataset consisting of 81 patients, with a ratio of 2∶1. Using radiomics technique, a total of 3 384 radiomics features were extracted from the tumor and its periphery at arterial-phase and portal-phase images of CT scan. In the training dataset, a radiomics signature was constructed and predicted its performance after dimension reduction of stable features by using aggregated feature selection algorithms [feature ranking via maximal relevance and minimal redundancy (MRMR) combined with random survival forest (RSF) + LASSO-COX regression analysis]. Risk factors for tumor recurrence were selected using the univariate COX regression analysis, and two radiomics models including radiomics 1 (preoperative) and radiomics 2 (postoperative) were constructed and predicted their performance using backward stepwise multivariate COX regression analysis. The two models were validated in the training and test dataset. Observation indicators: (1) follow-up; (2) construction of HCC recurrence-related radiomics signature for early-stage HCC after resection; (3) prediction performance of HCC recurrence-related radiomics signature for early-stage HCC after resection; (4) construction of HCC recurrence-related radiomics prediction model for early-stage HCC after resection; (5) validation of HCC recurrence-related radiomics prediction model for early-stage HCC after resection; (6) comparison of the prediction performance of radiomics model with that of other clinical statistical models and current HCC staging systems; (7) stratification analysis of postoperative recurrence risk based on radiomics models for early-stage HCC after resection. Patients were followed up using outpatient examination or telephone interview once every 3 months within the first 2 years and once every 6 months after 2 years. The follow-up included collection of medical history, laboratory examination, and abdominal ultrasound examination. Contrast-enhanced CT or magnetic resonance imaging (MRI) examination was performed once every 6 months, and they were performed in advance on patients who had suspected recurrence based on laboratory examination or abdominal ultrasound for further diagnosis. Follow-up was up to January 2019. The endpoint was time to recurrence, which was from the date of surgery to the date of first detected disease recurrence or metastasis. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed by the t test. Measurement data with skewed distribution were described as M (range), and comparison between groups was analyzed by the Mann-Whitney U test. Count data were described as absolute numbesr or percentages, and comparison between groups was analyzed using the chi-square test. The survival curve and survival rate were respectively drawn and calculated by the Kaplan-Meier method, and the survival analysis was performed using the Log-rank test. Serum alpha-fetoprotein level was analyzed after the natural logarithm transformation. X-tile software was used to select the optimal cut-point for continuous markers. Results:(1) Follow-up: all the 243 HCC patients received follow-up. Patients in the training dataset were followed up for 4.2-109.2 months, with a median follow-up time of 51.6 months. Patients in the test dataset were followed up for 12.7-107.6 months, with a median follow-up time of 73.2 months. The 2-, 5-year disease-free survival rates were 77.8% and 53.1% of the training dataset respectively, versus 86.4% and 61.7% of the test dataset. There was no significant difference in terms of disease-free survival between two datasets ( χ2=1.773, P>0.05). (2) Construction of HCC recurrence-related radiomics signature for early-stage HCC after resection: of the 3 384 radiomics features, 2 426 radiomics features with high stability were selected for analysis. There were 37 radiomics features identified after combining the top 20 radiomics features ranked by MRMR and RSF algorithms. LASSO-COX regression algorithm further reduced their dimensionality to retain 7 radiomics features and construct a radiomics signature. The indicators including region, scanning phase, and weighting coefficient of above mentioned seven features were Feature 1 (peritumoral, arterial phase, 0.041), Feature 2 (peritumoral, arterial phase, -0.103), Feature 3 (peritumoral, arterial phase, -0.259), Feature 4 (intratumoral, arterial phase, 0.211), Feature 5 (peritumoral, portal venous phase, -0.170), Feature 6 (intratumoral, portal venous phase, 0.130), and Feature 7 (intratumoral, portal venous phase, 0.090), respectively. Radiomics signature score=0.041×Feature 1-0.103×Feature 2-0.259×Feature 3+ 0.211×Feature 4-0.170×Feature 5+ 0.130×Feature 6+ 0.090×Feature 7. (3) Prediction performance of HCC recurrence-related radiomics signature for early-stage HCC after resection: the radiomics signature showed favorable prediction performance in both training and test datasets, with respective C-index of 0.648 [95% confidence interval ( CI): 0.583-0.713] and 0.669 (95% CI: 0.587-0.750). (4) Construction of HCC recurrence-related radiomics prediction model for early-stage HCC after resection: results of univariate analysis showed that ln(serum alpha-fetoprotein), liver cirrhosis, tumor margin status, arterial peritumoral enhancement, intratumoral necrosis, radiomics signature, satellite nodules, and microvascular invasion were related factors for tumor recurrence after resection of early-stage HCC ( hazard ratio=1.202, 1.776, 1.889, 2.957, 1.713, 4.237, 4.364, 4.258, 95% CI: 1.083-1.333, 1.068-2.953, 1.181-3.024, 1.462-5.981, 1.076-2.728, 2.593-6.923, 2.468-7.717, 2.427-7.468, P<0.05 ). Results of multivariate analysis showed that the radiomics model 1 (preoperative) consisted of ln(serum alpha-fetoprotein), tumor margin status, and radiomics signature ( hazard ratio=1.145, 1.838, 3.525, 95% CI: 1.029-1.273, 1.143-2.955, 2.172-5.720, P<0.05); the radiomics model 2 (postoperative) consisted of ln(serum alpha-fetoprotein), radiomics signature, microvascular invasion, and satellite nodules ( hazard ratio=1.123, 2.386, 3.456, 3.481, 95% CI: 1.005-1.254, 1.501-3.795, 1.863-6.410, 1.891-6.408, P<0.05). Risk prediction formulas: radiomics model 1 = 0.135×ln(serum alpha-fetoprotein)+ 0.608×tumor margin status (0: smooth; 1: non-smooth)+ 1.260×radiomics signature; radiomics model 2 = 0.116×ln(serum alpha-fetoprotein)+ 0.870×radiomics signature + 1.240×microvascular invasion (0: absent; 1: present)+ 1.247×satellite nodules (0: absent; 1: present). (5) Validation of HCC recurrence-related radiomics prediction model for early-stage HCC after resection: in both training and test datasets, radiomics model 1 provided good prediction performance, with respective C-index of 0.716 (95% CI: 0.662-0.770) and 0.724 (95% CI: 0.642-0.806), while radiomics model 2 provided better prediction performance, with respective C-index of 0.765 (95% CI: 0.712-0.818) and 0.741 (95% CI: 0.662-0.820). Calibration curves demonstrated good agreement between model-predicted probabilities and observed outcomes. (6) Comparison of the prediction performance of radiomics model with that of other clinical statistical models and current HCC staging systems: in the training dataset, the prediction performance of radiomics model 1 for tumor recurrence after resection of early-stage HCC was significantly different from that of ERASL model (preoperative), Barcelona clinic liver cancer (BCLC) staging, Hong Kong liver cancer (HKLC) staging, and cancer of the liver Italian program (CLIP) classification (C-index=0.562, 0.484, 0.520, 0.622, 95% CI: 0.490-0.634, 0.311-0.658, 0.301-0.740, 0.509-0.736, P<0.05); the prediction performance of radiomics model 2 for tumor recurrence after resection of early-stage HCC was significantly different from that of ERASL model (postoperative), Korean model, and the eighth edition TNM staging (C-index=0.601, 0.523, 0.513, 95% CI: 0.524-0.677, 0.449-0.596, 0.273-0.753, P<0.05). In the test dataset, the prediction performance of radiomics model 1 for tumor recurrence after resection of early-stage HCC was significantly different from that of ERASL model (preoperative), BCLC staging, HKLC staging, CLIP classification (C-index=0.540, 0.473, 0.504, 0.545, 95% CI: 0.442-0.638, 0.252-0.693, 0.252-0.757, 0.361-0.730, P<0.05); the prediction performance of radiomics model 2 for tumor recurrence after resection of early-stage HCC was significantly different from that of ERASL model (postoperative), Korean model, and the eighth edition TNM staging (C-index=0.562, 0.513, 0.521, 95% CI: 0.451-0.672, 0.399-0.626, 0.251-0.791, P<0.05). (7) Stratification analysis of postoperative recurrence risk based on radiomics models for tumor recurrence after resection of early-stage HCC: according to the analysis of X-tile, the score of radiomics model 1 < 1.4 (corresponding to total points < 62.0 in nomogram) was classified into low-risk group while the score of radiomics model 1 ≥ 1.4 (corresponding to total points ≥ 62.0 in nomogram) was classified into high-risk group. The score of radiomics model 2 < 1.7 (corresponding to total points < 88.0 in nomogram) was classified into low-risk group while the score of radiomics model 2 ≥ 1.7 (corresponding to total points ≥ 88.0 in nomogram) was classified into high-risk group. In the training dataset, the 2- and 5-year recurrence rates were 14.1%, 35.3% for low-risk patients and 63.0%, 100.0% for high-risk patients, which were predicted by radiomics model 1. There were significant differences between the two groups ( χ2= 70.381, P<0.05). The 2- and 5-year recurrence rates were 12.9%, 38.2% for low-risk patients and 81.8%, 100.0% for high-risk patients, which were predicted by radiomics model 2. There were significant differences between the two groups ( χ2= 98.613, P<0.05). In the test dataset, the 2- and 5-year recurrence rates were 5.6%, 29.3% for low-risk patients and 70.0%, 100.0% for high-risk patients, which were predicted by radiomics model 1. There were significant differences between the two groups ( χ2= 64.453, P<0.05). Ther 2- and 5-year recurrence rates were 5.7%, 28.1% for low-risk patients and 63.6%, 100.0% for high-risk patients, which were predicted by radiomics model 2. There were significant differences between the two groups ( χ2= 58.032, P<0.05). Conclusions:The 7-feature-based radiomics signature is built by selection of CT radiomics features in this study, and then HCC recurrence-related radiomics prediction model for early-stage HCC after resection is constructed. The proposed radiomics models can complement the existing clinical-radiological-pathological prognostic sources, accurately and individually predict tumor recurrence risk preoperatively and postoperatively, which facilitate clinical decision-support for patients with early-stage HCC.

目的:探讨联合应用前列地尔与丹参注射液防治老年髓部骨折下肢深静脉血栓(deep vein thrombosis,DVT)的临床效果.方法:选取2013年1月-2018年1月老年髓部骨折患者62例,年龄68～85岁,平均(74.0±3.2)岁.其中股骨颈骨折行人工双极股骨头置换术24例,股骨转子间骨折行股骨近端髓内钉内固定术38例.随机分为两组,各31例,观察组术后每日联合静滴前列地尔注射液20μg+丹参注射液20 ml,对照组术后皮下注射低分子肝素钠4000 IU/d,疗程均为2周.根据患肢术后疼痛、肿胀情况,皮下出血、伤口内血肿是否形成,术后第14天复查多普勒超声有无血栓形成等指标,比较两组的临床疗效.结果:治疗2周后,观察组毗17例,良11例,可3例,差0例,毗良率为90.3％,3例存在轻度DVT,无皮下出血发生;对照组毗19例,良8例,可2例,差2例,毗良率为87.1％,其中2例出现DVT,术后切口弓流量明显增加2例,皮下出血1例.两组毗良率及DVT发生率比较,差异均无统计学意义(P>0.05).两组在治疗期间均无严重出血.结论:联合应用前列地尔加丹参与单用低分子肝素均具有较低的DVT发生率,值得临床推广.

Objective To compare the efficacy and safety of laparoscopic splenectomy (LS) and open splenectomy (OS) in the treatment of traumatic splenic rupture by Meta analysis. Methods Wanfang database,Medalink,CNKI, Chinese biomedical literature database, PubMed, Elsevier and SpringerLink were searched by computer. The search was conducted from January 2008 to December 2017 to identify all relevant literature and to trace the references of included studies. RevMan 5. 2 software was used for data analysis. Results Eventually,8 randomized controlled trials or high quality control studies and 603 patients were included into this study. Meta-analysis showed that LS was superior to OS in reducing intraoperative bleeding [MD= 115. 57,95％ CI: (- 213. 82, - 17. 33),P ＜ 0. 05],flatus time [MD = - 18. 70,95％ CI: (- 19. 84, - 17. 56),P ＜ 0. 05],postoperative hospital stay [MD = - 4. 53,95％ CI: (- 6. 44, - 2. 62),P ＜ 0. 05] and the incidence of postoperative complications [OR = 0. 25,95％ CI,(0. 15,0. 42),P ＜ 0. 05],while there was no significant difference in operation time between LS and OS[MD = - 3. 85,95％ CI: (- 17. 47,9. 77),P＜ 0. 05]. Conclusion Compared with OS,LS has the advantages of less intraoperative bleeding,early postoperative flatus,shorter average length of stay,and reduced incidence of postoperative complications. Laparoscopic splenectomy is safe and effective in the treatment of traumatic splenic rupture and can be spreaded in clinical practice.

目的 分析使用外固定架与内固定转换分期治疗旋后外旋Ⅳ°踝关节骨折脱位的疗效.方法 2010年1月至2017年3月,采用外固定架与内固定转换分期治疗62例旋后外旋型Ⅳ°踝关节骨折脱位,其中男45例,女17例,年龄21～82(48±4.5)岁.I期手法复位后外固定架固定,待软组织肿胀消退、表皮挫伤愈合后,II期行切开复位内固定术.术后观察骨折愈合及踝关节功能等情况,采用Mazur评分评定疗效.结果 62例患者均获随访,时间8～18(12±2.5)个月,外固定架使用时间为7～20(14±1.3)d.所有骨折均愈合,时间12～16周.根据Mazur功能评分:优38例,良17例,可5例,差2例,优良率为88.7％.有2例内固定术后感染、组织坏死,后行清创VSD引流+植皮后痊愈.无骨折不愈合、畸形愈合等发生.结论 旋后外旋Ⅳ°踝关节骨折脱位软组织损伤严重,分期治疗效果好、并发症少,选择适当时机更换内固定是成功的关键.

In a typical oil-in-water emulsion drug product, oil droplets with varied sizes are dispersed in a water phase and stabilized by surfactant molecules. The size and polydispersity of oil droplets are critical quality attributes of the emulsion drug product that can potentially affect drug bioavailability. More critically, to ensure accuracy in characterization of the finished drug product, analytical methods should introduce minimal physical perturbation (e.g., temperature variation or dilution) before the analysis. The classical methods of dynamic light scattering or electron microscopy can be used but they generally require sample dilution or harsh preparation conditions, respectively. By contrast, the size distribution of emulsion formulations can be assessed with a simple and noninvasive solution nuclear magnetic resonance method, namely, two-dimensional Diffusion Ordered SpectroscopY. The two-dimensional Diffusion Ordered SpectroscopY method probed signal decay of methyl resonances from oil and sorbate molecules and was applied to 3 types of U.S.-marketed emulsion drug products, that is, difluprednate, cyclosporine, and propofol, yielding measured droplet sizes of 40-280 nm in diameter. The high precision of ±6 nm of the new nuclear magnetic resonance method allows analytical differentiation of lot-to-lot and brand-to-brand droplet size differences in emulsion drug products, critical for drug-quality development, control, and surveillance.

Objective To analyze the recurrence of calculi and its related risk factors after laparoscopic cholecystectomy (LC) combined with laparoscopic choledocholithotomy T-tube drainage (LCHTD). Method From January 2014 to June 2016, clinical data of 89 cases of cholelithiasis combined with choledocholithiasis treated by LC combined with LCHTD, were analyzed retrospectively by using SPSS21.0 statistical software package. The recurrence rate, cumulative recurrence rate in 1-3 years and univariate analysis were performed by using χ2 test, while multivariate analysis was performed by using logistic regression analysis, and OR and 95% confidence interval were calculated. A P value of <0.05 was considered as statistically significant. Results The recurrence of calculi occured in 18 patients(20.22%) after LC combined with LCHTD, The cumulative recurrence rate was 2.25%(2/89) in one year, 5.62%(5/89) in two years and 12.36%(11/89) in three years. Univariate analysis showed that age, diameter of common bile duct, number of stones, lithotripsy, choledochal dilatation, cystic duct dilatation, combined with biliary or pancreatic inflammation were associated with recurrence of stones after combined surgery (P 1.5 cm), choledochal dilatation, cholecystic duct dilatation, combined with biliary or pancreatitis Symptoms were the independent risk factors for stone recurrence after combined surgery. Conclusion There are many factors influencing the recurrence of calculi after LC combined with LCHTD, even some of them would occur together. It is necessary to take pertinent measures to reduce the recurrence rate of calculi after LC combined with LCHTD. Key words: Cholecystolithiasis; Choledocholithiasis; Laparoscopes; Recurrence; Risk factors

Objective To investigate the therapeutic strategy of advanced hilar cholangiocarcinoma and to analyze its prognosis. Methods Retrospective study were performed in 68 patients with advanced hilar cholangiocarcinoma from January 2006 to December 2016, including the record and analysis in terms of gender, age, surgical options, Bismuth-Corlette type, tumor type, differentiation, vascular invasion, lymph node metastasis, oral anticancer drug, operation time, intraoperative blood loss, postoperative chemotherapy and radiotherapy, and the prognosis of patients. Statistical analysis were performed by using SPSS 21.0 software. The risk factors of prognosis were analyzed by using single factor analysis of variance, and multiple factor Logistic regression analysis were carried out on the related factors of advanced hepatic hilar cholangiocarcinoma, and the survival analysis were performed by using Kaplan-Meier method. Results There were significant difference in terms of surgical options, differentiation, vascular invasion, lymph node metastasis, and intraoperative blood loss, in the survival analysis of patients, which showing close correlation of prognosis of patients with advanced hilar cholangiocarcinoma (P<0.05). There were average survival of 35.2 months in R0 resection group, 27.4 months in R1 resection group, 16 months in R2 resection group. 14.6 months in drainage treatment group and 12 months in conservative treatment group. The survival time of the R0 resection group was higher than those of other groups respectively, with significant difference (P<0.05). Conclusion Surgical options, vascular invasion, lymph node metastasis, intraoperative blood loss, differentiation degree have close correlation with prognosis of patients with advanced hilar cholangiocarcinoma. Compared with R1 or R2 resection, drainage or conservative treatment, R0 resection could effectively prolong patients’ survival, is worthy of attention. Key words: Bile Duct Neoplasms; Antineoplastic Protocols; Prognosis

目的:探讨腹腔镜肠粘连松解术治疗粘连性肠梗阻的临床疗效.方法:收治粘连性肠梗阻患者75例,均开展腹腔镜肠粘连松解术,记录手术效果.结果:所有患者全部康复出院,随访6个月,2例术后3个月左右因常有腹痛再次手术,再随访3个月无复发.结论:腹腔镜粘连松解术治疗粘连性肠梗阻,具有手术创面小、术后发生再粘连概率小及预后效果较佳的优点.

Objective To evaluate the surgical treatment and clinic outcome of percutaneous fixation with precontoured long PHILOS locking compression plate on the proximal humerus fractures and humeral shaft fractures. Methods There were 22 patients of acute proximal humerus fractures and humeral shaft fractures without radial nerve injury were surgical treated by per percutaneous fixation with precontoured long PHILOS locking compression plate from January 2013 to January 2017.The interval from injury to operation was 2~10 days. According to the Neer classification,type Ⅱ (n=15)and type Ⅲ(n=7).All the fractures on humeral shaft were classified by AO/OTA as type A1(n=6),type A2(n=8),type B1(n=3), type B2(n=5). Functional outcome of shoulder was assessed using the Neer scoring system. Results All patients were followed up for operation, the follow up time was 11~24(15±3.3)months. Fractures had healed from 2~5(3±1.3)months. One patient had transient symptom of radial nerve paralysis,which disappeared within 4 months. No complications such as fracture ununion or internal fixator loosening. Sixteen cases were graded as excellent,4 as good,1 as fair,and the excellent and good rate was 90.9% according to Neer scoring system. Conclutions Long PHILOS combined with MIPPO technique in the treatment of proximal humerus fractures with humeral shaft,soft tissue injury is small,firm fixation,can effectively avoid radial nerve injury,worthy of clinical promotion.

The incidental gallbladder cancer (IGBC) is defined as the gallbladder cancer, which is diagnosed during or following cholecystectomy by pathological examinations, preoperatively considered as benign gallbladder disease. IGBC is usually not associated with readily discernible clinical signs and combined with other benign lesions. And the early clinical manifestations are usually non-specific. It is more difficult to diagnosis before operation. With the extensive operation of laparoscopic cholecystectomy, the patients with IGBC have increased. Modern imageology can improve the preoperative diagnosis of gallbladder cancer and reduce the incidence of IGBC. TNM staging system (AJCC 8th) for gallbladder cancer has an important guiding significance for treatment selection and prognosis of IGBC. Comprehensive treatment based on radical surgery is the most effective therapeutic option for IGBC. Secondary radical surgery appears to have a clear therapeutic effect in T2 and T3 patients with IGBC. Single surgical approach does not apply to the patients with IGBC in each stage, and the specific surgical approach should be based on TNM staging. Chemotherapy and radiotherapy has achieved certain results in the case of IGBC, but the overall effect is not satisfactory. There is a lack of attention to the research on IGBC at present. Clinically, there is still a lack of effective guidelines to treat IGBC, and the standard surgical regimens for IGBC remained controversial. In this paper, the authors give a brief overview of the research progress and doubtful points in the treatment of IGBC.

Objective To evaluate the effects of treating talus posterior fracture by headless compression cannulated screw through posteromedial approach.Methods From Jan.2012 to Dec.2015,5 cases of talus poste-rior fracture were treated,including 3 males and 2 females,aged from 27 to 62 years,with an average of 46.2 years. One case had a simple fracture,and 4 patients had associated joint dislocation.All cases were diagnosed by X-ray and CT scan and treated by headless compression cannulated screw through posteromedial approach.After the soft tissue swelling subsided,about 1 week after injury(4-10days),surgical treatment was applied.Postoperative X-ray films were reviewed regularly and the results were evaluated using the American Orthopaedic Foot & Ankle Society (AOFAS).Results All cases were followed up from 8 to 14 months with an average of 12.3 months.They had no postoperative wound infection,and had no nerve injury.The average score of AOFAS was 84(57-94).Only one pa-tient had traumatic arthritis after 1 year.Conclusion Open reduction and internal fixation of the talus posterior fracture process by headless compression cannulated screw through posteromedial approach can not only clearly show fractures and articular surface,but also can avoid malleolus osteotomy.

Penicimutanolones A (1) and B (2), penicimutanolone A methyl ether (3), and penicimumide (4), four new antitumor metabolites, were isolated from a neomycin-resistant mutant of the marine-derived fungus Penicillium purpurogenum G59. The structures of the compounds were elucidated by spectroscopic methods, and the absolute configurations were determined by X-ray crystallography and calculated ECD. In MTT and SRB assays, compounds 1-3 showed strong inhibitory effects on 14 human cancer cell lines. Compounds 1 and 2 maybe induce apoptosis of cancer cells mainly due to the inhibition of the expression of survivin, a client protein of HSP90. In addition, in vivo antitumor activity was observed for compound 1 in murine sarcoma HCT116 tumor-bearing Kunming mice, using docetaxel as a positive control. (C) 2018 Elsevier Masson SAS. All rights reserved.