Volume 99 ·  Issue 21 ·  2019

Ankle fracture is one of the common fractures in trauma and orthopedics, and it is not uncommon for patients with deltoid ligament injury, which may lead to later medial pain and pronation deformity of the ankle. This article will combine literature and own clinical practice on the treatment of ankle fracture combined with deltoid ligament injury still controversial to discuss.

The treatment of intra-articular calcaneal fracture has always been a hot spot of foot and ankle trauma. With the development of treatment technology and internal fixation, especially the popularization of minimally invasive technology, the overall treatment effect has been significantly improved compared with before, especially the soft tissue complications have been significantly reduced. However, such issues as whether traditional techniques will eventually be replaced by minimally invasive techniques, whether the talus bone fragment is constant and undisplaced, whether its screws must be accurately placed, and whether the anatomical reduction of the articular surface is the most critical factor affecting the final effect and the incidence of traumatic arthritis are still the focus of misunderstandings at present.

There are differences in joint movement, cartilage thickness, metabolism and mechanical factors between ankle and knee joints, which help to explain the differences in the incidence of primary osteoarthritis of knee and traumatic arthritis of ankle. This article discusses the staging treatment of ankle arthritis.

Post-stroke depression is the most common brain dysfunction after stroke, which can delay the recovery process after stroke, increase the disability rate, mortality rate and recurrence rate of stroke. In-depth understanding of depression caused by stroke is conducive to the timely identification of post-stroke depression, which is convenient for early intervention and promotes patient recovery.

Enuresis (NE) is a common disease in children and adolescents. If it is not treated in time, it often has adverse effects on the physical and mental health of patients, and even causes mental disorders, emotional disorders and social disorders^[1]。 In recent years, NE has received more and more attention from the society. This consensus is compiled with reference to the NE-related guidelines of the International Association for Pediatric Urine Control (ICCS), the World Health Organization, Japan, the United States, and the United Kingdom, and combined with the results of NE-related research recently published in PubMed database and CNKI and Wanfang database, aiming to formulate and standardize the diagnosis and treatment plan of NE patients in China and the related terminology used in the diagnosis and treatment process, so as to provide clinical reference.

To investigate the clinical and imaging characteristics of distal tibiofibular synostosis in postoperative ankle fractures and its effects on the ankle mobility.

The clinical and imaging data of 47 patients with distal tibiofibular synostosis treated surgically from October 1991 to June 2013 were analyzed retrospectively. There were 30 males and 17 females, aged from 15 to 68 years with a mean age of (39±13) years. The original fracture types, internal fixation profiles, imaging features of distal tibiofibular synostosis were recorded. Ankle range of motion (ROM) and complications at the last follow-up were also evaluated.The ROMs of healthy and fractured sides were compared with paired sample rank test.

The patients were followed up for 3 to 204 months (mean 25.4 months). Of the patients, 34(72.4%) were ankle fractures, 7(14.9%) were distal tibiofibular fractures, 1(2.1%) was tibiofibular shaft fracture, 2(4.3%) were tibial shaft fractures associated with lateral malleolus fracture and the resting 3(6.4%) were Pilon fractures. In patients with ankle fractures, 76.5%(26/34) of the synostosis occurred at the distal tibiofibular syndesmosis, while 23.5%(8/34) at the proximal of the tibiofibular sydesmosis; in patients with distal tibiofibular fracture, 85.7%(6/7) of the tibiofibular synostoses occurred at the fracture sites. The synostosis occurred at the level of syndesmotic screws in 8 patients (88.9%, 8/9) fixed with distal tibiofibular syndesmotic screws. And synostosis occurred at the sites of the distal locking screws in all (3/3) of the patients fixed with intramedullary nails. At the last follow-up, the active plantarflexion, active dorsiflexion and passive dorsiflexion in the affected side was 0°(0°, 5°), 2°(0°, 5°), 5°(0°, 10°) less than those in the healthy side, respectively (Z=-3.493, -4.491, -5.130, all P<0.05).During the follow-up, 4 patients complained of lateral ankle discomfort with no impact on daily life.

Post-operative distal tibiofibular synostosis mainly occurs at the sites of fractures, distal tibiofibular syndesmotic screw sites and the sites of the distal locking screws of tibial intramedullary nails. ROM of the injured ankle decreases in comparison with that at the contralateral side, although no obvious symptoms are observed and no intervention needed.

To discuss the methods and clinical outcomes of selective tarsometatarsal (TMT) arthrodesis for old Lisfranc injury.

The clinical data of 36 cases with old Lisfranc injury treated by selective arthrodesis from January 2010 to October 2016 in the Department of Orthopedics in Shanghai Sixth People′s Hospital were analyzed retrospectively. There were 16 males and 20 females in this group with a mean age of (40±6) years. The information of pre-operative and post-operative X-ray, American Orthopaedics Foot and Ankle Society (AOFAS) midfoot score and pain Visual Analogue Scale (VAS) score was collected. The complications were also recorded. The pre- and post-operative data were compared with t test.

The 36 patients got a follow-up for at-least 2 years (averaged (4.3±1.6) years, ranged from 2 to 8 years). The post-operative AOFAS midfoot score was improved from (44±7)(28-60) to (83±7)(76-97)(t=-37.1, P<0.05), and the VAS score decreased from (6.3±2.5)(5-9) to (1.6±1.3)(0-3)(t=23.7, P<0.05). Implant breakage occurred in two patients and the symptom was relieved after the removal of implants.

The selective TMT arthrodesis for old Lisfranc injury may relieve the symptoms, improve the function and life quality of patients by restoring the medial arch and midfoot and forefoot alignment.

To evaluate the effects of modified posteromedial approach combined raft technique in the treatment of posterior Pilon fractures with collapsed articular surface.

A retrospective analysis was conducted on the clinical data of 51 patients with posterior Pilon fractures combined with collapsed articular surface treated in West China Hospital between January 2014 and June 2017. There were 30 males and 21 females with an average age of 49 years (range, 19-66 years).Subjective assessment of the results was performed according to the pain visual analog scale (VAS).The general function recovery was assessed with American Orthopaedic Foot & Ankle Society (AOFAS) ankle hindfoot scale at the latest follow-up. The fracture reduction quality was determined according to Burwell-Charnley imaging standard by the anteroposterior(AP)/mortise X-ray view and three-dimensional CT of the ankle on the 3rd day after operation. The t-test was used to compare the normal distribution parameters.

Primary healing of incision and bone were obtained in all patients without loosening, breakage or infection of internal fixation in (3.7±0.7) months (range, 3-6 months). According to the Burwell-Charnley′s standards, 50 cases achieved anatomical reduction, 1 case achieved fair reduction. According to AOFAS scales, the results were excellent in 41 cases, good in 9, and fair in 1; the excellent rate was 98.0%. According to the AOFAS scores, the average score was 93.6±2.2. The preoperative VAS score was 7.5±1.1, and the postoperative score was 0.3±0.7, in which the difference was statistically significant (t=31.231, P=0.000). At the last follow-up, the angle of injured side were 13.3°±3.4° in dorsal extension, 33.5°±4.7° in plantar flexion, and 46.9°±6.1° in the range, while angel of uninjured side were 19.8°±2.3°, 36.0°±5.7° and 55.6°±2.7°, respectively; there were significant differences in the up-mentioned indexes between the both sides (t=78.932, 121.231, 113.432, all P<0.05).

Excellent short-term effectiveness can be achieved through the modified medial approach in patients with posterior Pilon fractures, which can be used to restore the ankle joint surface under direct vision; and with the raft technique, a small plate is used to fix small fragments firmly with less soft tissue complications.

To evaluate the related risk factors of cerebrovascular complications after carotid endarterectomy (CEA) and to improve the efficacy of CEA in the treatment of ischemic stroke.

The clinical data of 295 patients with atherosclerotic carotid artery stenosis who underwent CEA in the Department of Vascular Surgery, Beijing Anzhen Hospital, Capital Medical University from January 2013 to March 2017 were retrospectively analyzed.

As the results of the single-factor analysis of logistics, severe lower limb artery stenosis (RR=5.667, P=0.017), systolic blood pressure before the carotid artery clamping (RR=6.659, P=0.010), diastolic blood pressure before the carotid artery clamping (RR=3.981, P=0.046), stump pressure (RR=5.359, P=0.021), diastolic blood pressure after surgery (RR=9.550, P=0.002), diastolic blood pressure of the first day after surgery (RR=7.932, P=0.005) were influencing factors of postoperative cerebrovascular complications after CEA. The results of multi-factor analysis of logistic regression indicated that diastolic blood pressure before the carotid artery clamping (RR=0.953, P=0.024) and stump pressure to basic systolic blood pressure index (SSI)>0.25 (RR=0.086, P=0.049) were independent risk factors for postoperative cerebrovascular complications after CEA.

Systolic blood pressure before carotid artery clamping and SSI>0.25 are independent risk factors for postoperative cerebrovascular complications after CEA. Close follow-up and drug treatment for patients after CEA might be beneficial to reduce postoperative carotid artery restenosis.

To investigate the prognostic values of preoperative prognostic nutritional index (PNI) in patients with lower-grade gliomas.

In the study, 379 patients with pathological diagnosis of lower-grade gliomas were enrolledwhich were confirmed in The First Affiliated Hospital of Zhengzhou University (2011-02 to 2016-05). Kaplan-Meier method was used to calculate the survival rates. log-rank was used to calculate the differences in group. Cox regression model was used to conduct multivariate analysis.

The cutoff value of PNI was 46.70. The median survival time of PNI≤47.80 and PNI>47.80 subgroups were 46.76 and 67.37 months with statistical significance (P<0.001). High PNI predicted a better survival rate. Multivariate survival analysis demonstrated that low PNI was an independent risk factor to evaluate the prognosis of glioma patients. In lower-grade gliomas, high PNI predicted better survivals in TERT mutation only (P=0.003) and triple-negative group (P=0.007).

In lower-grade gliomas, low PNI predicts worse survivals and PNI have differential prognostic significances in molecular groups of lower-grade gliomas.

To explore the efficacy of dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) histogram molecular imaging index, apparent diffusion coefficient (ADC) in different types of lung cancer and explore their correlation with Ki-67.

A total of 33 cases of lung cancer patients confirmed by pathology in Shaoxing People′s Hospital from March 2017 to March 2018 were collected, 28 males and 5 females aged 50-85 years old, including 15 cases of squamous cell carcinoma, 12 cases of adenocarcinoma, and 6 cases of small cell carcinoma. All patients performed DCE-MRI and DWI imaging within one week before surgery or puncture. ADC values, DCE-MRI quantitative perfusion parameters by histogram metrics analysis (mean value, skewness, kurtosis, uniformity, entropy, energy, quantile) of K^trans, K_ep, V_e, and V_p were then collected. Ki-67 expression in lung cancer tissue was detected by immunohistochemical method. One-way analysis of variance and least significant difference were used to compare the differences among the parameters of the three groups which were normal distribution and equal variances, while Kruskal-Walls test and Mann-Whitney U test were used to compare the parameters that did not conform to normal distribution or variance. Pearson correlation analysis was used to compare the correlations between quantitative perfusion histogram parameters, ADC values and immunohistochemical scores of Ki-67.

The Ki-67 count in small cell lung cancer(458±82,P=0.011) and squamous cell carcinoma(355±277, P=0.034)were significantly higher than that in adenocarcinoma (168±164). The correlation analysis showed that there was a significant negative correlation between ADC values and Ki-67 (P=0.018, r=-0.416). And V_e (Q5, Q10) was negatively related to Ki-67 (P=0.017, r=-0.420; P=0.040, r=-0.366). In squamous cell carcinoma patients, V_e (homogeneity) was significantly negatively correlated with the expression of Ki-67 (P=0.033, r=-0.570). K^trans(homogeneity) and V_e (homogeneity, Q5, Q10, Q25) were significantly positively correlated with ADC values (P value from 0.001 to 0.035, r value from 0.545 to 0.765).

DCE-MRI quantitative perfusion histogram parameters, ADC value can evaluate the lung cancer cell proliferation activity in different pathological types.

To evaluate the relationship between the femoral trochlear dysplasia(FTD) and the degeneration of the patellofemoral cartilage by using MR T2mapping technique.

Sixty two subjects with FTD(aged 18-45 years) were enrolled in Tianjin First Center Hospital from January 2016 to December 2017,the controls which both age and gender were matched.T2mapping scan were aquired for each subject and control. Compare the differences of the T2mapping values for each area between subjects and controls, and compare Dejour types of femoral trochlear in different age groups, respectively.

The T2mapping value of subjects was significant lower than controls: the superficial-femoral-lateral layer (sFL) (P=0.000) and the superficial-patella-lateral layer (sPL) (P=0.009). In the group of age less than 30 years, the T2mapping value of subjects was significant lower than controls:sFL (P=0.001) and sPL (P=0.015). In group of age greater than 30 years, the T2mapping value of subjects was significant lower than controls: sFL (P=0.035). In difference Dejour types of FTD, the T2mapping value of type B-D was lowest in sFL(P=0.014),sPL(P=0.000), the superficial-patella-medial layer (sPM) (P=0.020) and the the T2mapping value of type B-D was highest in the deep-femoral-medial layer (dFM) (P=0.006). The difference was statistically significant, P<0.05.

The FTD might cause the early degeneration of patellofemoral cartilage, which significantly appear in the young age; The type B-D of FTD is more likely to cause the wider range of superficial cartilage injure and involved some part of deep layer; the injure shows dehydration change in superficial cartilage and edema in deep layer.

The identification of neovascularization in carotid plaque in carotid artery stenosis by contrast-enhanced ultrasound (CEUS) provides other risk markers for stroke besides carotid artery stenosis -intraplaque neovascularization.

From January 2017 to September 2017, 40 patients with carotid atherosclerosis plaque were examined by contrast-enhanced ultrasound in China-Japanese Friendship Hospital. The enhancement intensity (EI) measured by contrast-enhanced ultrasound was compared with the micro-vessel density (MVD) measured by histopathology after carotid endarterectomy (CEA). Contrast-enhanced ultrasound was used to observe whether there was enhancement in the plaque and the enhancement was divided into 0-2 grades. The EI in plaque, the ratio of EI in plaque to EI in carotid artery lumen were calculated by time intensity curve quantitative analysis software. Pathological sections of carotid plaques after CEA were stained with CD34 and neovascularization density was measured.

There were significant differences in age, EI1, EI1/EI2 and CD34 among patients with different grades of plaque enhancement (P<0.05), but no significant differences in gender and EI2 (P>0.05). The density of neovascularization obtained by CD34 staining was highly positively correlated with EI1 (r=0.836, P<0.001), EI1/EI2 (r=0.955, P<0.001), but not with age (r=0.066, P=0.684), EI2 (r=0.159, P=0.328).

Contrast-enhanced ultrasound can observe the neovascularization in carotid plaque, which is a simple and non-invasive method to evaluate the stability of carotid plaque. CEUS may also help to extract features of vulnerable plaques, such as acute intraplaque hemorrhage.

To analyze MRI findings of hypovascular clear cell renal cell carcinoma.

The clinical data and MRI findings of patients with hypovascular clear cell RCC confirmed by pathology from February 2016 to March 2017 were retrospectively analyzed in General Hospital of Chinese People′s Liberation Army. According to the diameter of the lesions, they were divided into two groups of diameter ≤4 cm and group of diameter > 4 cm. The data was analyzed by using χ ² to compare clinical data and tumor imaging characteristics between the two groups.

Thirty-four patients had 34 hypovascular lesions.The solid part of the tumor showed a slightly hypo- and isointense in 31 lesions, and high signal in 3 lesions; T₁WI showed slightly lower and equal signal in 29 lesions and high signal in 5 lesions; DWI showed equal low signal in 10 lesions, 24 tumors were mainly high signal; 33 lesions showed pseudo-capsule; tumor hemorrhage in 12 lesions, necrosis in 9 lesions and cystic change in 22 lesions, lipid component in 4 lesions. There were 19 lesions with diameter ≤ 4 cm and 15 lesions with diameter > 4 cm. The surgical methods and bleeding in the lesion were statistically different between the two groups ( P<0.05).

The MRI findings of hypovascular clear cell RCC are low signal on T₂WI, high signal on DWI mainly, less lipid. Laparoscopic radical resection was more suitable for lesions with diameter >4 cm and these lesions were more likely to bleed within the tumor.

To investigate the relationship of STOX1expression and pathogenesis of early onset preeclampsia.

65 cases of preeclampsia women who delivered in Shanghai Pudong Hospital from October 2015 to June 2018, were recruited, which included 31 cases with early onset preeclampsia (early onset group, gestational week<34 weeks) and 34 patients with late onset preeclampsia (late onset group, gestational week ≥34 weeks). 34 cases women who received caesarean section because of pelvic structural deformities, breech presentation, macrosomia and social factors were included as the control group(gestational week ≥34 weeks) were selected as control group.The expression and localization of STOX1 mRNA and protein in placenta of three groups of maternal were evaluated by immunohistochemistry SP, RT-qPCR and Western blotting.

(1) The expression of STOX1 in placenta mainly distributed in the cytoplasm of placental syncytiotrophoblasts, cytotrophoblasts, vascular endothelial and mesenchymal cells, a few in the cell nucleus.The staining intensity of STOX1 in early onset group was significantly stronger than that in late onset group, the staining intensity of the late onset group was similar to that of the control group. The positive expression rates of STOX1protein in early onset group, late onset group and control group were 96.8%(30/31), 70.6%(24/34), 67.6%(23/34) respectively, which was higher in early onset group than that in late onset group(P=0.005). There was no statistical difference of STOX1 level between the late onset group and the control group(P=0.793). (2)Relative expression of STOX1 mRNA in early onset group, late onset group and control group were 0.054 3±0.003 5,0.037 5±0.000 7,0.035 2±0.000 4 respectively, which was significantly higher in early onset group than that in late onset group(P<0.05), while there was no statistical difference between the late onset group and the control group(P>0.05).(3)Relative expression level of STOX1 protein in early onset group, late onset group and control group were 0.78±0.04,0.59±0.020 and 0.54±0.018 respectively, which is higher in early onset group than that in late onset group(P<0.05). There was no statistical difference of STOX1 level between the late onset group and the control group(P>0.05).

The pathogenesis of early onset and late onset preeclampsia may be different. Up-regulated expression of STOX1 in placenta may be associated with the pathogenesis of early onset preeclampsia.

This patient came to the hospital mainly because of dizziness for 6 days. The patient had a previous history of epilepsy. CT on admission showed that the temporal horn of the left ventricle occupied space, with a slightly lower density inside, and spotty calcification at the edge. Further MRI examination showed that the lesion was located in the left hippocampus and partially protruded into the temporal horn of the left lateral ventricle, resulting in obstruction of cerebrospinal fluid circulation and enlargement of the temporal horn of the lateral ventricle. Specialist hospital consultation: epithelioid glioblastoma, BRAF V600E mutant. CT examination after surgery revealed total resection of the tumor. This paper discusses the imaging, clinical and histopathological features of E-GBM in order to provide some valuable information for the preoperative diagnosis of E-GBM.

This article reports the precautions of anesthesia in patients with Debakey type Ⅲ aortic dissection undergoing radical gastrectomy. For patients with Debakey type III aortic dissection undergoing non-cardiovascular surgical anesthesia, the core idea of "ensuring perioperative hemodynamic stability and adequate sedation and analgesia" must be taken to avoid the rupture of existing dissection, so that patients can safely and smoothly pass the perioperative period.

Progressive supranuclear palsy (PSP) is a neurodegenerative disease with vertical supranuclear ocular movement disorder and balance disorder as the main clinical manifestations. Its non-motor symptoms may precede motor symptoms and aggravate the severity of the disease. Usually, we pay more attention to the non-motor symptoms such as cognition and neglect the symptoms of autonomic nervous function. Now, the related research on PSP autonomic nervous dysfunction in digestive system, cardiovascular system, genitourinary system and perspiration function is reviewed and summarized.

General anesthesia or general anesthesia combined with epidural anesthesia were used for pheochromocytoma surgery. Invasive arterial pressure and central venous pressure were monitored during the operation, and transesophageal echocardiography and pulmonary arterial pressure were monitored in severe patients. Hypertension and arrhythmia were controlled before ligation of tumor veins, and hypotension was avoided by volume expansion and drug support after ligation. It is necessary to be alert to the possibility of catecholamine cardiomyopathy, multiple endocrine tumors and undiagnosed pheochromocytoma. Pregnancy complicated with pheochromocytoma should be determined according to the time of discovery.