简介：AbstractPurpose:The most popular surgical approach to manage Lisfranc fracture-dislocations is the double-incision approach, which frequently causes a variety of complications, such as skin necrosis, rotational malreduction of the first tarsometatarsal joint (TMTJ) and lateral column dorsoplantar malreduction of the TMTJ. We introduce a three-incision approach to treat Lisfranc fracture-dislocations with only minor postoperative complications and good foot function.Methods:We prospectively selected 30 previously healthy patients, ranging from 18 to 60 years of age, but only 23 patients completed the follow-up and thus were finally included, with an average age of 38.1 ± 12.9 years. All patients have sustained Lisfranc fracture-dislocations involving all three-column; 13.0% (3/23) were Myerson classification type A (medial), 47.8% (11/23) were type A (lateral), and 39.1% (9/23) were type C2. All patients were treated via a three-incision approach: a long incision made along the lateral border of the second ray was used as a working incision to visualize and reduce the first three TMTJs, as well as to apply internal fixation instrumentation; a 2 cm medial incision was made at the medial side of the first TMTJ as an inspecting incision, ensuring good reduction of the first TMTJ in medial and plantar view; another 1 cm inspecting incision was made at the dorsal side of the fourth/fifth TMTJ to prevent sagittal subluxation of the lateral column. Mean ± SD was used for quantitative data such as operation time, follow-up time and foot function scores. Postoperative complications were documented, and foot function was evaluated using the American orthopaedic foot & ankle society score, foot function index and Maryland foot score at follow-up. The foot function of the injured foot and contralateral foot of the same patient was at the end of follow-up, and independent sample t-test was used for statistical analysis.Results:The median operation time was 117.9 ± 14.6 min (range 93 - 142 min). All complications occurred within three months after the operation, and included delayed wound healing (17.4%), superficial infection (8.7%), complex regional pain syndrome (4.3%) and neuroma (4.3%). There was no case of postoperative skin necrosis or malreduction. At the end of follow-up of 14.1 ± 1.2 months (range 12-16 months), the median American orthopaedic foot & ankle society score of the operated foot was 89.7 ± 5.7, the median foot function index was 21.7 ± 9.9, and the median Maryland foot score was 88.7 ± 4.8. There were no significant differences between the operated and contralateral sides, in terms of foot function, at the end of followup (p > 0.05).Conclusion:The three-incision approach can provide adequate visualization of all TMTJs to ensure anatomical reduction and offer sufficient working space to apply internal fixation instrumentation, which is effective in treating three-column Lisfranc fracture-dislocations with minor soft tissue complications and satisfactory functional recovery.

简介：Thesethreecasesofreinfectionsyphilisallhadcompletemedicalhistories,clinicalsymptoms,andlaboratoryrecordsofpriorprimaryorsecondarysyphilisinfection.Theauthorheldthatthemainreasonforreinfectionwasfailureofdiagnosisandtreatmentofsexpartners.

简介：TheLargeIntestineMeridianofHand-Yangming1.TheMeridian[Course]Startingfromtheradialsideofthetipoftheindexfinger,goingupwardthroughtheregionbetweenthe1stand2ndmetacarpalbonestoreachtheradialsideofthewrist;thenpassingalongtheradialsideofthedorsalaspectofthearmtotheshoulderwherethemeridianturnstothesupraclavicularfossa;enteringthechesttoconnectwiththelungandjoinwithitspertainingorgan,thelargeintes-tine.

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简介：TheGallBladderMeridianofFoot-Shaoyang1.TheMeridian【Course】Themeridianstartsfromtheoutercanthusandgoestowardsthetemplere-gion.Travellingthroughtheretroauricularre-gion,itreachestheshoulderandentersthesupraclavicularfossa.Abranch,separatingfromtheretroauric-ularregion,enterstheearandcomesoutinfrontoftheeartoreachtheoutercanthus.Anotherbranchgoesdownwardfromtheoutercanthustomeettheotherpartofthemeridianatthesupraclavicularfossa.Thestraightportionofthemeridiande-scendsfromthesupraclavicularfossathroughthehypochondriumandreachesthehipjoint.Theinnerportionofthemeridianpassesthroughthediaphramtoconnectwiththeliverandenterthegallbladder,itspertainingor-gan.Furtherdownwarditemergesfromthe

简介：Arthritisreferstotheinflammationofthejointscausedbyvariouskindsofetiologies.Clin-ically,therearerheumaticarthritis,rheumatoidarthritis,goutyarthritisandosteoarthritis.Arthritisistermed"BiSyndrome"intradi-tionalChinesemedicine."Bi",inChinese,means"stagnation"or"obstruction".Tradition-alChinesemedicineholdsthatBisyndromere-sultsfromtheinvasionofpathogenicwind,coldanddampness,orwind,coldandheat.Upontheinvasion,thesepathogenswillcauseobstruc-

简介：AbstractHuman-elephant conflict (HEC) in India is becoming a growing health problem causing many fatalities every year. Elephants produce injuries by trampling, stomping, squeezing, tossing in the air, or crushing/targeting the head and chest commonly. The adult elephants are most aggressive in their mating season, leading to maximum incidences of HECs in this period. These attacks are mostly unprovoked, though most HECs are provoked. In this case series, the authors described the injuries sustained by three survivors in a short span of one month due to the sudden and unprovoked elephant attack. All the injuries were mild to moderate in severity and involved the chest in common. Timely rescue and prompt initiation of treatment were pivotal in their survival. The authors also want to create awareness about the mating season of elephants to minimize these unfortunate events in the future.

简介：Objective:Toinvestigatetheclinicalfeaturesandthereasonofmisdiagnosisofconsolidativeprimarypulmonarylymphoma.Methods:Retrospectivestudywasconductedforthreecaseswithconsolidativeprimarypulmonarylymphoma(PPL).Therelevantliteraturesofprimarypulmonarylymphomainrecentyearswerealsoreviewed.Results:Allpatientshadbeenmisdiagnosedforalongtimeduetothenon-specificclinicalfeatures.Conclusion:ConsolidativePPLisdifficulttodiagnoseandismisdiagnosedfrequentlyinclinic.DefinitivediagnosisofPPLrequiresanadequatebiopsyspecimen.Themostimportantprognosticfactoristhehistology.

简介：Rabbitlimbalcornealepithelialcells,cornealendothelialcellsandkeratocyteswereculturedonamnioticmembrane.Phasecontrastmicroscopeexaminationwasperformeddaily.Histologicalandscanelectronmicroscopicexaminationswerecarriedouttoobservethegrowth,arrangementandadhesionofcultivatedcells.Resultsshowedthatthreecornealcelltypesseededonamnioticmembranegrewwellandhadnormalcellmorphology.Culturedcellsattachedfirmlyonthesurfaceofamnioticmembrane.Cornealepithelialcellsshowedsingularlayerorstratification.Cellboundarieswereformedandtightlyopposed.Cornealendothelialcellsshowedcobblestoneorpolygonalmorphologiccharacteristicsthatappeareduniforminsize.Thecellulararrangementwascompact.Keratocyteselongatedandshowedtriangleordendriticmorphologywithmanyintercellularjointswhichcouldformnetworks.Inconclusion,amnioticmembranehasgoodscaffoldproperty,diffusioneffectandcompatibilitywithcornealcells.Thebasementmembranesideofamnioticmembranefacilitatedthegrowthofcornealepithelialcellsandendothelialcellsandcelljunctionsweretightlydeveloped.Thespongylayerofamnioticmembranefacilitatedthegrowthofkeratocytesandintercellularjointswererich.Amnioticmembraneisanidealbiomaterialforlayeringtissueengineeredcornea.

简介：Thankstothedevelopmentofmetallographicandopticaltechniques,thequantitativecharacterisationofthegeometryofroughsurfaceshasbecomeveryusefulinpracticalapplications.Today,numerousdifferentmethodsareavailablefordeterminingthreedimensionalco-ordinates,linearprofilesorheightcontourstoareasonabledegreeofaccuracyandwithinanacceptabletimeframe,andforevaluatingsuchdata.Inthisarticle,theuseofsuchtechniquesinthefieldoffractographyisdemonstratedwithreferencetoanumberofcasestudiesdealtwithbytheauthor'sownteam,supplementedbyseveralexamplesfromotherresearchgroups.Thefollowingexamplesarediscussed:Inaceramicmaterialdifferentfracturepathswerediscernedcorrespondingtodifferenttesttemperatures.Inhardmetals,itwasshownthathoththesub-criticalandsupercriticalpropagationofcracksoccurreddalongthesamepath.Frommeasurementsoftheproportionoffracturesurfacesoccurringalongandinthevariousdifferentphasespresentandthedepthofdimplesoccurringduringductilefractureinthebinderphase,thefractureenergyofEC-Co-hardalloyswithdifferentcobaltcontentsandtungstencarbidegrainsizeswascalculatedandfoundtobeinexcellentagreementwithactualexperimentalresults.Inthecaseofceramicfibre-aluminiummatrixcpmpositematerials,bymeasuringthebeightdistributionofthepositionsoffractureofthefibres,theloadtransferintheregionofthefracturesurfacewasdetermined.withthisinformationamodelwasdevelopedwhichexplainsthesignificantvariationinstrengthofthesematerialsFinally,amodelwasdevelopedformetallicmaterialsusingwhich,fromtheexperimentallydetermineddistributionsoftheheightandinclinationofthefracturefacets,thestressintensityofroughnessinducedcrackclosingcouldheaccuratelypredicted.

简介：位和手掌的degloving损害仍然是坚持的挑战。我们使用了在前面偏一边的大腿拍动与这个索引，中间和戒指手指的degloving损害对待一个18岁的、右手的男工人。拍动被指定包支撑degloving损害的三根手指的全部圆周并且形成露指手套手。三根手指的远侧的方阵的全部的长度被保留几乎完全。施主缺点被裂口厚度皮肤接枝盖住。在第一操作以后的三个月，X射线学揭示了终端phalanxexr

简介：AbstractObjective:To investigate the roles of transcription factors (TFs) in the etiology of complex human birth defects, including neural tube defects (NTDs), congenital heart diseases (CHDs), and hypospadias.Methods:We examined the overlap of genetically associated genes among NTDs, CHDs, and hypospadias. We then compared the expression profiles of these diseases based on all the detected genes and disease-associated TFs. The differentially expressed TFs that we obtained were further subjected to functional enrichment analysis to elucidate their role in the development of these birth defects.Results:TF genes were significantly enriched in complex birth defects (P= 5.95 × 10-24). NTDs, CHDs, and hypospadias showed distinct gene expression profiles compared with the controls. Although TFs could not efficiently separate CHDs from normal subjects, distinct gene expression profiles of TFs could distinguish NTDs and hypospadias from controls. Differentially expressed TFs can be used to characterize NTDs, hypospadias, and controls. The enriched TFs in biological processes (BPs) reflected the different morphological processes of NTDs, CHDs, and hypospadias.Conclusions:This study indicates that abnormal expression patterns of specific TFs may disrupt the normal requirements for developmental equilibrium through the related BPs. The investigation of genetically associated genes and gene expression profiles for the three different complex birth defects provides new insights into how the dysregulation of TFs influences their developmental process.

简介：AbstractBackground:Hemifacial microsomia (HFM), which involves multiple sites with different levels of severity, is the second most common congenital craniofacial deformity after cleft lip and palate. However, three-dimensional (3D) measurements of mandibular deformities have not yet been studied in detail. The objective of this study is to investigate the method of 3D measurements of mandibular deformities in HFM patients.Methods:A total of 48 HFM patients were included in this study. All clinical treatment for patients was performed in the Plastic Surgery Hospital of the Chinese Academy of Medical Sciences at Peking Union Medical College from June 2006 to June 2020. The patients’ 3D computerized tomography scan data were processed using medical imaging software, following four iterative steps: 3D reconstruction, mirroring, differential analysis, and partition.Results:The characteristics of the mandibular bone in HFM patients are mainly presented as follows: (1) compared to the normal side, the part of the bone body that extends from the ascending ramus to the pogonion (Po-NB) is analyzed using a dynamic process: less fullness-fullness-more fullness; (2) absences were frequently observed among the angular zones, that is, the height of the ascending ramus is deficient.Conclusions:HFM is a complicated condition with numerous variations in clinical presentation. We employed both 3D image reconstruction and computerization image processing techniques to investigate asymmetrical mandibular deformity in HFM patients in detail and with great accuracy. This will be of great use to clinicians for disease management.

简介：From1990to2000,weusedHanssonpin,AOhollow-pullingscrew,andbendablescrewtotreat150casesoffreshfemoralneckfractureandtheresultwasanalysedtocomparetheefficacyofthethreemethodsofinternalfixation.

简介：ToinvestigatetheexpressionlevelsofthreeDsbproteingenes,dsbB,dsbDanddsbG,atdifferenttimepointspostC.trachomatisinfection,mousefibroblast12cellswerechosentobeinfectedwithC.trachomatisserovarFstrainF/IC-Cal-13.C.trachomatiselementarybody(EB)-infected12cellswereharvestedimmediatelyafterEBattachmentontothecellsandevery4hourspostinfection(hpi)till44hpifortotalRNApreparation.RT-PCRassayswerethenemployedtoamplifycDNAwithprimerpairswhicharespecifictoC.trachomatisdsbgenesdsbB,dsbD,dsbGandtufArespectively.Therela-tiveexpressionlevelsofDsbproteingeneswereevaluatedascDNAratiosofgenedsbtogenetufA.OurresultsshowedthatthetranscriptionofdsbGstartedfrom12hpiandgraduallyincreasedtill44hpi.ThetranscriptionofdsbBanddsbDweredetectedat16hpiandreachedtheirpeaksat28hpiand24-28hpi,respectively.Moreover,therewasobvioustranscriptionofdsbBatthelaterstage(44hpi),butnonefordsbDatthistimepoint.WecametotheconclusionthattheexpressionlevelsofthethreeDsbproteingenesaredifferentduringthedevelopmentalcycleofC.trachomatist.Theymayplayaroleinmid-to-latestageofthedevelopmentalcycleofC.trachomatis.

简介：客观：为了选择腰部的transpedicular的一个合适的方法，在三个方法之中在不同腰部的层次拧紧固定(Roy-Camille“s方法，Magerl”s方法和杜“smethod)在中国人口。方法：三维(3-D)图象与被电子横梁CT扫描的42个成年腰部的片断的图象数据被重建。腰部的小花梗螺丝钉固定的三个方法在3-D上被模仿重建的图象和植入小花梗螺丝钉的参数被测量。结果：在从入口点的距离有统计上重要的差别到在三个方法之间的小花梗轴(P<0.001)。Thedistances由“s方法从L1是最短的到L4，并且距离测量了byMagerl”的杜测量了s方法在L5是最短的(P<0.05)。从L1没有重要差别到L2(P>0.05)，但是对在插入TSA(横向的节角度)的安全范围的L5的从L3的重要差别在三个方法之间被发现(P<0.05)。从L3到L4，TSA的插入的安全范围由杜测量了“s”和Magerls方法比那测量byRoy-Camille显著地大“s方法(P<0.05)，但是他们之间没有重要差别(P>0.05)。AtL5，TSA的插入的安全范围由Magerl测量了“s方法在三个方法之中是最大的(P<0.05)。结论：在三个方法之中，杜“因为它到小花梗轴的从入口点的距离最短，TSA的安全范围最大，s方法是从L1toL4的最好的选择；Magerl“s方法能从L3被使用到L5并且是在L5的最好的选择；Roy-Camille”s方法在L1和L2是适用的。

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简介：AbstractPurpose:Secondary displacement represents a frequent complication of conservative treatment of fractures, particularly of the distal radius. The gap space between skin and cast may lead to a certain degree movements and this increased mobility might favor redisplacement. The aim of this study was to develop a new 3D method, to measure the gap space in all 3 geometrical planes, and to validate this new technique in a clinical setting of distal radius fractures.Methods:This study applies 3D imaging to measure the space between plaster and skin as a potential factor of secondary displacement and therefore the failure of conservative treatment. We developed and validated a new methodology to analyze and compare different forearm casts made of plaster of Paris and fiberglass. An unpaired t-test was performed to document differences between the investigated parameters between plaster of Paris and fiberglass casts. The significance level was set at p< 0.05.Results:In a series of 15 cases, we found the width of the gap space to average 4 mm, being slightly inferior on the radial side. Comparing the two different casting materials, plaster of Paris and fiberglass, we found a significantly larger variance of space under casts made of the first material (p=0.39). A roughness analysis showed also a markedly significantly higher irregularity of the undersurface of plaster of Paris as compared with fiberglass.Conclusion:This study allows for a better understanding of the nature of the "gap space" between cast and skin and will contribute to develop and improve new immobilization techniques and materials.

简介：AbstractObjectives:To demonstrate three-hundred and sixty degrees of maxillary sinus (MS) surgical approaches using cadaveric dissections, highlighting the step-by-step anatomy of each procedure.Methods:Two latex-injected cadaveric specimens were utilized to perform surgical dissections to demonstrate different approaches to the MS. The procedures were documented with macroscopic images and endoscopic pictures.Results:Dissections were performed to approach the MS medially (endoscopic maxillary antrostomy and ethmoidectomy), anteriorly (Caldwell-Luc), superiorly (transconjunctival/transorbital approach), inferiorly (transpalatal approach), and posterolaterally (preauricular hemicoronal approach).Conclusion:A number of approaches have been described to address pathology in the MS. Surgeons should be familiar with indications, limitations, and surgical anatomy from different perspectives to approach the MS. This paper illustrates anatomic approaches to the MS with detailed step-by-step cadaveric dissections and case examples.

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