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BACKGROUND:Accurate reduction of ankle fractures under direct vision has become a common understanding among foot and ankle surgeons.How to fully expose free or compressed fragments of the posterior ankle remains one of the most challenging problems. OBJECTIVE:To explore the clinical efficiency of the para-Achilles tendon approach in exposing and repositioning the posterior malleolus sandwich fracture. METHODS:A retrospective study was made for 26 patients with posterior malleolus sandwich fracture treated with open reduction and internal fixation via para-Achilles tendon approach from January to December 2020 in The Second People's Hospital of Dalian.21 of 26 cases were managed with the lateral approach of Achilles tendon and 5 cases were managed with the medial approach of Achilles tendon.There were 19 males and 7 females,with the age of 24-69 years,averagely 38.6 years.The operation time and postoperative complications were recorded.The fracture reduction condition was evaluated by Burwell-Charnley imaging standard.Before operation,3 months after operation and last follow-up,visual analog scale score,ankle plantar flexion and dorsiflexion and American Orthopedic Foot&Ankle Society Ankle Hind Score were used to evaluate the treatment effect. RESULTS AND CONCLUSION:(1)All 26 patients were followed up for an average of 14.6 months(range 13-18 months).The operation time was 52-85 minutes(average 64.2 minutes).(2)Part of the skin edge of the lateral malleolus incision was necrotic in one patient and healed completely after a dressing change.Incision healing of the other patients was in one stage.(3)Through Burwell-Charnley imaging standard,anatomical reductions were obtained in 24 of 26,and good reductions were in 2 of 26,with an excellent and good rate of 100%.(4)At the last follow-up,the visual analog scale score(1.19±0.40)was significantly lower than the preoperative score(6.81±0.80)(P<0.01).Ankle plantar flexion(33.5±5.02)° and ankle plantar back stretch(17.23±0.99)° were significantly increased compared with preoperative data(14.58±2.50)° and(5.81±1.02)°(P<0.01).American Orthopedic Foot&Ankle Society Ankle Hind Score was improved to(89.31±3.62)points compared to preoperative(46.00±5.45)points(P<0.01).The results were excellent in 23 patients and good in 3 patients,with an excellent and good rate of 100%.(5)It is concluded that the open reduction and internal fixation via the para-Achilles tendon approach for the treatment of posterior malleolus sandwich fracture were efficient with decreased operation time,satisfying fracture reduction,fewer complications,satisfactory motion range,and functional recovery.

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Objective:To evaluate the clinical outcomes of Chaput tuberosity osteotomy and lateral malleolus sagittal osteotomy in the treatment of talus osteochondral lesions with autologous osteochondral transplantation (AOT).Methods:From January 2017 to December 2019, Chaput tuberosity osteotomy and lateral malleolus sagittal osteotomy were performed in the AOT treatment of 11 patients with talus osteochondral lesions. They were 9 men 2 women, with a mean age of 32. 6 years (range, from 22 to 45 years). Their lesions were all Hepple type V. Their American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS), International Knee Documentation Committee Knee Evaluation Form (IKDC) score, and imaging data were measured pre- and post-operatively for assessment of clinical outcomes.Results:All the patients were followed up for 13 to 24 months (average, 15.6 months). Their AOFAS (94.3±2.9) and VAS (1.2±0.4) scores at the final follow-up were significantly improved compared with the pre-operative values (49.5±6.6 and 5.7±1.2) ( P<0.05). There was no significant difference between their pre- and post-operative IKDC scores for the ipsilateral knee joint ( P>0.05). The imaging showed that the talus cystic change disappeared and the grafted bone was fully fused with the talus with no abnormal change in the joint space. Conclusion:In the AOT treatment of talus osteochondral lesions, Chaput tuberosity osteotomy and lateral malleolus sagittal osteotomy can obviously relieve ankle pain and improve ankle function.

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BackgroundSevere acute respiratory coronavirus 2 (SARS-CoV-2) is a newly identified virus which mainly spreads from person-to-person. Presence of SARS-CoV-2 has been constantly reported in stools of patients with coronavirus disease 2019 (COVID-19). However, there is a paucity of data concerning fecal shedding of the virus in pediatric patients. ObjectiveTo investigate dynamic changes of SARS-CoV-2 in respiratory and fecal specimens in children with COVID-19. MethodsFrom January 17, 2020 to February 23, 2020, three pediatric cases of COVID-19 were reported in Qingdao, Shandong Province, China. Epidemiological, clinical, laboratory, and radiological characteristics and treatment data of these children were collected. Real-time fluorescence reverse-transcriptase-polymerase-chain reaction (RT-PCR) was performed to detect SARS-CoV-2 RNA in throat swabs and fecal specimens. Patients were followed up to March 10, 2020, the final date of follow-up, and dynamic profiles of RT-PCR results were closely monitored. ResultsAll the three pediatric cases were household contacts of adults whose symptoms developed earlier. Severity of disease was mild to moderate and fever was the most consistent and predominant symptom at onset of illness of these children (two cases had body temperature higher than 38.5{degrees}C). All children showed increased lymphocytes (>4.4x109 /L) with normal white blood cell counts on admission. Radiological changes were not typical for COVID-19. All children showed good response to supportive treatment. Clearance of SARS-CoV-2 in respiratory tract occurred within two weeks after abatement of fever, whereas viral RNA remained positive in stools of pediatric patients for longer than 4 weeks. Two children had fecal SARS-CoV-2 turned negative 20 days after throat swabs showing negative, while that of another child lagged behind for 8 days. InterpretationSARS-CoV-2 may exist in gastrointestinal tract for a longer time than respiratory system. Persistent shedding of SARS-CoV-2 in stools of infected children indicates the potential for the virus to be transmitted through fecal excretion. Massive efforts should be made at all levels to prevent spreading of the infection among children after reopening of kindergartens and schools.

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Objective To investigate the potential diagnosis value of tumor signal enhancement rate (SER)combined with long-to-short axis ratio of breast lumps in axillary lymph node metastasis in patients with breast cancer by using dynamic contrast-enhanced MRI (DCE-MRI).Methods patients with primary breast cancers were enrolled in the study,MR examinations were performed before surgeries.SER features and long-to-short axis ratio of breast lumps were obtained.Receiver operating characteristic curves (ROC) were plotted to assess the diagnostic performance.Results When MR SER ≥180.5% and long-to-short axis ratio of breast lumps ≤0.56,the diagnostic performance of the combination in terms of AUC was the highest (AUC=0.826),in comparison with that of MR SER or long-to-short axis ratio of breast lumps alone.The associated sensitivity and specificity were 93.8% (60/64)and 88.7% (47/53),respectively.Conclusion The combination of MR SER and long-to-short axis ratio of breast lumps can further improve the ability to identify lymph node metastasis in patients with breast cancer in DCE-MRI,and provide a reference basis for clinical therapy and prognosis.

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BACKGROUND:Conventional imaging method has significant limitations in the diagnosis of knee meniscus injury, which is difficult to detect the ful extent of the knee meniscus. OBJECTIVE:To evaluate the knee meniscus injury with magnetic resonance imaging. METHODS:The knee meniscus injury patients diagnosed with clinical treatment were retrospectively analyzed, and the characteristics of the magnetic resonance imaging were analyzed and graded. Then, the meniscus injury was analyzed and compared with the arthroscopic or surgical results. RESUTLS AND CONCLUSION:In the magnetic resonance imaging of knee meniscus injury, the Ⅰ level knee meniscus injury was presented as the punctate or round high signal that did not contacted with the surface of the meniscus, Ⅱ level knee meniscus injury was presented as the horizontal or oblique line or strip-like high signal in the meniscus, and Ⅲ level knee meniscus injury was presented as lines and complex high signal in the meniscus that extended to the articular surface of the meniscus, and accompanied with morphological changes of the meniscus. Magnetic resonance imaging, as a noninvasive checking method, can clearly show the meniscal degeneration and tearing, and correctly diagnosed the location, shape and severity of meniscus injury, which has significant guiding value in determine the clinical treatment options.

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<p><b>OBJECTIVE</b>To investigate the association of two single nucleotide polymorphisms (SNPs) of beta 2-adrenoceptor (beta 2-AR) gene with hypertension in elderly patients.</p><p><b>METHODS</b>The study samples were collected from unrelated Chinese Han population of Dabie Mountain in Anhui province. Eighty-six elderly patients with hypertension and 43 controls were selected. Genotypes of +1053 and +1239 SNPs were typed by polymerase chain reaction-restriction fragment length polymorphism.</p><p><b>RESULTS</b>The frequencies of the two SNPs complied well with the Hardy-Weinberg equilibrium in normal group. The distribution of genotypes AA, GA,GG of the SNP at locus +1239 in moderate and severe hypertension group was significantly different from that in normal group (chi square=8.67, P<0.05). There were evident differences in the frequencies of alleles of the two groups (chi square=4.02, P<0.05). No significant difference was observed in the distribution of genotypes of the SNP at locus +1053 between the two groups.</p><p><b>CONCLUSION</b>These data indicate that the SNP at locus +1239 of beta 2-AR gene is associated with hypertension in elderly patients.</p>

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Objective To evaluate the CT findings of invasive pulmonary aspergillosis(IPA) in patients with leukemia.Methods Plain CT scanning of chest was performed in 9 cases of leukemia in company with IPA proved by sputum culture.5 of them underwent over twice CT re-scanning,CT findings of IPA were analysed.Results The lesions were seen more common in the bilateral upper lobe and dorsal segment of lower lobe,mainly located in the peripheral and sub-pleural lung field.Of the 9 cases,the lesions appeared as multi-nodular shadows in 5,single nodule in 2 and sub-pleural consolidation with ground-glass opacity around them in 2,of these 2 cases,one accompanied by multi-nodules.Halo-sign around the nodules in 6 cases and air cresent sign or cavity in 6 were seen.There were scattered ground-glass opacities and patchy attenuations in the bilateral lung in 4 cases.The adjacent pleura of lesion was slightly thinkened in 5 cases.Conclusion The incidence of IPA in leukemia patients is rather high,and CT features of IPA are of certainly characteristics.

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Objective To evaluate the correlation between the contrast enhanced features on spiral computed tomography(SCT) and microvessel density(MVD),TP,TGF-?_1 expression.Methods Forty seven cases with hepatocellular carcinoma(HCC) proved pathologically were examined with enhanced dual-phase SCT scanning at the arterial phase and the portal vein phase.The SCT features including the size of HCC lesions,enhanced patterns,capsule patterns,the diameter of tumor,intrahepatic daughter foci and tumor-emboli in portal veins were studied.The expression of TP,TGF-?_1 and MVD were detected by immunohistochemical SP method.The enhanced features of SCT were compared with the immunohistochemical results and clinicopathological characteristics of HCC.Results TP and MVD were correlated with metastasis and capsule patterns(P0.05).Conclusion The expression of TP,TGF-?1 and angiogenesis of HCC can be evaluated by some SCT features in a certain degree.

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Superoxide dismutase was prepared from human crythrocytes. The sample was purified using a DEAE-cellulose column and chromatography on Sephadex G-75. During purification the produce determined the protein peak and SOD active peak at the same time to decide the SOD was present. The enzyme exhibited an ultraviolet absorption spectra with a maximum at 270-275 nm. Polyacrylamide disc gel electrophoresis revealed three bands which were in dose agreement with the active bands by reduction of NBT. The molecular weight was 41687, 31623 and 15136. The specific activity of human SOD possessed 3300 units per mg It contained 2 eq of Cu, Zn per mole of enzyme, respectively.