ObjectiveTo investigate the classification and clinical value of unilateral cervical lateral mass fracture (C3-7).MethodsFrom January 2008 to December 2017, 68 patients with unilateral cervical lateral mass fracture who had received treatment in Affiliated Hospital of Southwest Medical University, were included. According to the position of fracture, the fractures were classified into three types: articular process fractures (type A), isthmus fracture (type B), and comminution (type C). Two subtypes of articular process fractures were type A1 and type A2. Type A1 refered to articular process fracture with no or slight displacement. Type A2 refered to articular process fractures result in foraminal stenosis and nerve root compression. Single-level anterior cervical disectomy and fusion (ACDF) or anterior cervical corpectomy and fusion (ACCF) or conservative treatment was used in type A1. Posterior decompression, fixation and fusion or the method of posterior decompression associated with ACDF were suited to A2. Single-level ACDF was used in type B as well. Type C underwent two-level ACDF or ACCF or posterior procedure.ResultsThere were 35 cases of Type A1, of which 31 patients underwent single-level ACDF, 2 patients underwent ACCF, and 2 patients received conservative treatment, but one of the two underwent ACDF due to delayed cervical instability. Among the 7 cases of type A2, 4 underwent posterior foraminal decompression and posterior fusion with pedicure screw fixation, 2 underwent single-level ACDF and posterior decompression, and 1 underwent single section ACDF and posterior decompression combined with pedical screw fixation. Type C accounted for 21 cases of all targets. Fourteen performed two-level ACDF, 6 performed ACCF, and 1 performed posterior fixation with pedicure screw and expansive open-door laminoplasty. Six patients showed postoperative complications, including C5 root palsy in one case, incision hematoma in two and pulmonary infection in three. There were no case with incision infection or aggravating nervous injury. Sixty-two patients (91.2%) were followed up with a mean duration of 14 months. All the patients obtained bony fusion and no internal fixation failure or kyphosis was found.ConclusionsAccording to fracture position and CT, the unilateral cervical lateral mass fracture can be classified as type A1, type A2, type B, and type C. A satisfied clinical result can be obtained when choosing an appropriate treatment in accordance with different fracture types.
Objective To evaluate the characteristics, classification, treatment methods, and cl inical outcomes of the spoke heel injuries in children. Methods From June 2001 to June 2008, 289 children with bicycle or motorcycle spoke heel injuries were treated, including 179 males and 110 females aged 2-12 years old (average 3.9 years old). There were 179 cases of skin contusion and laceration (type I), 83 cases of skin and soft tissue defect with Achilles tendon exposure (type II), and 27 cases of wide skin and soft tissue defect with the Achilles tendon defect and rupture (type III). The defect size of the skin or the soft tissues ranged from 3 cm × 2 cm to 11 cm × 7 cm in type II and type III injury. The time between injury and hospital admission was 1-53 days (average 14.5 days). Child patients with type I injury were managed with dressing or suturing after debridement. For the child patients with type II injury, the wound was repaired with the regional fascia flap in 53 cases, the reverse sural neurocutaneous vascular flap in 19 cases, the reverse saphenous neurocutaneous vascular flap in 9 cases, and the lateral supramalleolar flap in 2 cases. For the child patients with type III injury, 6 cases underwent primary repair of the Achilles tendon followed by the transposition of the reverse sural neurocutaneous vascular flap, 3 cases received primary repair of the wound with the reverse sural neurocutaneous vascular flap and secondary reconstruction of the Achilles tendon with the upturned fascia strip or the ipsilateral il iotibial tract transplant, and 18 cases underwent primary repair of the wound and the Achilles tendon with the sl iding bi-pedicled gastrocnemius musculocutaneous flap. The flap size ranged from 4 cm × 2 cm to 30 cm × 12 cm. All the donor sites were closed bypartial suture and spl it-thickness skins graft. The lower l imbs were immobil ized with plaster spl ints after operation. Results All the flaps survived except for 1 case of type II suffering from distal flap venous crisis 3 days after operation and 6 cases of type III suffering from distal flap necrosis 3-5 days after operation. All those flaps survived after symptomatic treatment. All the skin grafts at the donor site survived uneventfully. All the wounds healed by first intention. All child patients were followed up for 15-820 days (average 42 days). Child patients with type I and type II injury had a full recovery of ankle functions. While 25 cases of type III injury had ankle dorsal extension degree loss (10-30°) and unilateral plantar flexion strength decrease 3 months after operationwithout influence on walking, and 2 cases recovered well. Conclusion Spoke heel injury in children has special mec hanisms of injury, and the choice of proper treatment method should be based on the types of injury.
Objective To explore the correlation between homocysteine （Hcy） level and the risk of breast cancer，and try to find a new method to reduce the risk factors and benefit for treatment of breast cancer. Methods From January2010 to December 2012， 245 cases of breast cancer （breast cancer group）， 109 cases of benign breast tumor （benign breast tumor group）， and 78 cases of healthy women （healthy control group） in the Sichuan Provincial People’s Hospital， who were in accordance with the inclusion criteria， were analyzed retrospectively. The difference of Hcy level was compared among three groups. Meanwhile the relation between Hcy level and patients’s age， blood glucose， serum creatinine， estrogen receptor （ER）， progesterone receptor （PR）， Ki-67 （%）， tumor diameter， or axillary lymph node status was analyzed.Results ① The Hcy level was significantly different among the breast cancer group， benign breast tumor group， and healthy control group （P＜0.001）. The Hcy level of the breast cancer group was significantly higher than those of the benignbreast tumor group （P＜0.001） or healthy control group （P＜0.001）， but the Hcy level was not significantly different bet-ween the benign breast tumor group and healthy control group （P=0.082） . ② The Hcy levels of different types of the breastcancer （type of Luminal A， Luminal B， Her-2， and triple negative） were significantly higher than those of the benign breast tumor group （except for Her-2 type， P＜0.05） or healthy control group （P＜0.05）. ③Plasma Hcy level of the patients with benign and malignant breast tumor was positively correlated with age （r=0.197， P=0.004） or serum creatinine level （r=0.381， P＜0.001）， but not correlated with blood glucose （r=0.023， P=0.668）. ④Plasma Hcy level of the patients with malignant breast tumor was positively correlated with age （r=0.267， P=0.007） or serum creatinine level （r=0.341， P＜0.001）， but not correlated with blood glucose （r=-0.005， P=0.935）， tumor diameter （r=-0.049， P=0.443）， axillary lymph node status （r=-0.006， P=0.921）， or Ki-67 （%） （rs=-0.029， P=0.650）. Conclusions Plasma Hcy level of breast cancer patient is abnormally elevated， and it may have some relation with the occurrence of breast cancer.
Objective To summarize a new type of proximal humerus fracture—proximal humerus degloving fracture, and discuss its injury mechanism, classification criteria, and treatment methods. Methods The clinical data of 23 patients with proximal humerus degloving fracture between September 2009 and September 2016 was retrospectively analyzed. There were 14 males and 9 females, with an average age of 39.7 years (range, 21-66 years). The causes of injury was sprain in 2 cases, falling from height in 8 cases, and traffic accident in 13 cases. The time from injury to operation was 3-116 days (mean, 17.1 days). There were 2 cases of posterior dislocation of humeral head, 3 cases of anterior dislocation of humeral head, 3 cases of other fractures, and 2 cases of brachial plexus injury. All patients had varying degrees of rotator cuff injuries. According to the self-determined fracture classification criteria, there were 6 cases of internal rotation type, 14 cases of external rotation type, and 3 cases of abduction type. All patients underwent open reduction and internal fixation. Results All patients were followed up 9-24 months (mean, 17 months). All incisions healed by the first intention. X-ray films showed that all fractures healed at 3-5 months after operation (mean, 3.6 months). According to the Neer’s shoulder functional evaluation criteria at 6 months, the shoulder function was rated as excellent in 16 cases, good in 5 cases, fair in 1 case, and poor in 1 case, and the excellent and good rate was 84.6%. The rotator cuff tear recurred in 1 case and was repaired again. Conclusion The injury mechanism of proximal humerus degloving fracture may be the extreme internal rotation, extreme external rotation, or extreme abduction. Reduction and internal fixation is an effective treatment. The focus of the treatment is not only the fixation of the fracture, but also the repair and reconstruction of the rotator cuff.
ObjectiveTo investigate the association between tumor necrosis factor (TNF)-α gene polymorphism and susceptibility to chronic obstructive pulmonary disease (COPD) in eastern Heilongjiang province.MethodsA total of 347 COPD patients in the Department of Respiratory Medicine, the First Affiliated Hospital of Jiamusi University, were enrolled from January 2016 to January 2017. In the same period, 338 healthy subjects in the hospital physical examination center were selected as controls. The genotype of the two groups was analyzed by high resolution melting (HRM) and gene sequencing. The genotype and allele probability of the two groups were compared and analyzed by the SHEsis genetic imbalance haplotype analysis.ResultsBoth TNF-a –308 G/A co-dominant model and recessive model have significant differences between COPD patients and healthy subjects (P=0.036, OR 1.512, 95%CI 1.023 – 2.234; P=0.027, OR 1.202, 95%CI 1.024 – 1.741). –850G/A co-dominant model (P=0.000, OR 1.781, 95%CI 1.363 – 2.329), dominant model (P=0.000, OR 0.391 7, 95%CI 1.363 – 2.329) and hyper-dominant model (P=0.000, OR 2.680, 95%CI 1.728 – 4.156) in the two groups were statistically different. The haploid analysis and haploid genotype analysis showed statistically significant differences (all P<0.05, OR>1, 95%CI>1) at +489, –308, –850 sites by allele A, G, A, respectively between the two groups. There was a significant difference in the lung function between the –308G/A, –863C/A mutant genome and the wild type (P=0.038, P=0.02) in COPD patients according to the classification of lung function.ConclusionsA allele in TNF-α –308 and G allele in TNF-α –850 locus may be risk factors for COPD in the eastern Heilongjiang Province, and the risk of homozygous genotype is higher. +489A, –308G and –850A respectively may be the predisposing factor of COPD while the three genotypes of AGA patients were at higher risk. TNF-α –308 A allele and –863 A allele are related to lung function deterioration, and the two sites with A allele in patients with COPD indicate poor lung function.
Objective To summarize the injury characteristics of the whole hand degloving injury and to explore its classification and treatment. Methods Between December 1999 and May 2010, 41 cases of the whole hand degloving injury were admitted for treatment. There were 28 males and 13 females with an average age of 35 years (range, 18-58 years). The causesof injury included mangled injury in 28 cases and crush injury in 13 cases. The interval between injury and surgery was 1-10 hours (mean, 3 hours). According to self-made classification standard for whole hand degloving injury, 11 cases were rated as type I, 5 cases as type II, 4 cases as type III, 8 cases as type IV, and 13 cases as type V. Type I injury was treated by replantation surgery with vascular anastomosis, type II by reconstruction with thumb flap and the second toe containing dorsal skin flap, type III by reconstruction with the second toe containing dorsal skin flap of both feet, type IV by replantation surgery with vascular anastomosis, and type V by reconstruction with thumb flap containing dorsal skin flap (8 cases) or repairing with abdominal flap (5 cases). The size of the dorsal flap was between 9 cm × 6 cm and 17 cm × 11 cm and the dorsal donor site was covered with free skin grafting. Results After surgery, partial necrosis occurred at fingers in 6 patients with type I injury, and at fingers and palm skin in 6 patients with type IV injury; the flaps, the reconstructed fingers, and replanted skin all survived in the others. The grafted skin at donor sites successfully healed. Forty cases were followed up from 6 months to 7 years (mean, 14 months). The skin color and texture were close to normal hand in the cases undergoing replantation, who had the best function restoration with S2-S4 sensory recovery; the hand function was basically restored with S2-S3 sensory recovery in the cases undergoing finger reconstruction with thumb and toe flaps; and the restoration of the hand function was not satisfactory with S1-S2 sensory recovery in the cases undergoing abdominal flaps. Conclusion Whole hand degloving injury can be classified into different types according to injury degree and this will help choose the cl inical treatment plan. The appropriate treatment based on these types can obtain better cl inical effectiveness.
Objective To discuss the severity grading and procedure design of concealed penis. Methods Between June 2004 and April 2008, 196 cases of concealed penis were surgically corrected. The age ranged from 1 year and 4 months to 44 years, with a median of 9 years. They presented with inconspicuous penis and abnormal cavernosa development. Four cases compl icated by glanular hypospadias and 3 cases by penile epispadias. They were classified as mild in 49 cases, moderate in 109, and severe in 38 according to severity. Surgical procedures were selected based on varied anatomical changes in different categories. Results All the patients got satisfactory appearance immediately after surgery. No voiding problem, wound infection, and skin necrosis were found. With 6 months to 48 months (mean 16 months) follow-up, most patients achieved good results and the penile appearance resembled that after circumcision. Mild penile retraction was noted in 1 moderate case and 1 severe case; and recurrence occurred in another one, the result was satisfactory after reoperation. Conclusion Various surgical procedures can be adopted for concealed penis. The key point is to design procedures according to the anatomical abnormalities.
ObjectiveThis article aims to summarize the historical evolution of thyroid cancer molecular classification and explore the establishment of a precise classification system based on molecular characteristics and its impact on clinical applications. MethodsA literature review was conducted to analyze and organize the recent influences of molecular classification of thyroid cancer on clinical diagnosis and treatment. ResultsIn recent years, the classification of thyroid cancer has introduced molecular features such as BRAF and RAS mutations, highlighting the close association between these molecular characteristics and prognosis. For example, the BRAF V600E mutation is associated with high aggressiveness in papillary thyroid cancer, while RAS mutations suggest malignant potential in follicular tumors. With the advancement of multi-omics research, classification strategies based on multi-omics have shown significant value in the diagnosis, monitoring, treatment, and prognostic assessment of thyroid cancer. Although multi-omics integration has significantly improved the accuracy of prognostic assessments in thyroid cancer, there are still limitations, including imprecise detection of tumor heterogeneity and insufficient sensitivity and specificity of molecular biomarker detection.ConclusionsThe classification of thyroid cancer is developing towards the integration of molecular features to achieve more precise diagnosis and treatment. To accomplish this goal, it is necessary to overcome the challenges of tumor heterogeneity and the limitations of detection technologies in the future, and to promote the practical application of molecular classification in clinical settings.
