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Background: Midclavicular fractures are common clinically, accounting for about 76% of all clavicular fractures. Recent studies have revealed a previously unrecognized incidence of nonunion and malunion after conservative treatment of more severe midclavicular fractures. Our aim was to evaluate the clinical outcomes of midclavicular fractures treated with titanium elastic nails. Methods: From February 2005 to February 2007, 41 patients with displaced midclavicular fractures received open reduction and internal fixation with a titanium elastic nail inserted through the sternal end of the clavicle. We evaluated the visual analogue scale (VAS), the Constant score and the Disabilities of the Arm, Shoulder and Hand (DASH) scale to determine outcomes. Results: A mean follow-up of 14.5 months (range 7-24 mo) revealed radiographic fracture union in all patients with an average clinical healing time of 2.2 months. Mean subjective pain 3 days after surgery was significantly lower than the day before surgery (p < 0.001). The mean range of motion 3 days after surgery was significantly improved compared with the day before surgery (p < 0.001). The nails were removed in all patients a mean of 7.2 months (range 5.4-9.5 mo) after surgery, and no fractures recurred. The mean postoperative DASH score was 2.5 (range 0.5-8.0) and the mean postoperative Constant score was 95.2 (range 86.5-97.0). Conclusion: Limited open reduction and internal fixation with titanium elastic nails is a safe and minimally invasive surgical procedure for the treatment of displaced midclavicular fractures in adults and achieves good functional results and high patient satisfaction. Contexte: Les fractures medioclaviculaires sont frequentes et representent quelque 76% du total des fractures de la clavicule. Des etudes recentes ont revele une incidence auparavant non reconnue de non-consolidation et de mauvaise consolidation apres un traitement conservateur de fractures medioclaviculaires plus graves. Nous voulions evaluer l'issue clinique des fractures medioclaviculaires reduites au moyen de clous elastiques en titane. Methodes: De fevrier 2005 a fevrier 2007, 41 patients victimes d'une fracture medioclaviculaire deplacee ont subi une intervention ouverte de reduction et de fixation interne au moyen d'un clou elastique en titane insere par l'extremite sternale de la clavicule. Nous avons evalue l'echelle visuelle analogue (EVA), le score de Constant et l'echelle des incapacites du bras, de l'epaule et de la main (Disabilities of the Arm, Shoulder and Hand--DASH) pour determiner les resultats. Resultats: Un suivi moyen a 14,5 mois (intervalle de 7 a 24 mois) a revele a la radiographie une consolidation de la fracture chez tous les patients dont la duree moyenne de guerison clinique s'est etablie a 2,2 mois. La douleur subjective moyenne 3 jours apres l'intervention chirurgicale etait beaucoup moins forte que la veille de l'intervention (p < 0,001). L'amplitude moyenne du mouvement 3 jours apres l'intervention chirurgicale etait beaucoup amelioree comparativement a la veille de l'intervention (p < 0,001). Les clous ont ete retires chez tous les patients en moyenne 7,2 mois (intervalle de 5,4 a 9,5 mois) apres l'intervention et il n'y a eu aucune recidive des fractures. Le score DASH postoperatoire moyen s'est etabli a 2,5 (intervalle de 0,5 a 8,0) et le score de Constant moyen apres l'intervention etait de 95,2 (intervalle de 86,5 a 97,0). Conclusion: Une reduction ouverte limitee et la fixation interne au moyen de clous elastiques en titane constituent une intervention chirurgicale securitaire et a effraction minimale pour traiter la fracture medioclaviculaire deplacee chez les adultes, qui produit de bons resultats fonctionnels et un taux eleve de satisfaction chez les patients., Midclavicular fractures are common clinically, accounting for about 76% of all clavicular fractures. Nondisplaced or minimally displaced midclavicular fractures respond well to conservative treatment. (1) However, recent studies have revealed [...]

This paper presents a new method for applying reliability-based design approaches to slope stability analysis. In this method the soil properties are considered to be random variables. The factor of safety of the slope is found using Bishop's simplified method for noncircular slip surfaces. By considering the variability of the soil properties, the probability of failure is determined from the reliability index ([beta]). The minimization problem (determination of the lowest [beta] value for the range of variables and possible slip surfaces considered) is solved using a genetic algorithm approach, which simultaneously locates the critical slip surface and determines the reliability index. The performance of the new method is compared to some existing reliability approaches when applied to case histories of slope failures from the geotechnical literature. The new approach is seen to provide reasonable and consistent estimates of the reliability index and critical slip surface. DOI: 10.1061/(ASCE)1090-0241(2007)133:7(878) CE Database subject headings: Slope stability; Probabilistic methods; Reliability; Algorithms; Safety factors.

To investigate the genetic diversity and phylogenetic relationship of castor, genetic diversities and relationships among 30 domestic cultivars and 1 French cultivar were assessed by SSR and EST - SSR markers. Results showed a moderate diversity level among these cultivars, with average 2. 267 alleles per locus, 0. 553 Shannon index, 0.345 Neis expected heterozygosity and 0.289 polymorphism information content (PIC) respectively. The 31 castor cultivars were clustered into 7 groups at the similarity coefficient of 0. 730. Most cultivars were clusted into the same breeding units or regions. Among the 171 primers, 10 were used to construct a clear and polymorphic footprint, and can be used in the identification of cultivars. [ABSTRACT FROM AUTHOR]

How to combine regional ecological risks and local ecological needs to construct ecological security is one of the main issues of its application in territorial spatial governance and associated with whether it can be effectively applied. Based on the "source" accessibility and the quality of space, we constructed the ecological security pattern of Xianyang City through the way of source-corridor-node. During the construction processes, we combined the cha-racteristics of topography, influencing factors of regional ecological security, and landscape characteristics. We coupled them with morphological spatial pattern analysis (MSPA) and comprehensive evaluation results of ecological resistance, ecological connectivity and ecosystem service value, and superimposed with ecological gradient ana-lysis. The results showed that there were 66 ecological sources, with a total area of 2506.65 km 2 , accounting for 24.6% of the total area of Xianyang City, which were mainly distributed in the northeast, west and central mountainous areas. There were 106 ecological corridors with a total length of 823.5 km, including potential corridors, water systems, irrigation canal sites, Qinzhidao and other natural and cultural systems, which extended along the ecological source to the northwest and south Weihe River. There were 20 ecological nodes to improve ecological connectivity, which were mainly distributed between second layers of loess tableland and arid mountainous areas with banded distribution in the north part of the city.

Objective: To investigate the surgical skills and clinical curative results of arthroscopic treatment of ankle instability combined with anteromedial impingement syndrome., Methods: From February 2019 to August 2020, 13 patients with ankle instability combined with anteromedial impingement were retrospectively analyzed. There were 10 males and 3 females with age of (40.0±15.1) years old. The course of disease was(44.1±33.2) months. All patients had history of ankle sprain. MRI showed the injury of anterior talofibular ligament. All patients had anteromedial pain and pressing pain when ankle dorsiflexion. All patients were treated with ankle debridement and Brostr?m-Gould surgery under ankle arthroscopic. Postoperative results were evaluated by VAS(visual analogue scale) and AOFAS-AH(American Orthopaedic Foot and Ankle Society Ankle-Hindfoot scale, AOFAS-AH)., Results: All 13 patients completed the surgery successfully with an operative time of 60 to 90 minutes. All the surgical incisions healed by first intention, and no complications such as incision infection, skin necrosis and neurovascular injury. Follow-up time was (18.1±4.7) months. At the latest follow-up, the VAS score was 1.2±1.1, which was significantly lower than the preoperative score 4.8±1.5 ( P <0.05);the AOFAS-AH score 94.2±5.1 was significantly higher than the preoperative score 65.5±11.5 ( P <0.05). The AOFAS-AH score at the final follow-up ranged from 84 to 100. All patients walked with normal gait without ankle instability or impingement recurrence., Conclusion: Ankle anteromedial impingement syndrome combined with ankle instability is easy to be ignored clinically. Such kind of anteromedial impingement syndrome is mostly related to osteophyte at dorsal medial talar neck. Arthroscopic treatment of ankle instability combined with anteromedial impingement syndrome has satisfactory curative effect with safety and minimal injury.

Objective: To comprehensively analyze the status quo of autologous sperm preservation in the human sperm bank in Beijing and better utilize the existing resources for the preservation of male fertility., Methods: We retrospectively analyzed the geographical data and semen quality of 251 males with autologous sperm preservation in the Human Sperm Bank, Science and Technology Research Institute, National Health and Family Planning Commission of China from July 2006 to December 2016., Results: The rate of autologous sperm preservation in the Human Sperm Bank was as low as 8.76% between July 2006 and December 2010 but increased annually by 119% on average from 2011 to 2013. Of the 251 males involved, 204 (81.27%) were aged 20－39 years, 175 (69.72%) had bachelor's or master's degree, 223 (88.84%) had no child, 69 (27.49%) got less than 10 tubes of semen samples frozen, and 26 (10.36%) had their semen samples cryopreserved only once. The utilization rate of the cryopreserved sperm was only 5.58 % (n = 14). The main reason for autologous sperm preservation was carcinoma (55.78% ［n = 140］), including blood cancer (22.31% ［n = 66］), testicular cancer (13.15% ［n = 33］) and other cancers (16.33% ［n = 41］). Compared with the non-cancer males, the cancer patients had a significantly reduced mean sperm concentration (90.45 vs 60.53 ×10⁶/ml, P < 0.05), total sperm count (311.3 vs 175.8 ×106, P < 0.05), percentage of progressively motile sperm (PMS) (49.21% vs 43.55%, P < 0.05) and recovery rate of PMS (68.13% vs 52.17%, P < 0.05). In the subgroups of testicular, blood and other cancers, the sperm concentration averaged 37.68, 57.98 and 90.69 ×10⁶/ml, the semen volume 2.73, 2.82 and 3.41 ml, the total sperm count 93.29, 158.41 and 349.49 ×106, the percentage of PMS 45.32%, 43.47% and 44.49%, and the recovery rate of PMS 48.32%, 50.07% and 61.09%, respectively, the sperm concentration and total sperm count significantly lower in the testicular cancer patients than in the other two groups (P < 0.05)., Conclusions: The number of the cases of autologous sperm preservation in Beijing is increasing year by year, and the majority of them are cancer patients. As most of the cancer patients have missed the best period for sperm preservation, sperm bank workers should endeavor to increase the public awareness of autologous sperm preservation.

Objective: To explore the expression and clinical significance of LI (liver-intestine)-cadherin mRNA and protein expression level in hepatocellular carcinoma., Methods: Reverse transcription-polymerase chain reaction (RT-PCR) and immunohistochemical techniques were used to detect the expression of the LI-cadherin mRNA and protein in 56 cases of hepatocellular carcinoma, 44 cases of corresponding paracancerous tissues and 9 cases of normal liver tissues. The relationships with its clinicopathological characteristics were analyzed., Results: The mRNA of LI-cadherin was expressed in 56 cases of hepatocellular carcinoma tissues and 44 cases of corresponding paracancerous tissues. But its expression was not detected in normal tissues. Semiquantitative analysis showed that the mRNA expression level of LI-caherin was greater in hepatocellular carcinoma tissues than that in corresponding paracancerous tissues (0.653 ± 0.147 vs 0.534 ± 0.138). The differences were statistically significant (P < 0.01). The positive rates of LI-cadherin protein were 64.29% (36/56) in hepatocellular carcinoma tissues, 22.73% (10/44) in paracancerous tissues and 0% (0/9) in normal tissues., Conclusion: The expression of LI-cadherin is up-regulated significantly in HCC. The over-expression of LI-cadherin protein is correlated with the lymph node metastasis and tumor thrombi in portal vein. It indicates that LI-cadherin may play an important role in the progression and metastasis of HCC.

Objective: To employ reverse first dorsal metatarsal artery island flap to recover the donor site of great toe after free lateral pulp flap transfer, and decrease the morbidity of microsurgical donor site., Methods: From February 2000 to June 2004, 12 cases of soft tissue defect in thumb and finger were treated by free lateral pulp flap of great toe transplantation, and that the secondary defect of great toes were repaired by reverse first dorsal metatarsal artery flap according to the anatomical communicating between first dorsal metatarsal artery and plantar metatarsal artery. The donor exposure of dorsal pedis were straightly sutured., Results: All the lateral pulp flaps of great toe and the reversed first dorsal metatarsal flaps survived uneventfully with desirable appearance and sensation. In thumb and finger defect reconstructed with lateral pulp flaps of the great toe, there was in mean static two-point discrimination of 6 mm at 10 month follow-up, that was 10 mm in reverse flaps., Conclusions: It is an instructive and practical creation to adopt the reverse first dorsal metatarsal artery flap to recover the raw surface in the lateral aspect of the great toe, which minimizes the morbidity at the donor site and gains the twin-win results.

Objective: To establish an experimental liver metastatic model of gallbladder cancer and isolate the subpopulation with high metastatic potential from the model, which may serve as a reliable tool in research on liver metastasis of gallbladder cancer in vivo and in vitro., Methods: Human gallbladder cancer cells of the line GBC-SD were cultured. Ten nude athymic BALB/c mice, aged 4 approximately 5 weeks, underwent inoculation of suspension of GBC-SD cells into the spleens and then their spleens were resected. Three weeks later laparotomy was performed to observe if liver metastasis occurred. Once liver metastasis was discovered, the mice were killed and the livers were taken out to undergo microscopy, tumor cells were isolated from the metastatic foci and cultured in vitro, and then inoculated into other 10 mice in the same way as their parents cells for the second round of selection. The similar steps were repeated, altogether for three rounds of selection and a total 30 mice were inoculated in 3 rounds so as to find subpopulation with high metastatic potential. Another 10 mice underwent subcutaneous inoculation, 90 days later the mice were killed to observe if pulmonary metastasis occurred. PCR was used to detect the 3 microsatellite sequences D14S68, D18S69, and D20S199 in the DNA samples of the gallbladder cancer cells of the parent cell line GBC-SD, the isolated cells of the subpopulation with high metastatic potential, and the liver of experimental animal., Results: 90% of the mice inoculated subcutaneously with the GBC-SD cells developed subcutaneous tumors, however, no mouse in this group died and no pulmonary metastasis was found. The liver metastatic rate was 65% in the 10 mice undergoing intrasplenic inoculation. Thus a metastatic model of human gallbladder cancer in nude mice was established. The liver metastatic tumors were uniformly distributed throughout the liver parenchyma with predominance to the periphery. Despite multiple sites of involvement, the left lobes were most commonly affected in all experimental animals. Histological examination of the metastatic lesion demonstrated adenocarcinoma. Gross hepatic metastasis was detected 10, 7, and 5 weeks after the inoculation respectively in the first, second, and third round selection respectively with an incidence rate of metastases of 60%, 70%, and 90% respectively. From the third round metastatic model a subpopulation with high metastatic potential was isolated and designated as GBC-SD/M, which exhibited the similar histological characteristics as its parent cell line GBC-SD under inverted light microscopy. The three amplified bands at the sites 14S68, D18S69, and D20S199, amplified with the three pairs of specific primers for the three homo-specific microsatellites, were detected in the GBC-SD cells and GBC-SD/M cells, but not in the liver of tumor-bearing animal., Conclusion: A liver metastasis model of human gallbladder cancer has been established, a reliable and efficient tool for study on the metastasis of gallbladder cancer to liver in vivo. Isolated from hepatic metastasis, the line of GBC-SD/M is a subpopulation with high metastatic potential, retaining the histological properties and identification of genetic background of its parent cell line GBC-SD.

Objective: To review the experience for the management of hepatocellular carcinoma with tumor thrombus in inferior vena cava., Methods: From July 2003 to May 2005, hepatectomy combined with thrombectomy were performed on 7 cases of hepatocellular carcinoma with tumor thrombus in inferior vena cava. In order to remove the tumor thrombus in inferior vena cava, total hepatic vascular exclusion were adopted on all cases to control the blood flow of IVC. According to the position of extension of tumor thrombus, 5 different procedures were adopted in the cases to control the suprahepatic IVC and extract the tumor thrombus out of IVC and atrium. Procedure 1: Median sternotomy, extracorporeal bypass, cardiac arrest, incision on right atrium and IVC were performed on 1 case for thrombectomy. Procedure 2: Median sternotomy, extracorporeal bypass without cardiac arrest, incision on IVC and (or without) incision on right atrium were performed on 2 cases for thrombectomy. Procedure 3: Abdominal approach to control intrapericardial IVC through an incision on diaphragm was performed on 1 case for thrombectomy. Procedure 4: Abdominal approach to control suprahepatic IVC above diaphragm through a small incision made on vena cava foramen for thrombectomy was performed on 1 case. Procedure 5: Abdominal approaches to control suprahepatic IVC below diaphragm for thrombectomy were performed on 2 cases., Results: All operations were successfully performed. The postoperative complications included pleural effusion in 1 case, subphrenic fluid collection in 1 case and wound infection in 1 case. The average survival time of 7 cases was 9.8 month. The longest survival time was 26 months., Conclusion: Hepatectomy and thrombectomy can be safely performed on the case of HCC combined with tumor thrombus in IVC. Surgical treatment can relieve the patient from the risk of sudden death caused by heart failure and pulmonary.

Objective: To evaluate wound healing after pancreaticojejunostomy of three anastomotic methods., Methods: Fifty-four domestic piglets were divided into three groups according to the types of anastomoses: group of end-to-end pancreaticojejunal invagination (EE group), group of binding pancreaticojejunostomy (BP group) and group of inkwell pancreaticojejunostomy (IP group). Bursting pressure, breaking strength and histopathological findings of anastomosis were assessed on operative day and on the 5th and 10th day after operation., Results: Bursting pressure was (67+/-8) mm Hg, (96+/-11) mm Hg and (131+/-9) mm Hg in EE group on day 0, 5 and 10; and (140+/-8) mm Hg, (179+/-10) mm Hg and (269+/-13) mm Hg in BP group; and (102+/-10) mm Hg, (171+/-18) mm Hg and (254+/-24) mm Hg in IP group. Compare to EE group, bursting pressure of BP group and IP group were all increased with significant differences (P<0.05). Another significant difference was observed between BP group and IP group after anastomoses on operative day. Breaking strength was (4.6+/-0.6) N, (5.8+/-0.5) N and (7.1+/-0.6) N in EE group on 0 d, 5 d and 10 d; and (4.5+/-0.4) N, (6.6+/-0.4) N and (10.0+/-0.6) N in BP group; and (4.6+/-0.3) N, (6.5+/-0.4) N and (9.1+/-0.9) N in IP group. A similar value of anastomoses was shown in BP group and IP group on day 0, day 5 and day 10, but significant increase was demonstrated compared to EE group on day 5 and 10. Anastomotic site was well repaired by connective tissue and the cut surface of pancreatic stump was covered by mucosal epithelium in BP group and IP group on day 10, but the cut surface was incompletely repaired by granulation tissue and no regeneration of the epithelium was found in EE group., Conclusions: Wound healing of binding pancreaticojejunostomy and inkwell pancreaticojejunostomy is more rapid and better than end-to-end pancreaticojejunal invagination, but breaking strength of inkwell pancreaticojejunostomy is weaker than binding pancreaticojejunostomy.

Objective: To explore the clinical value and significance of retrograde caudate lobectomy., Methods: From December 2003 to January 2005, 7 patients underwent retrograde caudate lobectomy in which division and ligation of short hepatic veins were carried out at the final stage of the procedure in stead of at the initial stage., Results: The procedures were carried out smoothly with no operative death in all the 7 cases including isolated complete caudate lobectomy in 4 cases, isolated partial caudate lobectomy in 1 case, combined right half liver resection in 2 case. The average operation time, blood loss and length of stay after operation was (273 +/- 44) min, (1114 +/- 241) ml (800-1500 ml) and 16 days respectively. Complications including pleural effusion and ascites in 1 case respectively were fully recovered. During the follow-up, 1 patient died at 6 months for tumor recurrence in lung and the remaining 6 patients are alive at the follow-up of 5 to 16 months., Conclusions: Retrograde caudate lobectomy is a new procedure suitable for those caudate neoplasms which are adhering to or infiltrating to IVC or too big to move side by side. The application of this technique can converse certain kind of caudate lobe tumor from non-resectable to resectable resulting in widening the indication.