BACKGROUND:Artificial hip replacement by the posterolateral approach is generally introduced as a treatment for femoral neck fracture in the elderly, but it is limited by the need for a large incision, cutting off the extortor, and postoperative hip dislocation. The supercapsular percutaneously-assisted total hip (SuperPATH) approach was developed based on the original lateral approach. The SuperPATH approach for hip replacement is characterized by the reduced chance of damaging blood vessels and nerves, reducing intraoperative blood loss, retaining all the joint capsules and supinator, and significantly reducing the incidence of postoperative hip dislocation. OBJECTIVE:We hypothesized that the SuperPATH approach for hip replacement can achieve better efficacy in the elderly with femoral neck fractures and promote the recovery of postoperative hip function compared with the posterolateral approach. METHODS/DESIGN:This is a prospective, single-center, open-label, randomized control ed clinical trial that will be completed at the Pudong Hospital of Fudan University, Shanghai, China. Forty patients with femoral neck fractures were randomly divided into two groups to undergo femoral head replacement by the SuperPATH approach in the experimental group, and by the conventional posterior approach in the control group. The follow-up period is 1 week and 6 months. The main outcome measures are Harris hip scores at baseline, and at 1 week and 6 months postoperatively to assess functional recovery of the hip. Secondary outcome measures to evaluate the advantages of the SuperPATH approach include the length of surgical incision, intraoperative blood loss, operative time, 24-hour postoperative drainage, and hospital stay. Other outcome measures include the incidence of adverse reactions at 1 week and 6 months after surgery. The study protocol was approved by the Ethics Committee of the Pudong Hospital of Fudan University, China, and performed in accordance with the guidelines of the Declaration of Helsinki, formulated by the World Medical Association. Written informed consent was obtained from all participants. DISCUSSION:The aim of this trial is to test our hypothesis that the SuperPATH approach is safer and more reliable for hip functional recovery compared with the posterolateral approach for the artificial hip replacement in femoral neck fractures of the elderly.

Objective To investigate the feasibility and safety of laparoscopic radical resection for rectal carcinoma.Methods A total of 80 patients with rectal carcinoma received laparoscopic radical resection in our hospital from March 2004 to January 2008.During the operation,adequate proximal and distal bowel segments,and mesentery and lymph nodes surrounding the tumor were resected completely.And then lower anterior resection(Dixon)and sigmoid colostomy for abdominal perineal resection(Miles)were implemented.Results Among the 80 patients,4 were converted to open surgery during the operation,and the other 76 patients were treated by laparoscopy successfully.Dixon surgery was performed on 44 cases with a mean operation time of(178?38)minutes,intraoperative blood loss of(61?17)ml,excised lymph nodes number of(11.3?2.9),and postoperative hospital stay of(7.1?3.2)days.Miles were carried out on 32 patients,in which the mean operation time was(231?49)minutes and intraoperative blood loss was(210?178)ml;a mean of(12.9?3.7)lymph nodes were resected,the postoperative hospital stay was(9.3?4.1)days.No residual cancer was found in the patients.After the treatment,1 patient developed stoma stenosis,5 showed perineal wound infection,1 had anastomotic leak,and 6 complained of urinary retention immediately after the surgery.No patient had postoperative hemorrhage or died after the procedure.Follow-up was achieved in 70 cases for 9 to 48 months,during which 5 patients had recurrence,2 died of multiple organ failure induced by multiple metastasis,and 5 patients developed ileus.Conclusion Laparoscopic resection for rectal carcinoma is safe and feasible for selected patients,when the surgeons are skilled with experience on both open colectomy and laparoscopic surgery.

AIM and METHODS: To study the immunological effect of measles vaccine therapy on asthmatic children, we examined the changes of interleukin-12 , interleukin-13 and total serum IgE levels in plasma and cultured peripheral blood mononuclear cells(PBMC) supernatant by means of ELISA in 13 mild-moderate asthmatic children treated with measles vaccine. Results were compared with 12 anti-symptomatic treatment mild-moderate asthmatic children and 17 normal children control group. RESULTS:After measles vaccine treatment, IL-13 and total serum IgE levels decreased remarkably, statistically lower than that of group receiving only anti-symptomatic treatment. There was no statistical difference in IL-12 level between the two group. Correlation analysis: 1)IL-12 level of plasma was negatively correlated to the level of serum total IgE, there was no correlation of supernatant IL-12 in PBMC to the total serum IgE; 2)IL-13 levels in plasma and PBMC were positively correlated to the level of total serum IgE; 3) IL-12 level was negatively correlated to IL-13. CONCLUSION: Measles vaccine could down-regulate IL-13 level, therefore decrease total IgE synthesis, but not affect IL-12 level in asthmatic children.

BACKGROUND: The biomechanical features of arch-dental shape memory connector designed for fractures in pelvis or the parts adjacent to joints are analyzed through biomechanical calculation and experimental measurements.OBJECTIVE: To explore the relationship between the changes in shape of arch-dental shape memory connector and the load on it.DESIGN: Both biomechanical calculation and the experimental measurement were conducted for mutual supplementation and confirmation.SETTING: The Orthopedic Department of Changhai Hospital Affiliated to the Second Military Medical University of Chinese PLA and the Life Science and Bioengineering College of Tongji University.MATERIALS:The trial was conducted from at Shanghai Changhai Hospital and Life Science Laboratory of Tongji University from April 2002 to April 2004. The subjects were arch-dental shape memory connectors.METHODS: We calculated the stress in and around the fracture face produced by arch-dental shape memory connector according to Moire principle and we also measured the changes in the shape of arch-dental shape memory connector. The relationship between load and the changes in the shape of arch-dental shape memory connector was explored.MAIN OUTCOME MEASURES: To explore whether the results of biomechanical calculation and those of the experimental measurement are consistent.RESULTS: Biomechanical calculation found that the relationship between the load (P) and the displacement(δ) in arch-dental shape memory connector was P = 13.69δ. The experimental measurement found that the load on the connector and the displacement were in a linear relationship.CONCLUSION: The relationship between the load and the displacement in arch-dental shape memory connector was linear within its elastic range and the biomechanical calculation results were consistent with the results of the experimental measurement.

BACKGROUND: Various therapies can be used to treat humeral fracture,but serious complications like bone disunion, etc. Are often left over. New biomechanical analytical methods are tried to be applied to provide new approaches for the functional prognosis in humeral fracture and bone disunion.OBJECTIVE: To construct humeral three-dimension model to explore its correlated biomechanical significance.DESIGN: To construct humeral three-dimension finite element model. SETTING: Department of orthopedics of a military medical university-affiliated hospital and institute for biological science and bioengineering of a university.PARTICIPANTS: The study was conducted in Shanghai Changhai Hospital and the Laboratory of Biological Science of Shanghai Tongji University. One piece of typical adult wet humerus sample was selected.INTERVENTIONS: Cross section image of each humeral layer was obtained from the selected wet humerus sample by CT scanning, and humeral three-dimensional model was constructed by large finite element analytic software ANSYS5.6.MAIN OUTCOME MEASURES: ① Biomechanical features of the constructed humeral three-dimension mode; ② Differences from clinical reality and key similarities.RESULTS: The constructed humeral three-dimensional model vividly reflected the true humeral anatomic morphology and biomechanical behavior. Its precision was judged by the comparison with CT image.CONCLUSION: The construction of humeral three-dimension finite element model provides a precise model for the researches of normal humeral mechanical behavior and the basic mechanics of internal fixation after fracture.

Objective To design a controller for the air environment of cabins of special vehicles .Methods The microprocessor was used to collect and store parameters ,and calculate automatically the operative mode of actuators ,such as the fan,air-conditioner,oxygenerator,air cleaner, filtering and boosting devices according to the preset target values .Output commands by RS485 were used to control actuators .Results and Conclusion The controller is capable of control integration for air-adjusting equipment while improving the control effect of the air quality in cabins of special vehicles .

BACKGROUND:Macropore morphology of a composite scaffold prepared by the three-dimensional printing technique is of great importance in determining the physicochemical and biological properties of tissue engineering scaffolds.OBJECTIVE:To fabricate strontium-containing mesoporous (Sr-MBG) bioactive glass (PCL) scaffolds by the three-dimensional printing technique, and to explore the effect of these scaffolds on MC3T3-E1 proliferation and osteogenic differentiation, thereby to find out the optimal macropore morphology.METHODS: Sr-MBG/PCL composite scaffolds were fabricated by the three-dimensional printing technique. The angles between fibrous latitudes and longitudes were set to 45°, 60° and 90°. Then the proliferation and alkaline phosphatase activity of MC3T3-E1 cells on the scaffolds were tested.RESULTS AND CONCLUSION: Cell counting kit-8 results showed that MC3T3-E1 cells could proliferate on all the three kinds of scaffolds. The proliferation rate of MC3T3-E1 cells on the 45° Sr-MBG/PCL scaffolds was just slightly higher than that on the 60° and 90° Sr-MBG/PCL scaffolds at days 1 and 4 (P > 0.05), but there was a significant increase at day 7 (P < 0.05). The 45° Sr-MBG/PCL scaffolds exhibited a significant increase in alkaline phosphatase activity of MC3T3-E1 cells compared to the 60° and 90° Sr-MBG/PCL scaffolds at day 14 (P < 0.05), while there was no significant difference among three groups at day 21 (P > 0.05). These results indicate that the 45° Sr-MBG/PCL scaffold is more suitable to promote the proliferation and osteogenic differentiation of the MC3T3 cells than the 60° and 90° Sr-MBG/PCL scaffolds.

BACKGROUND: Three-dimensional (3D) printing technique has showed unparalleled advantages in the field of tissue engineering scaffold preparation because of its outstanding merits of convenience, efficiency, controllability and ability to construct complex shapes.OBJECTIVE: To fabricate Fe-containing mesoporous calcium-silicate (MCS) /poly (3-hydroxybutyrate-co-3-hydroxyhexanoate) (PHBHHx) composite scaffolds using the 3D printing technique and to test the characterization and cellular biocompatibility of the composite scaffolds.METHODS: Four groups of Fe-containing MCS/PHBHHx composite scaffolds were fabricated using 3D printing technique. The molar percentage of Fe in these four groups was 0%, 5%, 10%, 15%, respectively and they were marked as 0Fe-MCS/PHBHHx, 5Fe-MCS/PHBHHx, 10Fe-MCS/PHBHHx and 15Fe-MCS/PHBHHx. The scanning electron microscopy was used to observe the microstructure of the scaffolds after being soaked in the simulated body fluid.Osteoblast cell lines MC3T3-E1 were seeded on these four groups of scaffolds as well. Cell counting kit-8 method was adopted to test the cell proliferation at 1, 3, 7 days of culture. Intracellular alkaline phosphatase activity was tested at 7 and 14 days of culture.RESULTS AND CONCLUSION: (1) Compared with the scaffolds with no soaking process, spherical particles were formed on the scaffolds because of mineralization after soaking 3 days in the simulated body fluid. (2) At 1 day of culture,there was no difference in cell proliferation among the four groups. At 3 days of culture, the proliferation rate of the 15Fe-MCS/PHBHHx scaffold was remarkably higher than that of the rest three groups (P < 0.05). At 7 days of culture,the proliferation rate was significantly higher in the 10Fe-MCS/PHBHH and 15Fe-MCS/PHBHHx scaffolds than the 0Fe-MCS/PHBHH scaffold (P < 0.05), as well as significantly higher in the 15Fe-MCS/PHBHHx scaffold than the 10Fe-MCS/PHBHH scaffold (P < 0.05). (3) At 7 days of culture, no difference in alkaline phosphatase activity could be found among these four groups of scaffolds; however, at 14 days, the 5Fe-MCS/PHBHHx, 10Fe-MCS/PHBHHx and 15Fe-MCS/PHBHHx scaffolds exhibited an enhanced alkaline phosphatase activity compared with the 0Fe-MCS/PHBHHx scaffold. Meanwhile, the 15Fe-MCS/PHBHHx showed the highest alkaline phosphatase activity.These findings indicate that the MCS/PHBHH scaffolds containing Fe could promote the proliferation and osteogenic differentiation of the MC3T3-E1 cells.

Objective To identify primary gout biomarkers. Methods Isobaric tags for relative and absolute quantitation (iTRAQ) technique combined with liquid chromatography-tandem mass spectrometry (LC-MS/MS) was used to screen differentially expressed proteins, and to identify potential biomarkers by analysis of the biological process, cellular components, molecular functions, KEGG pathways and protein-protein interactions. Difference between two groups were measured byt test. Results We identified 95 differentially expressed proteins (50 up-regulated proteins and 45 down-regulated proteins, respectively), and 20 significant KEGG pathways. Among them, glyceraldehyde-3-phosphate dehydrogenase (GAPDH), α-enolase (ENOA), phosphoglycerate kinase (PGK1), glucose-6-phosphate isomerase (G6PI) and moesin might play a role in the pathogenesis of primary gout. Conclusion iTRAQ technology can detect differentially expressed proteins from proteome, provides a strong theoretical basis for the study of biomarkers and evidence for the mechanisms in primary gout. However, further studies are needed.

Objective To design a new method of posterior wall reconstruction for severely corn-minuted and obsolete fracture of the posterior wall of the aeetabulum. Methods (1) Biomechanical study (from two perspectives: the stability and the stress distribution on the femoral head and the acetabu-lure) : six fresh adult' s pelvis and femur specimens were collected and divided into experimental group ( consisted of the left sides) and control group ( consisted of the right sides). After the defects of the pos-terior wall were made, the defects were anatomically reconstructed with the harvested ilium by acetabular tridimentional memory fixation system (ATMFS) in the experimental group, whereas the acetabular frag-ments were repositioned to the defect sites and fixated by the plates and screws in the control group. Lon-gitudinal and latitudinal displacement, stability of the anatomically reconstructed posterior wall of the ace-tabulum, the fitness of femoral head to the acetabulum after anatomical reconstruction and mean and maxi-mum pressure of anterior wall, posterior and cupuh of the acetabuhm were analysed and compared. (2) Cinical study: The posterior wall defect on the harvested ilium piece was repaired with 3-directional loc-king of ATMFS in 10 male patients (at age of 16-50 years, mean 36.4 years) from January 2000 to June 2002. There were seven patients with flesh acetabular fractures and three with old acetabular fractures.The period from fracture to reconstruction for the patients with old fractures was 58-251 days ( 137.7 days an average). The patients were foUowed up for 5.8 years (average 5.2-7.1 years). Results (1) Biomechanical study showed no statistical difference upon stability and fitness of femoral head to acetabu-lum after reconstruction in experimental and control groups. (2) Clinical study: postoperative X-ray film showed no repeated displacement of the fracture and the patients began out-of-bed movement with weight bearing after 1.6 months (1.2-2.1 months). Heterotopic ossification was found in two patients, with no influence on the joint function. According to the elinieal ranking standard of Modified d' Aubigne and Postal, the excellence rate was 93%. Conclusions Anatomical reconstruction of posterior wall of the acetabulum by using serf ilium with ATMS has good stability and stress distribution of the femoral head and the reconstructed acetabulum in clinical application and offers a new method for treatment of severely comminuted and obsolete fracture of posterior wall of acetabulum.